ORIGINAL ARTICLE The Journal of Nursing Research h VOL. 25, NO.
4, AUGUST 2017
Professional Values, Job Satisfaction, and
Intent to Leave Among Nursing Managers
Filiz Kantek1* & Ayla Kaya2
ABSTRACT
Downloaded from https://journals.lww.com/jnr-twna by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3tjcLwhL8g9bZhhig7WeJvtdXEOzCvs7GHX+AedTidzRxAL8e4wUQ9g== on 02/09/2020
Background: The professional values that are typically attributed
to nursing managers influence the behaviors of staff nurses as
well as of nursing managers. Therefore, the efficient planning and
implementation of nursing services require that nursing managers
raise their awareness of professional nursing values.
Purpose: This study aims to investigate the correlations be-
tween professional values, job satisfaction, and intent to leave
the job and the institution.
Methods: This descriptive and cross-sectional study was con-
ducted on 216 nursing managers in nine different hospitals in
Turkey. The data were collected using a personal information
form, Nursing Professional Values Scale, Minnesota Job Satis-
faction Questionnaire, and scales on intent to leave the job and
the institution.
Results: Results indicate a positive correlation between the
professional values of nurses and their job satisfaction and
suggest a negative correlation between professional values and
intent to leave the job and the institution. Furthermore, agency
was found to be a determinant of job satisfaction.
Conclusions: Strong professional values were found to in-
crease job satisfaction and decrease the intent to leave the job
and the institution.
KEY WORDS:
nursing managers, professional values, values, job satisfaction,
intent to leave.
Introduction
Professional values are standards that are created by exe-
cutors and professional groups (Weis & Schank, 1997).
Dempsey (2009) noted professional values as one of the
leading factors that influence human behaviors (Dempsey,
2009). Professional values in nursing bear much signifi-
cance with regard to developing professional socialization
and quality nursing care (Altun, 2008). Nurses must raise
awareness toward professional values to perceive the sig-
nificance of professional roles (Altun, 2008; Keskin &
Yıldırım, 2006).
Professional values of nurses derive their inspiration from
ethical values (codes; Orak, 2005). Basic values a nurse should
have are aesthetics (satisfaction with the quality of objects,
phenomenon, and people), self-sacrifice (taking care of other
people’s health, well-being, and happiness), equality (having
same rights and privileges), independence (ability to make
Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
the right choice in decisions or actions), altruism (showing
respect to innate and natural values of human beings, singu-
larity, and uniformity), justice (approving fair, moral, and
just principles), and truth (devotion to truth; Altun, 2008;
Keskin & Yıldırım, 2006).
Acquiring professional nursing values is accomplished
through professional socialization, with primary professional
socialization initiated in nursing schools. Furthermore, pro-
fessional socialization is maintained and further developed
after graduation, particularly in the workplace (Waugaman
& Lohrer, 2000). Institutional policies and culture enhance
interactions with colleagues, other professionals, and pa-
tients in the workplace. If the professional values of em-
ployees match the professional values in an institution, job
satisfaction increases, resulting in increased levels of institu-
tional commitment. If not, employees experience low levels
of job satisfaction and increased intent to leave their jobs
(Şimşek, 2014; Tak & Çiftçioğlu, 2008).
The efficient practice of these values requires that nurses
have higher levels of professional values and job satisfac-
tion (Hendel & Gefen-Liban, 2003). Bang et al. (2011)
stated that higher levels of professional values relate posi-
tively to higher levels of job satisfaction in nurses (Bang
et al., 2011).
Job satisfaction is characterized as the correspondence
between the expectations and the gains of an employee from
their institutions and is expressed via professional attitudes,
beliefs, knowledge, behaviors, and assessments (Alam &
Mohammad, 2010). Lower levels of job satisfaction have
often been cited as the leading factor affecting the intent of
nurses to leave (Alam & Mohammad, 2010; Castle, Engberg,
Anderson, & Men, 2007; Gurková, Čáp, Žiaková, &
Ďurišková, 2012; Ma, Lee, Yang, & Chang, 2009). It has
been additionally noted that nurses generally have higher
levels of intent to leave than employees in other professions
(Karakuş, 2011).
Intent to leave refers to the perceptions of employees
toward their jobs and institutions rather than their actual
behaviors and is a significant indicator of personnel turnover
(Cheng & Liou, 2011). High rates of turnover contribute to
labor shortages in nursing and adversely affect patient outputs
and nursing costs (Liou, 2009), which highlights the urgency
of identifying and implementing strategies that effectively
1
PhD, RN, Associate Professor, Faculty of Nursing, Department of
Nursing Management, Akdeniz University, Turkey & 2MSN, RN,
Research Assistant, Faculty of Nursing, Akdeniz University, Turkey.
319
The Journal of Nursing Research
reduce the intention of nurses to leave their positions or
institutions.
Nursing managers bear the responsibility of ensuring a
healthy workplace for nurses and of improving their job satis-
