International Journal of Nursing Studies 39 (2002) 867–878

The influence of nurses’ working motivation and

job satisfaction on intention to quit: an empirical
investigation in Taiwan
Huey-Ming Tzeng*
Department of Nursing, I-Shou University, No. 1, Section 1, Hsueh-Chang Road, Ta-Hsu Hsiang, Kaohsiung County 840, Taiwan
Received 21 August 2001; received in revised form 21 January 2002; accepted 22 April 2002

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 significant 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 linked to job satisfaction and good outcomes. Research

A competitive healthcare market is indeed quality-
oriented, and improving the quality of healthcare
services is a continuing challenge to managers in the
healthcare industry. Similar to the western societies,
Taiwan’s 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: +886-7-
6577056.
E-mail address: tzeng hueyming@yahoo.com
(H.-M. Tzeng).
of Leiter et al. (1998) concluded that patients, who
stayed on wards where nursing staff felt more exhausted
or more frequently expressed their intention to quit,
were less satisfied with their medical care. This study
confirmed the importance of understanding nurses’ job
satisfaction and intention to quit as both concepts,
which would contribute to patient outcomes. Several
recent studies further confirmed that nurses’ job
satisfaction contributed to the perceptual levels of
patient satisfaction with nursing care, which is one of
the most important clinical outcome indicators (Tzeng
and Ketefian, 2002; Tzeng et al., 2002; Tzeng et al.,
2001). Moreover, both nurses’ job satisfaction and
patient satisfaction have been identified in the Nursing
Report Card for Acute Care (American Nurses Associa-
tion, 1995) as two of the important nursing quality

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 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878
outcome indicators. Nurses’ intention to quit has a
strong effect on their actual action of turnover, which
might lead to certain amount of decrease in the quality
and increase in the cost for patient care (Alexander et al.,
1998).
In a local conference for enhancing the communica-
tion among hospital nursing executives, nurse educators
and government officers in Taiwan, it was concluded
that nurses’ turnover rates among hospitals have been
decreased from up to 50% down to below 10%. In some
public healthcare institutions, the turnover rates were
even lower than 5% per year. In other words, Taiwan’s
turnover rates were no longer a severe issue for the nurse
market. This trend might be caused by the changes in the
macro-economical environment (e.g., cost containment,
more supply than demand for nurses, difficulties for
nurses to change their career path). As for nurses’
intention to quit was related to their loyalty and work
performance (Dolan et al., 1992), nurses’ intention to
quit, instead of turnover, was determined as the target
variable of this study. As a result, this exploratory
project aimed to investigate the effects of working
motivation, job satisfaction, and general perceptual
factors as related to jobs, on nurses’ intention to quit.
The purpose of this study was to develop and test a
conceptual model of nurses’ intention to quit, and to
contribute to the developing domain of nursing outcome
studies.
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, organiza-
tional commitment, and motivation to perform well, and
these factors, in turn, influenced organizational out-
comes. Organizational outcomes included, for example,
patient satisfaction and employees’ intention to quit.
Study of Bjorvell and Brodin’s (1992) found that half
of the nursing staff wanted to quit their jobs. Those
nurses, who had intention to quit, perceived themselves
as less satisfied with several aspects (job dimensions of
cooperation, job complexity, help received from super-
iors, and sufficient 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
benefiting the quality of patient care and the respective
hospitals, possible remedies to address these job
stressors were improving nurses’ quality of life, mental
health, and decreasing the rate of turnover.
Keel (1993) indicated that burnout affects mainly
nurses, physicians, social workers and teachers. Burnout
seems to be caused by stressful working conditions,
disproportional-high efforts (time, emotional involve-
ment, and empathy) and dissatisfaction with jobs. For
the goals of lowering professional stress and improved
satisfaction, social support and improved team coopera-
tion could protect nurses against burnout.
Study of Abbott et al. (1994) noted the relationship
between the form of practice models (e.g., case manage-
ment, managed care) and the levels of nurses’ job
satisfaction. They concluded that managed care had a
positive impact on nurses’ job satisfaction. Thus,
according to Kovner et al. (1994) research (on the
relative impact of various nursing care delivery models
and administration interventions on nurses’ job satisfac-
tion), pay, autonomy, and professional status were
important predictors of job satisfaction. Different
administration initiatives had impact on the satisfaction
levels of interactions and task requirements. Initial
dissatisfaction with these administration initiatives was
noted. Moreover, study of Kennerly (1996) concluded
that initiating shared governance did not influence the
levels of nurses’ job satisfaction, anticipated turnover,
and perceived work effectiveness. Increases in autonomy
were not continued over time.
Armstrong-Stassen et al. (1994) examined the rela-
tionship between nurses’ job satisfaction dimensions,
burnout, and intention to quit. Results demonstrated
that career future and burnout (emotional exhaustion)
predicted the levels of nurses’ intention to quit. Kind of
work, amount of work, and career future were
associated with burnout. Parker and Kulik (1995)
demonstrated that work support and job stress were
predictors of nurses’ burnout. Higher turnover rates
were associated with poorer self-rated and supervisor-
rated job performance, more sick leaves, more reported
absences for mental health reasons, and higher intention
to quit. Lim and Yuen’s (1998) concluded that demands
from patients/relatives, doctors, and perceived job image
were correlated with nurses’ job satisfaction. Demands
from patients/relatives and perceived job image were
found to be associated with nurses’ intention to quit.
Kivimaki et al. (1995) found that job satisfaction and
motivation to perform well were related to the levels of
job enrichment. The nurses occupying highly enriched
jobs reported significantly higher job satisfaction and
motivation.
Professional growth opportunities, workload, dissa-
tisfaction with work hazards, and relationship with
coworkers, were found to predict nurses turnover. In
nursing care delivery systems, the following aspects
(support for autonomy, executives’ leadership styles,
communication, adequate time for patient care, the
 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878 869

