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Abstract
The present era of cost-containment pressures indicates that nursing executives have to ensure that, their nurses have
a work environment with the work characteristics known to be linked to job satisfaction and good outcomes. The
research hypothesis investigated here was: the higher nurses levels on general job satisfaction, overall satisfaction with
their professional role, and general job happiness, the lower their intention to quit would be. The controlling variables
included demographic characteristics, working motivation, and nine job satisfaction subscales. This study was
conducted in 3 hospitals located in southern Taiwan. All nurses working for these 3 hospitals were the target subjects.
The overall response rate (648 completed questionnaires) was 82%. The nurses Job Satisfaction and the perceptual
degree of its importance questionnaire was used. Ordinal logistics regression analyses were utilized. General job
satisfaction, general job happiness, satisfaction with salary and promotion, institution, educational background, and
age of nurses youngest child were proved to be signicant predictors of nurses intention to quit. Suggestions for future
studies and administrative strategies in decreasing nurses intention to quit were discussed. r 2002 Elsevier Science Ltd.
All rights reserved.
Keywords: Working motivation; Job satisfaction; Intention to quit; Nurse
1. Introduction
A competitive healthcare market is indeed qualityoriented, and improving the quality of healthcare
services is a continuing challenge to managers in the
healthcare industry. Similar to the western societies,
Taiwans healthcare industry became a cost-containing
environment after the government implemented the
National Health Insurance System in 1995. The present
era of cost-containment pressures indicates that nursing
executives have to ensure that, their nurses have a work
environment with the work characteristics known to be
*Tel.: +886-9261-50912, 886-7-6577711x5752; fax: +886-76577056.
E-mail address: tzeng hueyming@yahoo.com
(H.-M. Tzeng).
0020-7489/02/$ - see front matter r 2002 Elsevier Science Ltd. All rights reserved.
PII: S 0 0 2 0 - 7 4 8 9 ( 0 2 ) 0 0 0 2 7 - 5
868
2. Literature review
Previous studies (e.g., McNeese-Smith, 1996; Lee
et al., 1999; Tzeng, 1997) report that managerial factors
affected employees attitudes, job satisfaction, organizational commitment, and motivation to perform well, and
these factors, in turn, inuenced organizational outcomes. Organizational outcomes included, for example,
patient satisfaction and employees intention to quit.
Study of Bjorvell and Brodins (1992) found that half
of the nursing staff wanted to quit their jobs. Those
nurses, who had intention to quit, perceived themselves
as less satised with several aspects (job dimensions of
cooperation, job complexity, help received from superiors, and sufcient time for nursing care delivery), than
did those who did not have any intention to quit. Results
also showed that the head nurses seemed to have an
important supportive function, and suggested that a
supportive institution might reduce personnel turnover
in hospitals.
Dolan et al. (1992) concluded that occupational
stressors, lack of professional latitude, and role of
problems, predicted nurses intention to quit their
working healthcare organizations. For the aims of
beneting the quality of patient care and the respective
hospitals, possible remedies to address these job
869
Demographic Characteristics
Hospital
Age
Marital status (single, married,
divorce or separated)
Years of professional experience
Tenure
Motivation (dream job, interest, for
money, no other choice, family
expectation)
Dependent Variable:
Intention to quit
Fig. 1. The conceptual framework of nurses intention to quit. The ordinal dependent variable, having intention to quit, was rated into
ve categories: [(1) least agreeable, (2) disagreeable, (3) neutral, (4) agreeable, and (5) most agreeable]. The explanatory variables
included demographic characteristics, job satisfaction subscale, and three general perceptual factors.
870
4. Methods
4.1. Subjects
This study was conducted in 3 hospitals located
in southern Taiwan. These hospitals nursing administrators acted as members of the Human Subject
Review committees. Committee members reviewed
this research proposal for approval, and assured having
appropriate human subject protection. The attached
cover sheet indicated that all collected data would
be used for research purposes only. Data would be
kept condential, and subjects identication will be
protected.
These 3 hospitals were located in the same demographic area. One of them is a Christian teaching
hospital (Hospital A), another one is a private-owned
local hospital (Hospital B), and the other one is a local,
veterans hospital (Hospital C). Data were collected
during the period from December 1999 to March 2000.