faction and intent to stay (Baykal, Altuntaş, & Sökmen, 2006;
Bostan & Köse, 2011). Moreover, nursing managers play a
key role in establishing the nursing culture in medical insti-
tutions (Fennimore & Wolf, 2011; Gray & Shirey, 2013).
The professional values of nursing managers refer to their
professional skills such as accurately evaluating the care
quality, improving their service performances, and assuring
the intent to stay of nurses (Hendel & Gefen-Liban, 2003;
Weis & Schank, 1997).
Concepts related to professional values, job satisfaction,
and intent to leave have been used in nursing for a long time.
Numerous articles have been published on these concepts
and their correlations.
However, the correlations between professional values,
job satisfaction, and intent to leave of nursing managers in
Turkey remained unstudied, leaving a gap in the literature.
A review of the recent studies in the field yielded limited
data on nurses in management positions. Therefore, this study
targeted nursing managers to investigate the correlation be-
tween nursing managers’ professional values and their job
satisfaction and intent to leave their job or institution. Re-
sults may provide valuable data to help better understand
organizational outputs such as the professional values, the
job satisfaction, and the intent to leave of nursing managers.
Aim
This study investigates the correlations between professional
values, job satisfaction, and intent to leave for nursing managers.
Methods
Research Hypotheses
1. Professional values correlate significantly with job
satisfaction.
2. Professional values correlate significantly with intent
to leave the job.
3. Professional values correlate significantly with intent
to leave the institution.
4. Job satisfaction correlates significantly with profes-
sional values.
5. Job satisfaction correlates significantly with intent to
leave the job.
6. Job satisfaction correlates significantly with intent to
leave the institution.
Design
This study was designed as a cross-sectional study with a
descriptive correlation approach to investigate the correla-
tions among the professional values, job satisfaction, and
intent to leave of nursing managers.
320
Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
Filiz Kantek et al.
Sample
The study was carried out on 216 nursing managers working
in nine hospitals (six private hospitals, two public hospitals,
and one university hospital) located in one city in Turkey. All
of the 248 nurses in management positions (nurse director,
nurse assistant director, supervisor, and clinical head nurse)
in the target hospitals were invited to participate. No sam-
pling method was utilized because being a nurse in a manage-
ment position and being willing to participate were the only
inclusion requirements. Valid data were collected from 216
nursing managers. The mean age of nursing managers was
36.42 T 6.79 years (minimum [min] = 23 years, maximum
[max] = 56 years). Their mean duration of professional expe-
rience was 15.78 T 7.31 years (min = 2 years, max = 32 years),
mean duration of professional management was 5.50 T 5.46 years
(min = 1 years, max = 32 years), and mean amount of time
spent in the same institution was 4.06 T 4.09 years (min =
1 years, max = 28 years).
Instruments
Nursing professional values scale
The Nursing Professional Values Scale (NPVS) was used to
analyze the professional values of nursing managers. The
original NPVS, developed by Weis and Schank (1997), in-
cludes 44 items. The scale is a 5-point Likert-type scale with
five subdimensions. The five dimensions of this scale are dig-
nity (11 questions), responsibility (nine questions), active ser-
vice (eight questions), security (four questions), and autonomy
(four questions). Scores from each dimension are as follows:
dignity, 17-18-19-28-29-31-32-33-34-35-36; responsibility,
6-7-8-9-10-11-13-14-16; active service, 4-12-15-20-21-22-
27-30; security, 1-2-3-5; and autonomy, 23-24-25-26. The
total score of the scale is the sum of the scores for the 36 items.
The scale was adapted for use in Turkey by Orak (2005).
The Turkish version of the NPVS includes 36 items, with an
internal consistency of .95. The internal consistency in this
study was found to be .91. The total score for the scale is
the sum of the scores for the 36 items (Orak, 2005), with
higher scores indicating higher levels of professional values.
Minnesota job satisfaction questionnaire
The job satisfaction of nurses was analyzed using the Minnesota
Job Satisfaction Questionnaire, which was developed by Weiss,
Dawis, England, and Lofquist (1967) to classify the job satis-
faction of employees. The questionnaire was adapted for
use in Turkey by Baycan in 1985 and tested for validity and
reliability. The internal consistency was found to be .77. The
questionnaire is a 5-point Likert-type scale and is composed
of 20 items that are designed to elicit internal and external
satisfaction factors. The overall satisfaction score is the sum
of individual item scores. Scores for the dimensions are as
follows: internal satisfaction, 1-2-3-4-7-8-9-10-11-15-16-20,
and external satisfaction, 5-6-12-13-14-17-18-19. Dimension
mean scores are found using the arithmetic average. The
Professional Values, Job Satisfaction, Intent to Leave
neutral value of satisfaction is 3 on the job satisfaction ques-
tionnaire (Aksungur, 2009). The questionnaire has been used
successfully by many researchers in Turkey to analyze the
job satisfaction of nurses. The reliability coefficient of the