degree of environmental uncertainty, and reported
nursing stress) contributed to job satisfaction, motiva-
tion to perform well at work, and a work group’s
effectiveness (Edgar, 1999; Healy and McKay, 1999;
Dunham-Taylor, 2000). Kangas and associates (1999)
further emphasized that a support environment was
most important to nurses’ job satisfaction. Thus, there
were no found differences in nurses’ job satisfaction or
patient satisfaction with nursing care in different
organizational structures or nursing care delivery
models (Kangas et al., 1999).
Adams and Bond (2000) found that in hospitals,
nurses’ interpersonal relationships (cohesive working
relationships, relationships with medical staff), their
perceptions of workload, and their evaluation of the
appropriateness of the system where nursing care are
practiced, were influential factors of nurses’ job satisfac-
tion. Analyses found that individual nurse character-
istics were not related to job satisfaction. Agho (1993)
indicated that the major determinants of nurses’ job
satisfaction were routinization, participation, integra-
tion, distributive justice, instrumental communication,
promotional opportunity, and positive affectivity. Mul-
ler-Smith (1999) reported that the potential for growth
rather than fear of loss invented energy and excitement,
which led to a joyful workplace and a strong sense of
accomplishment. Liou et al. (1997) identified similar
aspects for nurses’ job satisfaction, including indirect
working environment, direct working environment,
salary and promotion, self-growth, challenging work,
interaction and feedback with patients and family
members, leadership style, working atmosphere, and
family support and religion.
3. The conceptual and tested framework
According to the previously reviewed literature, the
conceptual framework (see Fig. 1) was developed.
Whereas, Adams and Bond (2000) found that individual
nurse characteristics were not related to job satisfaction
or intention to quit. Nurses’ demographic characteristics
were controlled in the model for exploratory purposes.
The explanatory variables of nurses’ intention to quit
were demographic characteristics, nine job satisfaction
subscales (indirect working environment, direct working
environment, salary and promotion, self-growth, chal-
lenge in work, interaction and feedback with patients
and family members, leadership style, working atmo-
sphere, and family support and religion), general job
satisfaction in the levels of satisfaction (general job
satisfaction); overall satisfaction levels with nurses’
professional role, general feeling when doing the job in
the levels of happiness (general job happiness). The
demographic characteristics included hospital, nurses’
age, marital status (single, married, or divorce/sepa-
rated), years of professional experience, tenure, highest
educational degree, going to school for a higher

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)

Job Satisfaction Subscales

Indirect working environment
Direct working environment
Salary and promotion Dependent Variable:
Self-growth
Challenge in work
Intention to quit
Interaction with and feedback from
patients and family members
Leadership style
Working atmosphere
Family support and religion

General Perceptual Factors

General job satisfaction
Overall satisfaction levels with the
professional roles
General job happiness