All the nurses working in these three institutions were
the target population (including the ones with managerial responsibilities, and excluding physician assistants),
for a total of 786 nurses. The questionnaire packages
were sent to the nurse subjects through the hospitals
nursing departments. This questionnaire packages (included a letter explaining the study purpose, a demographic information chart, a pre-stamped return
envelope, and a gift for appreciating subjects participation) were disseminated to all nurses through subjects
managers. The completed questionnaire (in a sealed
envelop) was returned to the principal investigator by
mail or through their nursing departments. Subjects
participated in this study voluntarily and anonymously. The overall response rate (648 completed
questionnaires) was 82%, and the correspondent rate
for each individual hospital ranged from 72% to
84%.
4.2. The nurses job satisfaction and the perceptual degree
of its importance questionnaire
This questionnaire set was written in Mandarin, and
only part of the items in this questionnaire was utilized.
There were a total of 48 items for measuring the levels of
the nine job satisfaction scales. Items were grouped into
9 scales: indirect working environment (6 items); direct
working environment (7 items); salary and promotion
(7 items); self-growth (3 items); challenge in work
(6 items); interaction with and feedback from patients
and family members (3 items); leadership style (7 items);
working atmosphere (7 items); and family support and
religion (2 items). Responses were given on a 5-point
Likert scale: ranging from 1 (least satised) to 5 (most
satised), and 9 (not applicable). Three general perceptual factors (general job satisfaction, overall satisfaction
with professional roles, general job happiness) were
rated from very satised or very happy to very
dissatised or very unhappy. The ordinal dependent
variable, having intention to quit, was rated into ve
categories: (1) Least agreeable, (2) disagreeable, (3)
neutral, (4) agreeable, and (5) most agreeable.
For the consistency of the tool, a test-retest method (2
weeks apart) was used. A total of 46 full-time nurses
participated in this test. The test-retest correlation
coefcients on items were ranged from 0.81 to 0.96. As
for the reliability analyses, alpha coefcients were
calculated using all the valid subjects. Except for the
satisfaction scale of family support and religion (alpha
coefcient=0.64), all the other alpha coefcients were
ranged from 0.74 to 0.92. For each scale, the mean value
was calculated by averaging the valid values of the
grouped items.
4.3. Data analyses
Data were entered and processed by using the
statistical package for the social sciences (SPSS) software, English version 10.0. Descriptive information for
all included variables was presented. Ordinal logistic
regression analyses were utilized to develop a model of
nurses intention to quit. The demographic characteristics were entered into the regression model rst,
followed by nine job satisfaction scales, and three
general job-related indicators at last. This procedure
allowed us to observe the changes on coefcients when
more explanatory variables were added into the
equation.
871
5. Results
Table 1 demonstrated the demographic information
of nurses. All participants were female, 26 years old with
more than 2.5 years of tenure in average. About 29.3%
of them were married, divorced or separated. Only
Table 1
Descriptive information (n 648)
Variables/values
Mean
SD
Minimum
Maximum
Age in years
Professional working experience in months
Tenure in months
Number of children
Age of the youngest child in years
Indirect working environment
Direct working environment
Salary and promotion
Self growth
Challenge in work
Interaction with patients and family members
Leadership style
Working atmosphere
Family support and religion
General job satisfaction
General satisfaction levels toward professional roles
General job happiness
Intention to quit
26.42
66.29
31.24
1.78
6.52
2.94
3.24
2.85
3.08
3.23
3.40
3.21
3.51
3.54
3.26
3.30
3.32
3.02
6.65
73.97
52.03
0.69
6.10
0.55
0.55
0.67
0.63
0.55
0.60
0.67
0.57
0.60
0.78
0.64
0.74
0.99
19.00
1.00
1.00
1.00
1.00
1.00
1.43
1.00
1.00
1.00
1.00
1.00
1.57
1.50
1.00
1.00
1.00
1.00
52.00
360.00
357.00
4.00
26.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
394
174
80
60.8
26.9
12.3
446
182
3
70.7
28.8
0.5
65
511
22
6
10.7
84.6
3.6
1.0
509
83
86.0
14.0
118
530
18.2
81.8
600
48
92.4
7.6
78
229
229
114
156
12.0
35.3
35.3
17.6
24.1
872
Table 2
Model tting information for three ordinal logistic regression models: nurses intention to quit as the dependent variable (the link
function is logit)
The chi-square test for goodness-of-ta
Modelb
Chi-square
Degree of freedom
Signicance
1
2
3
1501.89
1361.83
1327.51
1443.17
1211.11
1096.74
58.72
150.72
230.77
20
29
32
0.00**
0.00**
0.00**
Chi-square
Degree of freedom
Signicance
Pearson
Deviance
Pearson
Deviance
Pearson
Deviance
2073.90
1434.85
1895.82
1211.11
2677.67
1096.74
2112
2112
1919
1919
1864
1864
2
3
Model
Pseudo R-squared
2
3
0.72
1.00
0.64
1.00
0.00**
1.00
0.103
0.109
0.266
0.283
0.385
0.410
Note:
**p 0:01; 2-tailed.
a
The chi-square test for goodness-of-t compares the results of a study of data to determine how likely the sample results actually
are, given the parameter estimates. A good model is one, which results in a high likelihood of the observed values or a small value for
2 Log Likelihood.
b
The rst model included only demographic variables; the second model was composed of demographic variables and the 8 job
satisfaction scales; and the third model included demographic variables, 8 job satisfaction scales, and three general job-related
indicators.
c
The Pearsons chi-square test (also called the chi-square test of independence) examined a set of variables to determine whether they
are associated.
d
The Cox and Snell R2 measure operates in the same manner as the R2 measure in multiple regression, with higher values indicating
greater model t (less than 1). Nagelkerke, which has a range of 01, is a modication of the Cox and Snell R2 measure (Hair et al.,
1998).
873
Table 3
Parameter estimates of the ordinal regression models: nurses intention to quit as the dependent variable (the link function is logit)
Model
Variable
Threshold (intercept)
Intention to quita=1
Intention to quit=2
Intention to quit=3
Intention to quit=4
Location (explanatory variables)
Nurse age
Professional experience
Tenure
Number of children
Age of the youngest child
Hospital=A
Hospital=B
Hospital=C
Marital status
Single
Married
Divorced or separated
Education
Diploma
Associate degree
Bachelor degree
Master degree or higher
Part-time student status=no
Part-time student status=yes
Has a religion=no
Has a religion=yes
Administrative position=no
Administrative position=yes
Motivation to work
Dream job=no
Dream job=yes
Interest=no
Interest=yes
For money=no
For money=yes
No other choice=no
No other choice=yes
Family expectation=no
Family expectation=yes
Estimate
Standard
error
Wald w2
P value
95%CI
2.630
0.315
1.375
3.331
1.893
1.887
1.887
1.893
1.93
0.03
0.53
3.10
0.17
0.88
0.47
0.08*
7.00
4.69
3.04
1.12
0.010
0.004
0.002
0.351
0.006
0.066
0.751
&
0.046
0.004
0.002
0.191
0.033
0.302
0.321
0.05
0.81
1.06
3.39
0.03
0.05
5.48
0.83
0.37
0.30
0.07*
0.86
0.83
0.02**
0.10 to 0.08
0.004 to 0.01
0.002 to 0.007
0.73 to 0.02
0.06 to 0.07
0.66 to 0.53
0.12 to 1.38
1.554
0.971
&
1.144
1.103
1.85
0.77
0.17
0.38
0.69 to 3.80
1.19 to 3.13
0.587
0.401
0.777
&
0.204
&
0.116
&
0.145
&
0.806
0.770
0.894
0.53
0.27
0.76
0.47
0.60
0.39
2.17 to 0.99
1.91 to 1.11
2.53 to 0.98
0.241
0.72
0.40
0.27 to 0.68
0.194
0.36
0.55
0.27 to 0.50
0.349
0.17
0.68
0.54 to 0.83
0.249
0.09
0.77
0.41 to 0.56
0.184
1.62
0.20
0.13 to 0.59
0.169
6.66
0.01***
0.77 to 0.11
0.217
6.52
0.01***
0.98 to 0.13
0.194
3.19
0.07*
0.73 to 0.03
0.074
&
0.234
&
0.437
&
0.554
&
0.346
&
to
to
to
to
0.06
2.33
3.98
5.92
Threshold (intercept)
Intention to quit=1
10.294
2.413
18.20
0.00***
Intention to quit=2
7.755
2.388
10.54
0.00***
Intention to quit=3
5.804
2.378
5.96
0.02**
Intention to quit=4
Location (explanatory variables)
Nurse age
Professional experience
Tenure
Number of children
Age of the youngest child
3.664
2.375
2.38
0.12
15.02 to
5.57
12.44 to
3.07
10.47 to
1.14
8.32 to 0.99
0.030
0.005
0.003
0.351
0.032
0.049
0.004
0.003
0.214
0.036
0.38
1.54
1.19
2.70
0.79
0.54
0.21
0.28
0.10
0.37
0.13
0.00
0.00
0.77
0.04
to
to
to
to
to
0.07
0.01
0.01
0.07
0.10
874
Table 3 (continued)
Model
Variable
Job satisfaction indicators
Indirect working environment
Direct working environment
Salary and promotion
Self-growth
Challenge in work
Interaction with patients and family
members
Leadership style
Working atmosphere
Family support and religion
Estimate