questionnaire has been reported as .81Y.90 for overall satis-
faction, .80Y.86 for internal satisfaction, and .79Y.80 for exter-
nal satisfaction (Aksungur, 2009). The results of this study
suggest that the reliability coefficient was .81 for internal
satisfaction, .91 for external satisfaction, and .90 for over-
all satisfaction.
Intent to leave
Intent to leave the job was evaluated using a 3-point scale
(‘‘yes,’’ ‘‘no,’’ and ‘‘not certain’’) for the question, ‘‘Do you
intend to leave nursing within the next year?’’. Intent to leave
the institution was evaluated using a 3-point scale (‘‘yes,’’
‘‘no,’’ and ‘‘not certain’’) for the question, ‘‘Do you intend
to leave your institution within the next year?’’.
Personal information form
The personal information form gathered basic demographic
data on age, gender, and marital status as well as their in-
stitution of employment, educational status, duration of pro-
fessional experience, duration of experience in management,
and management position.
Data Collection
The study data were collected after written permission had
been received from the Board of Ethics. After informing
potential participants about the purpose of the study and
the confidentiality of all data provided, their oral assent
was sought. The participants were given the data forms,
which were collected by the researchers 1 day later. Partic-
ipants were given sufficient time to answer the questions, with
approximately 10Y15 minutes taken to complete the ques-
tionnaire. Twenty-two nursing managers were on sick leave
or annual leave at the time. Eight nursing managers refused
to participate in the study because of personal reasons. There-
fore, 226 forms were delivered, and 218 forms were collected.
Two of the collected forms were excluded from the data
analysis because of missing data. The response rate was thus
96.4%. No strategy was implemented to ensure that nurses
participated in the study. When working with a medium
effect size of p = .005 and 216 examples, the sample power
was found to be 0.99.
Analysis
The characteristics, professional values, job satisfaction, and
intent to leave of participants were analyzed using descriptive
analysis. Cronbach’s alpha reliability analyses were conducted
for professional values and job satisfaction. The correlation
between professional values, job satisfaction, and intent to
leave were analyzed using correlation analyses and multiple
regression analyses. All analyses were carried out using the
Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
VOL. 25, NO. 4, AUGUST 2017
SPSS (version 21; IBM Inc., Armonk, NY, USA). The signifi-
cance level was set at .05.
Ethical Considerations
Permission in writing was granted by the institutions where
the study was conducted. In addition, ethical approval was
received from the Akdeniz University Noninvasive Clinical
Research Board of Ethics (No. B.30.2.AKD.0.20.05.05). Par-
ticipants were informed that all data would be treated as
confidential and that only the researchers would have access
to the study data. Consent was assumed with the return of
the questionnaire.
Results
Table 1 shows the descriptive statistics related to participant
characteristics. Nearly all (94.4%) of the participants were
female, 56.0% were between 31 and 40 years old, 57.4%
held a university degree, 75.9% were married, nearly half
(43.1%) worked in a private hospital, and 85.6% worked
as clinical head nurse, and 86.6% had less than 11 years of
management experience. Furthermore, 5.1% of the partici-
pants expressed that they intended to leave their institution
within 1 year, and 2.8% expressed that they had considered
leaving their job within 1 year.
Table 2 shows the NPVS and job satisfaction scores for
the participants. The NPVS total score was 4.10 (SD = 0.52).
The autonomy dimension had the highest score (4.25, SD =
0.64), and the responsibility dimension had the lowest score
(4.01, SD = 0.57). Job satisfaction scores were 3.63 (SD =
0.64) for overall satisfaction, 3.77 (SD = 0.65) for internal
satisfaction, and 3.42 (SD = 0.73) for external satisfaction.
The correlation between professional values, job satisfac-
tion, and intent to leave was studied using correlation anal-
ysis (Table 3). The results indicate correlations between NPVS
and its subdimensions, job satisfaction, and intent to leave.
There was a positive and moderate correlation between NPVS
total scores and internal satisfaction (r = .348, p = .000) and
overall satisfaction (r = .329, p = .000). However, there was
a positive and weak correlation between external satisfac-
tion scores (r = .257, p = .000). NPVS total score was
significantly negatively correlated with intent to leave the
job (r = j.157, p = .021) and intent to leave the institution
(r = j.172, p = .011). Furthermore, there was a significant
and negative correlation between job satisfaction and intent
to leave the job (r = j.303, p = .000) and intent to leave the
institution (r = j.360, p = .000).
Multiple regression analysis was used to clarify which
professional values variables determined job satisfaction
and intent to leave (Table 4). The results indicate that only
the agency dimension had a significantly positive influence
on job satisfaction (F = 6.910, p = .000) and that the ex-
planatory power of job satisfaction was 14.1% (adjusted
R2 = .121, " = .321). However, it was reported that NPVS
variables did not have a similar effect on intent to leave the
job (F = 1.546, p = .177 and F = 1.818, p = .111).
321
The Journal of Nursing Research Filiz Kantek et al.