Fig. 1. The conceptual framework of nurses’ intention to quit. The ordinal dependent variable, having intention to quit, was rated into
five 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 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878

educational degree, having a religion, number of
children, the age of the youngest child, having admin-
istrative responsibilities, working motivation (dream
job, interest, for money, no other choice, or family
expectation). All nurse subjects in this study were
female, and as a result, gender was not included. The
dependent variable, intention to quit, was defined as an
ordinal variable, and rated in a 5-Likert scale [(1) least
agreeable, (2) disagreeable, (3) neutral, (4) agreeable,
and (5) most agreeable]. Definitions of included vari-
ables were listed in Appendix A: Definitions of the
variables. All the scales/items included in this study
were operationalized in the nurses’ job satisfaction and
the perceptual degree of its importance questionnaire.
The research hypothesis investigated here was: the
higher nurses’ levels on general job satisfaction, overall
satisfaction factor with their professional role, and
general job happiness, the lower their intention to quit
would be, after controlling for demographic character-
istics, working motivation, and nine job satisfaction
subscales.
4. Methods
4.1. Subjects
This study was conducted in 3 hospitals located
in southern Taiwan. These hospitals’ nursing adminis-
trators 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 confidential, and subjects’ identification will be
protected.
These 3 hospitals were located in the same demo-
graphic 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,
veteran’s 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 manage-
rial 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 (in-
cluded a letter explaining the study purpose, a demo-
graphic information chart, a pre-stamped return
envelope, and a gift for appreciating subjects’ participa-
tion) 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 ano-
nymously. 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 satisfied) to 5 (most
satisfied), and 9 (not applicable). Three general percep-
tual factors (general job satisfaction, overall satisfaction
with professional roles, general job happiness) were
rated from very satisfied or very happy to very
dissatisfied or very unhappy. The ordinal dependent
variable, having intention to quit, was rated into five
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
coefficients on items were ranged from 0.81 to 0.96. As
for the reliability analyses, alpha coefficients were
calculated using all the valid subjects. Except for the
satisfaction scale of family support and religion (alpha
coefficient=0.64), all the other alpha coefficients 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) soft-
ware, 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 character-
istics were entered into the regression model first,
followed by nine job satisfaction scales, and three
general job-related indicators at last. This procedure
allowed us to observe the changes on coefficients when
more explanatory variables were added into the
equation.
 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878 871

5. Results about 4.6% of participants had a baccalaureate, master

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
or higher degree. About 70.6% of nurses worked as a
nurse due to their own interest or just for money (35.3%
for each). In average, having an intention to quit was
rated as 3.02 (3, neutral) (SD=0.99). Except for the
aspects of indirect working environment and salary and

Table 1
Descriptive information (n ¼ 648)

Variables/values Mean SD Minimum Maximum

Age in years 26.42 6.65 19.00 52.00

Professional working experience in months 66.29 73.97 1.00 360.00
Tenure in months 31.24 52.03 1.00 357.00
Number of children 1.78 0.69 1.00 4.00
Age of the youngest child in years 6.52 6.10 1.00 26.00
Indirect working environment 2.94 0.55 1.00 5.00
Direct working environment 3.24 0.55 1.43 5.00
Salary and promotion 2.85 0.67 1.00 5.00
Self growth 3.08 0.63 1.00 5.00
Challenge in work 3.23 0.55 1.00 5.00
Interaction with patients and family members 3.40 0.60 1.00 5.00
Leadership style 3.21 0.67 1.00 5.00
Working atmosphere 3.51 0.57 1.57 5.00
Family support and religion 3.54 0.60 1.50 5.00
General job satisfaction 3.26 0.78 1.00 5.00
General satisfaction levels toward professional roles 3.30 0.64 1.00 5.00
General job happiness 3.32 0.74 1.00 5.00
Intention to quit 3.02 0.99 1.00 5.00