Standard
error
Wald w2
P value
95%CI
0.047
0.417
0.469
0.211
0.697
0.113
0.241
0.249
0.195
0.180
0.257
0.183
0.04
2.81
5.81
1.38
7.35
0.39
0.85
0.09*
0.02**
0.24
0.01***
0.54
0.52
0.90
0.85
0.14
1.20
0.47
0.315
0.213
0.048
0.193
0.207
0.173
2.67
1.06
0.08
0.10
0.30
0.78
0.69 to 0.06
0.62 to 0.19
0.29 to 0.39
0.325
1.024
&
0.362
0.377
0.81
7.39
0.37
0.01***
0.39 to 1.04
0.29 to 1.76
0.647
0.057
&
1.457
1.399
0.20
0.00
0.66
0.97
2.21 to 3.50
2.69 to 2.80
1.069
0.983
0.891
&
0.069
&
0.146
&
0.304
&
0.841
0.801
0.923
1.62
1.51
0.93
0.20
0.22
0.33
2.72 to 0.58
2.55 to 0.59
2.70 to 0.92
0.267
0.07
0.80
0.46 to 0.59
0.215
0.46
0.50
0.27 to 0.57
0.381
0.64
0.43
0.44 to 1.05
0.272
0.23
0.63
0.40 to 0.66
0.198
0.14
0.71
0.31 to 0.46
0.185
3.44
0.06*
0.71 to 0.02
0.238
0.37
0.55
0.61 to 0.32
0.211
0.41
0.52
0.55 to 0.28
12.063
2.498
23.32
0.00***
Intention to quit=2
9.298
2.469
14.49
0.00***
Intention to quit=3
7.179
2.454
8.56
0.00***
Intention to quit=4
Location (explanatory variables)
Nurse age
Professional experience
Tenure
Number of children
Age of the youngest child
4.783
2.448
3.82
0.05*
16.96 to
7.17
14.24 to
4.56
11.99 to
2.37
9.58 to 0.01
0.024
0.005
0.002
0.283
0.068
0.051
0.005
0.003
0.226
0.039
0.22
1.14
0.66
1.57
2.97
0.64
0.29
0.42
0.21
0.09*
0.12
0.00
0.00
0.73
0.01
Hospital=A
Hospital=B
Hospital=C
Marital status
Single
Married
Divorced or separated
Education
Diploma
Associate degree
Bachelor degree
Master degree or higher
Part-time student status=no
Part-time student status=yes
Has a religion=no
Has a religion=yes
Administrative position=no
Administrative position=yes
Motivation to work
Dream job=no
Dream job=yes
Interest=no
Interest=yes
For money=no
For money=yes
No other choice=no
No other choice=yes
Family expectation=no
Family expectation=yes
Threshold (intercept)
Intention to quit=1
0.131
&
0.074
&
0.344
&
0.144
&
0.135
&
to
to
to
to
to
to
to
to
to
to
to
0.43
0.07
0.09
0.56
0.19
0.24
0.08
0.01
0.01
0.16
0.15
875
Table 3 (continued)
Model
Variable
Job satisfaction indicators
Indirect working environment
Direct working environment
Salary and promotion
Self-growth
Challenge in work
Interaction with patients and family
members
Leadership style
Working atmosphere
Family support and religion
General items
General job satisfaction
Estimate
Standard
error
Wald w2
P value
95%CI
0.128
0.078
0.430
0.093
0.246
0.085
0.252
0.260
0.204
0.186
0.272
0.194
0.26
0.09
4.41
0.25
0.82
0.19
0.61
0.76
0.04**
0.62
0.37
0.66
0.62
0.59
0.83
0.27
0.78
0.47
0.187
0.160
0.177
0.200
0.216
0.180
0.87
0.55
0.96
0.35
0.46
0.33
0.58 to 0.20
0.58 to.26
0.18 to 0.53
0.788
0.188
17.55
0.00***
0.862
0.180
22.89
0.00***
0.150
0.173
0.75
01.16 to
0.42
01.22 to
0.51
0.19 to 0.49
Hospital=A
Hospital=B
Hospital=C
Marital status
Single
Married
Divorced or separated
Education
Diploma
Associate degree
Bachelor degree
Master degree or higher
Part-time student status=no
Part-time student status=yes
Has a religion=no
Has a religion=yes
Administrative position=no
Administrative position=yes
Motivation to work
Dream job=no
Dream job=yes
Interest=no
Interest=yes
For money=no
For money=yes
No other choice=no
No other choice=yes
Family expectation=no
Family expectation=yes
0.564
1.035
&
0.375
0.387
2.26
7.15
0.13
0.01***
0.17 to 1.30
0.28 to 1.79
1.199
0.532
&
1.495
1.434
0.64
0.14
0.42
0.71
01.73 to 4.13
02.28 to 3.34
1.790
1.639
1.436
&
0.167
&
0.138
&
0.425
&
0.866
0.820
0.944
4.28
4.00
2.31
0.04**
0.05**
0.13
3.49 to 0.09
3.25 to 0.03
3.29 to 0.42
0.280
0.36
0.55
0.38 to 0.72
0.224
0.38
0.54
0.30 to 0.58
0.407
1.09
0.30
0.37 to 1.22
0.279
0.39
0.54
0.72 to 0.37
0.208
1.20
0.27
0.64 to 0.18
0.191
0.68
0.41