TABLE 1. to be confirmed using data obtained from nursing managers.

Characteristics of Nursing Managers Therefore, this study addressed the correlation between pro-
(N = 216) fessional values, job satisfaction, and intent to leave the job
and the institution among nursing managers.
Characteristic n % Study findings found a positive correlation between par-
ticipants’ perceived professional values and job satisfaction,
Gender which echoed the results of previous studies. Ravari et al.
Female 204 94.4 (2013) conducted a study with nurses and concluded that
Male 12 5.6
job satisfaction would rise as nurses endeavored to develop
Age (years) professional values (Ravari et al., 2013). Prothero, Marshall,
30 and under 41 19.0 and Fosbinder (1999) found that nurses’ perceptions of pro-
31Y40 121 56.0
fessional values and job satisfaction were correlational (Prothero
41 and over 54 25.0
et al., 1999). A similar study conducted on nurses reported
Education a significant and positive correlation between professional
Vocational high school of nursing 33 15.3
values and job satisfaction (De Cooman et al., 2008). Keskin
Vocational college 33 15.3
BSN 124 57.4
and Yıldırım (2006) carried out a study in Turkey and found
MSN 26 12.0 a significant and positive correlation between the job satis-
faction and the personal values of nurses (Keskin & Yıldırım,
Marital status
Married 164 75.9
2006). Consequently, it may be presumed that raising aware-
Single 52 24.1 ness of professional values among nursing managers improves
job satisfaction.
Institutional affiliation
University hospitals 49 22.7
The results of the regression analysis indicate that pro-
Public hospitals 74 34.3 fessional values influence job satisfaction, with agency serving
Private hospitals 93 43.1 as the determinant of professional values. The agency dimen-
Current position in nursing
sion refers to the active participation and full responsibility of
Manager/coordinator/supervisor 31 14.4 nurses in all decisions that affect their patients and profes-
Clinical head nurse 185 85.6 sional standards, contribute to ethical practices, and imple-
Total years as a nursing manager
ment nursing standards (Orak, 2005). Klopper, Coetzee,
11 and less 187 86.6 Pretorius, and Bester (2012) reported an increase in job satis-
11Y20 25 11.6 faction when nurses were involved in decision-making pro-
21 and above 4 1.8 cesses in their hospitals (Klopper et al., 2012). It was
Total years in the institution as a additionally reported in related studies that job satisfac-
nursing manager tion could be achieved when nurses were decision makers
11 and less 199 92.2 in the establishment of nursing standards and institutional
11Y20 15 6.9 policies (Meeusen, Van Dam, Brown-Mahoney, Van Zundert,
21 and above 2 0.9