Frequency (valid percent) N %

Hospital
A 394 60.8
B 174 26.9
C 80 12.3
Marital status
Single 446 70.7
Married 182 28.8
Divorced or separated 3 0.5
Highest educational degree
Diploma 65 10.7
Associate degree 511 84.6
Baccalaureate degree 22 3.6
Master degree or higher 6 1.0
Part-time student status
No 509 86.0
Yes 83 14.0
Having a religion
No 118 18.2
Yes 530 81.8
Managerial responsibility
No 600 92.4
Yes 48 7.6
Working motivation (multiple choices)
Dream job 78 12.0
Interest 229 35.3
For money 229 35.3
No other choice 114 17.6
Family expectation 156 24.1
872 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878

promotion, most of the nurses felt satisfied to neutral
about their jobs.
In assessing overall model fit, the goodness of fit
measure compared the predicted probabilities to the
observed probabilities. Smaller values of the 2 log
likelihood measure indicated better model fit (Hair et al.,
1998). Table 2 indicated a good fit on all three ordinal
regression models. The explanatory variables in the third
model were statistically and significantly associated
(Pearson Chi-Square=2677.67, df=1864, p ¼ 0:01),
however (predictors should be independent to each
other.)
By observing Model 1 alone (Table 3) (when p was set
at 0.10), if a nurse was working at Hospital B
(estimate=0.751, Wald w2 ¼ 5:48; p ¼ 0:02), having less
number of children (estimate=0.351, Wald w2 ¼ 3:39;
p ¼ 0:07), and her motivation to work was not for
money (estimate=0.437, Wald w2 ¼ 6:66; p ¼ 0:01),
no other choice (estimate=0.554, Wald w2 ¼ 6:52;
p ¼ 0:01), and family members’ expectation
(estimate=0.346, Wald w2 ¼ 3:19; p ¼ 0:07), this nurse
would have higher intention to quit (the Nagelkerke
Pseudo R2 ¼ 0:109). For Model 2 (when p was set at
0.10), if a nurse was working at Hospital B (esti-
mate=1.024, Wald w2 ¼ 7:39; p ¼ 0:01) and having
lower satisfaction levels with direct working environ-
ment (estimate=0.417, Wald w2 ¼ 2:81; p ¼ 0:09),
salary and promotion (estimate=0.469, Wald
w2 ¼ 5:81; p ¼ 0:02), and challenge in work
(estimate=0.697, Wald w2 ¼ 7:35; p ¼ 0:01), and her

Table 2
Model fitting 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-fita

Modelb 2 log likelihood intercept only 2 log likelihood final model Chi-square Degree of freedom Significance

1 1501.89 1443.17 58.72 20 0.00**

2 1361.83 1211.11 150.72 29 0.00**
3 1327.51 1096.74 230.77 32 0.00**

Pearson’s chi-square testc

Model Chi-square Degree of freedom Significance

1 Pearson 2073.90 2112 0.72

Deviance 1434.85 2112 1.00
2 Pearson 1895.82 1919 0.64
Deviance 1211.11 1919 1.00
3 Pearson 2677.67 1864 0.00**
Deviance 1096.74 1864 1.00

Model Pseudo R-squared

1 Cox and Snell R2 0.103

Nagelkerke 0.109
2 Cox and Snell R2 0.266
Nagelkerke 0.283
3 Cox and Snell R2 0.385
Nagelkerke 0.410

Note:
**p ¼ 0:01; 2-tailed.
a
The chi-square test for goodness-of-fit 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 first 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 Pearson’s 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 fit (less than 1). Nagelkerke, which has a range of 0–1, is a modification of the Cox and Snell R2 measure (Hair et al.,
1998).
 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878 873

Table 3
Parameter estimates of the ordinal regression models: nurses’ intention to quit as the dependent variable (the link function is logit)