0.53 to 0.22
0.249
0.11
0.74
0.57 to 0.41
0.218
0.01
0.91
0.40 to 0.45
0.173
&
0.227
&
0.157
&
0.082
&
0.026
&
385
to
to
to
to
to
to
0.37
0.43
0.03
0.46
0.29
0.30
Notes:
*p 0:10; 2-tailed.
**p 0:05; 2-tailed.
***p 0:01; 2-tailed.
&: This parameter was set to zero because it was redundant.
Standard error=estimated precision of the coefcients.
95%CI=95% condence intervals for the coefcients.
Wald w2 =the Wald test statistic calculated from the data to be compared with the chi-square distribution with 1 degree of freedom.
a
The ordinal dependent variable, having intention to quit, was rated into ve categories: (1) least agreeable, (2) disagreeable, (3)
neutral, (4) agreeable, and (5) most agreeable.
876
877
Table 4
Denitions of the variables: operationalized in the Nurses Job Satisfaction and the Perceptual Degree of its Importance Questionnaire
Nurses job satisfaction aspects
Indirect working environment
Direct working environment
Salary and promotion
Self growth and development
Challenging work
Working atmosphere
Denition
The following nine scales were described as nurses satisfaction levels with
predefined job characteristics, which are:
A hospitals policies and benets (including leisure activities, housing,
parking, and vacation)
Medical equipments, working environment, scheduling, rotation to other
wards, working hours, workow, and stability of their jobs
Clinical ladder, fairness of the performance appraisal systems, bonuses, and
paid time off
Opportunities and arrangement of on-job training, participating in the
research activities, and writing or publication
Recognition for their achievements, independent thinking and decisionmaking, independent work, being challenged, competency towards their
jobs, and workload
The feedback from patients and family members, improvement of patients
conditions, and communication with patients and family members
How the hospital handles staffs complaints, direct supervisors leadership
styles, abilities of coordination, relationship with direct supervisors,
collaborative relationship among supervisors, and respect, fair treatment,
support and caring from their supervisors
The work units atmosphere, communication and the collaborative
relationship with physicians and other colleagues working in the same unit,
caring and support from their colleagues, and interaction with the
colleagues working in the other units
Caring and support from relatives regarding their jobs, and the religion of
the work place
Whether nurses often have intention to leave their currently working
hospital (in the scale from most agreeable to least agreeable)
Nurses overall perceptions towards the job in the levels of satisfaction
Nurses overall perceptions towards the professional roles they played in
the levels of satisfaction
Nurses overall perceptions towards their jobs, when they are doing their
jobs, in the levels of happiness
Nurses incentives (including dream job, interest, for money, no other
choice, and family expectation) to do their current jobs
Appendix A
Denitions of the variables: operationalized in
the Nurses Job Satisfaction and the Perceptual
Degree of its Importance Questionnaire is given in
Table 4.
References
Abbott, J., Young, A., Haxton, R., Van Dyke, P., 1994.
Collaborative care: a professional model that inuences job
satisfaction. Nursing Economics 12(3), 167-9, 174.
Adams, A., Bond, S., 2000. Hospital nurses job satisfaction,
individual and organizational characteristics. Journal of
Advanced Nursing 32 (3), 536543.
Agho, A.O., 1993. The moderating effects of dispositional
affectivity on relationships between job characteristics and
878