Note. BSN = Bachelor of Science in nursing; MSN = Master of Science in nursing.

TABLE 2.
Nursing Professional Values Scale
The results of the regression analysis indicate a significant
negative effect of job satisfaction on intent to leave the job
Scores and Job Satisfaction of Nursing
(F = 0.092, p = .000) and intent to leave the institution (F = Managers (N = 216)
31.815, p = .000; Table 5). The explanatory power of job
Scale Mean SD Min Max
satisfaction was 9.2% (adjusted R2 = .088, " = j.303) for in-
tent to leave the job and 12.9% (adjusted R2 = .125, " = j.360) NPVS
for intent to leave the institution. Security 4.22 0.56 1.75 5.00
Responsibility 4.01 0.57 1.67 5.00
Active service 4.06 0.59 1.25 5.00
Discussion Dignity 4.11 0.59 1.91 5.00
Autonomy 4.25 0.64 1.25 5.00
It has been suggested that making values applicable in pro-
Scale total score 4.10 0.52 1.61 5.00
fessional life significantly increases the level of job satisfac-
tion for nurses, eventually leading to lower levels of intent to Job satisfaction
Internal satisfaction 3.77 0.65 1.92 5.00
leave the job and the institution (Alam & Mohammad, 2010;
External satisfaction 3.42 0.73 1.25 5.00
Castle et al., 2007; Gurková et al., 2012; Hendel & Gefen-
Overall satisfaction 3.63 0.64 1.75 5.00
Liban, 2003; Ma et al., 2009; Ravari, Bazargan-Hejazi, Ebadi,
Mirzaei, & Oshvandi, 2013). However, this suggestion has yet Note. NPVS = Nursing Professional Values Scale.

322

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Professional Values, Job Satisfaction, Intent to Leave VOL. 25, NO. 4, AUGUST 2017

TABLE 3.
The Correlation Between Professional Values, Job Satisfaction, and Intent to
Leave the Job and the Institution (N = 216)
Item 1 2 3 4 5 6 7 8 9 10 11

1. Professional values 1 .755* .868* .911* .859* .800* .348* .257* .329*
2. Security .755* 1 .652* .672* .536* .591* .288* .232* .281*
3. Responsibility .868* .652* 1 .790* .592* .651* .263* .201* .252*
4. Active service .911* .672* .790* 1 .660* .775* .377* .278* .357*
5. Dignity .859* .536* .592* .660* 1 .565* .251* .183* .236*
6. Autonomy .800* .591* .651* .775* .565* 1 .355* .243* .327*
7. Internal satisfaction .348* .288* .263* .377* .251* .355* 1 .757* .954*
8. External satisfaction .257* .232* .201* .278* .183* .243* .757* 1
9. Overall satisfaction .329* .281* .252* .357* .236* .327* .954* .918* 1
10. Intent to leave the j.172* j.187* j.122 j.170* j.159* j.136* j.316* j.367* j.360* 1
institution
11. Intent to leave j.157* j.157* j.159* j.142* j.141* j.076 j.271* j.302* j.303* .734* 1
current position

*p G .05.