Model Variable Estimate Standard Wald w2 P value 95%CI

error

1 Threshold (intercept)
Intention to quita=1 2.630 1.893 1.93 0.17 7.00 to 0.06
Intention to quit=2 0.315 1.887 0.03 0.88 4.69 to 2.33
Intention to quit=3 1.375 1.887 0.53 0.47 3.04 to 3.98
Intention to quit=4 3.331 1.893 3.10 0.08* 1.12 to 5.92
Location (explanatory variables)
Nurse age 0.010 0.046 0.05 0.83 0.10 to 0.08
Professional experience 0.004 0.004 0.81 0.37 0.004 to 0.01
Tenure 0.002 0.002 1.06 0.30 0.002 to 0.007
Number of children 0.351 0.191 3.39 0.07* 0.73 to 0.02
Age of the youngest child 0.006 0.033 0.03 0.86 0.06 to 0.07
Hospital=A 0.066 0.302 0.05 0.83 0.66 to 0.53
Hospital=B 0.751 0.321 5.48 0.02** 0.12 to 1.38
Hospital=C &
Marital status
Single 1.554 1.144 1.85 0.17 0.69 to 3.80
Married 0.971 1.103 0.77 0.38 1.19 to 3.13
Divorced or separated &
Education
Diploma 0.587 0.806 0.53 0.47 2.17 to 0.99
Associate degree 0.401 0.770 0.27 0.60 1.91 to 1.11
Bachelor degree 0.777 0.894 0.76 0.39 2.53 to 0.98
Master degree or higher &
Part-time student status=no 0.204 0.241 0.72 0.40 0.27 to 0.68
Part-time student status=yes &
Has a religion=no 0.116 0.194 0.36 0.55 0.27 to 0.50
Has a religion=yes &
Administrative position=no 0.145 0.349 0.17 0.68 0.54 to 0.83
Administrative position=yes &
Motivation to work
Dream job=no 0.074 0.249 0.09 0.77 0.41 to 0.56
Dream job=yes &
Interest=no 0.234 0.184 1.62 0.20 0.13 to 0.59
Interest=yes &
For money=no 0.437 0.169 6.66 0.01*** 0.77 to 0.11
For money=yes &
No other choice=no 0.554 0.217 6.52 0.01*** 0.98 to 0.13
No other choice=yes &
Family expectation=no 0.346 0.194 3.19 0.07* 0.73 to 0.03
Family expectation=yes &

2 Threshold (intercept)
Intention to quit=1 10.294 2.413 18.20 0.00*** 15.02 to
5.57
Intention to quit=2 7.755 2.388 10.54 0.00*** 12.44 to
3.07
Intention to quit=3 5.804 2.378 5.96 0.02** 10.47 to
1.14
Intention to quit=4 3.664 2.375 2.38 0.12 8.32 to 0.99
Location (explanatory variables)
Nurse age 0.030 0.049 0.38 0.54 0.13 to 0.07
Professional experience 0.005 0.004 1.54 0.21 0.00 to 0.01
Tenure 0.003 0.003 1.19 0.28 0.00 to 0.01
Number of children 0.351 0.214 2.70 0.10 0.77 to 0.07
Age of the youngest child 0.032 0.036 0.79 0.37 0.04 to 0.10
874 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878

Table 3 (continued)

Model Variable Estimate Standard Wald w2 P value 95%CI

error

Job satisfaction indicators

Indirect working environment 0.047 0.241 0.04 0.85 0.52 to 0.43
Direct working environment 0.417 0.249 2.81 0.09* 0.90 to 0.07
Salary and promotion 0.469 0.195 5.81 0.02** 0.85 to 0.09
Self-growth 0.211 0.180 1.38 0.24 0.14 to 0.56
Challenge in work 0.697 0.257 7.35 0.01*** 1.20 to 0.19
Interaction with patients and family 0.113 0.183 0.39 0.54 0.47 to 0.24
members
Leadership style 0.315 0.193 2.67 0.10 0.69 to 0.06
Working atmosphere 0.213 0.207 1.06 0.30 0.62 to 0.19
Family support and religion 0.048 0.173 0.08 0.78 0.29 to 0.39