& Knape, 2010; Siqueira & Kurcgant, 2012), which sup-
ports the results of our study. Thus, the active participation
of nursing managers in institutional decision making may
increase job satisfaction.
The correlation between job satisfaction and intent to
leave the job and the institution was analyzed, showing a
negative correlation between these variables and job satis-
faction, which was the determinant of intent to leave the job
and the institution. In other words, nursing managers with
relatively low levels of job satisfaction reported relatively
higher levels of intent to leave their job and their institution.
Karakuş (2011) found that 68.4% of nurses who reported
low job satisfaction wanted to work in another institution
and 49.9% of these intended to leave their job (Karakuş,
2011). Moreover, it has often been asserted that a negative
correlation between job satisfaction and intent to leave was
the determinant of intent to leave the job and the institution
(Alam & Mohammad, 2010; Castle et al., 2007; Gurkova
et al., 2012; Ma et al., 2009). This assertion was supported
by our findings as well. As a result, it may be assumed that
nursing managers who have higher levels of job satisfaction
may have decreased levels of intention to leave their job and
their institution, as they are highly motivated by their posi-
tive perceptions toward their job.

TABLE 4.
Methodological Issues and Study
Regression Analysis of Professional
Values, Job Satisfaction, and Limitations
Intent to Leave (N = 216) Several limitations of this study must be considered when
interpreting the results of this research for future studies.
Intent to Intent to One significant limitation was that the study presented the
Leave the Leave the
Job Satisfaction Job Institution TABLE 5.
Independent
Variable " " "
Regression Analysis of Job Satisfaction
and Intent to Leave (N = 216)
Security .093 j.099 j.146
Responsibility j.108 j.094 .089 Intent to Leave Intent to Leave the
Independent the Job Institution
Active service .321* j.062 j.116
Variable " "
Dignity j.050 j.037 j.045
Autonomy .128 .117 .013 Job satisfaction j.303 j.360
2 2
R .141 .036 .041 R .092 .129
Adj. R2 .121 .013 .019 Adj. R2 .088 .125
**
F 6.910 1.546 1.818 F .092* 31.815*

*p G .05. **p G .001. *p G .01.

323

Copyright © 2017 Taiwan Nurses Association. Unauthorized reproduction of this article is prohibited.
The Journal of Nursing Research
perceptions of nursing managers toward professional values,
job satisfaction, and intent to leave only during the period of
the study. Another limitation may be that most of the par-
ticipants were female nurses. Therefore, the results should
not be generalized to male nurses or to mixed-gender nursing
manager groups.
Conclusions
This study identified professional values, job satisfaction, and
intent to leave the job and the institution from the perspective
of nursing managers. A positive correlation was found be-
tween nursing managers’ perception of professional values
and their job satisfaction levels, whereas a negative correlation
was found between perception of professional values and the
intent to leave the job and the institution. Furthermore, pro-
fessional values positively influenced job satisfaction, whereas
job satisfaction negatively influenced intent to leave the job
and the institution.
On the basis of these results, the promotion of profes-
sional values and job satisfaction in the institution should
help decrease turnover rates. Furthermore, institutions should
internally monitor levels of professional values, job satisfac-
tion, and intent to leave the job and the institution on a
regular basis.
There remain many unanswered questions regarding the
professional values of nursing managers. Thus, we suggest
that further studies be conducted to investigate organiza-
tional culture, leadership socialization, related processes, and
factors that influence the professional values of nursing man-
agers in order that new strategies may be developed to pro-
mote professional values. Finally, to assess and confirm the
reliability of the results obtained in this study, we recommend
reproducing the same research framework to target nursing
managers in different healthcare institutions.
Acknowledgments
This study was supported by Akdeniz University Scientific
Research Projects Unit.
Accepted for publication: September 9, 2015
*Address correspondence to: Filiz Kantek, Faculty of Nursing,
Department of Nursing Management, Akdeniz University,
Antalya, Turkey.
Tel: +90 (242) 3106129; Fax: +90 (242) 2261469;
E-mail: fkantek@akdeniz.edu.tr
The authors declare no conflicts of interest.
Cite this article as:
Kantek, F., & Kaya, A. (2017). Professional values, job satisfaction, and
intent to leave among nursing managers. The Journal of Nursing
Research, 25(4), 319Y325. doi:10.1097/jnr.0000000000000164
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