Hospital=A 0.325 0.362 0.81 0.37 0.39 to 1.04

Hospital=B 1.024 0.377 7.39 0.01*** 0.29 to 1.76
Hospital=C &
Marital status
Single 0.647 1.457 0.20 0.66 2.21 to 3.50
Married 0.057 1.399 0.00 0.97 2.69 to 2.80
Divorced or separated &
Education
Diploma 1.069 0.841 1.62 0.20 2.72 to 0.58
Associate degree 0.983 0.801 1.51 0.22 2.55 to 0.59
Bachelor degree 0.891 0.923 0.93 0.33 2.70 to 0.92
Master degree or higher &
Part-time student status=no 0.069 0.267 0.07 0.80 0.46 to 0.59
Part-time student status=yes &
Has a religion=no 0.146 0.215 0.46 0.50 0.27 to 0.57
Has a religion=yes &
Administrative position=no 0.304 0.381 0.64 0.43 0.44 to 1.05
Administrative position=yes &
Motivation to work
Dream job=no 0.131 0.272 0.23 0.63 0.40 to 0.66
Dream job=yes &
Interest=no 0.074 0.198 0.14 0.71 0.31 to 0.46
Interest=yes &
For money=no 0.344 0.185 3.44 0.06* 0.71 to 0.02
For money=yes &
No other choice=no 0.144 0.238 0.37 0.55 0.61 to 0.32
No other choice=yes &
Family expectation=no 0.135 0.211 0.41 0.52 0.55 to 0.28
Family expectation=yes &
3 Threshold (intercept)
Intention to quit=1 12.063 2.498 23.32 0.00*** 16.96 to
7.17
Intention to quit=2 9.298 2.469 14.49 0.00*** 14.24 to
4.56
Intention to quit=3 7.179 2.454 8.56 0.00*** 11.99 to
2.37
Intention to quit=4 4.783 2.448 3.82 0.05* 9.58 to 0.01
Location (explanatory variables)
Nurse age 0.024 0.051 0.22 0.64 0.12 to 0.08
Professional experience 0.005 0.005 1.14 0.29 0.00 to 0.01
Tenure 0.002 0.003 0.66 0.42 0.00 to 0.01
Number of children 0.283 0.226 1.57 0.21 0.73 to 0.16
Age of the youngest child 0.068 0.039 2.97 0.09* 0.01 to 0.15
 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878 875

Table 3 (continued)

Model Variable Estimate Standard Wald w2 P value 95%CI

error
Job satisfaction indicators
Indirect working environment 0.128 0.252 0.26 0.61 0.62 to 0.37
Direct working environment 0.078 0.260 0.09 0.76 0.59 to 0.43
Salary and promotion 0.430 0.204 4.41 0.04** 0.83 to 0.03
Self-growth 0.093 0.186 0.25 0.62 0.27 to 0.46
Challenge in work 0.246 0.272 0.82 0.37 0.78 to 0.29
Interaction with patients and family 0.085 0.194 0.19 0.66 0.47 to 0.30
members
Leadership style 0.187 0.200 0.87 0.35 0.58 to 0.20
Working atmosphere 0.160 0.216 0.55 0.46 0.58 to.26
Family support and religion 0.177 0.180 0.96 0.33 0.18 to 0.53
General items
General job satisfaction 0.788 0.188 17.55 0.00*** 01.16 to
0.42
General job happiness 0.862 0.180 22.89 0.00*** 01.22 to
0.51
Overall satisfaction levels with the 0.150 0.173 0.75 385 0.19 to 0.49
professional role

Hospital=A 0.564 0.375 2.26 0.13 0.17 to 1.30

Hospital=B 1.035 0.387 7.15 0.01*** 0.28 to 1.79
Hospital=C &
Marital status
Single 1.199 1.495 0.64 0.42 01.73 to 4.13
Married 0.532 1.434 0.14 0.71 02.28 to 3.34
Divorced or separated &
Education
Diploma 1.790 0.866 4.28 0.04** 3.49 to 0.09
Associate degree 1.639 0.820 4.00 0.05** 3.25 to 0.03
Bachelor degree 1.436 0.944 2.31 0.13 3.29 to 0.42
Master degree or higher &
Part-time student status=no 0.167 0.280 0.36 0.55 0.38 to 0.72
Part-time student status=yes &
Has a religion=no 0.138 0.224 0.38 0.54 0.30 to 0.58
Has a religion=yes &
Administrative position=no 0.425 0.407 1.09 0.30 0.37 to 1.22
Administrative position=yes &
Motivation to work
Dream job=no 0.173 0.279 0.39 0.54 0.72 to 0.37
Dream job=yes &
Interest=no 0.227 0.208 1.20 0.27 0.64 to 0.18
Interest=yes &
For money=no 0.157 0.191 0.68 0.41 0.53 to 0.22
For money=yes &
No other choice=no 0.082 0.249 0.11 0.74 0.57 to 0.41
No other choice=yes &
Family expectation=no 0.026 0.218 0.01 0.91 0.40 to 0.45
Family expectation=yes &

Notes:
*p ¼ 0:10; 2-tailed.
**p ¼ 0:05; 2-tailed.
***p ¼ 0:01; 2-tailed.
&: This parameter was set to zero because it was redundant.
Standard error=estimated precision of the coefficients.
95%CI=95% confidence intervals for the coefficients.
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 five categories: (1) least agreeable, (2) disagreeable, (3)
neutral, (4) agreeable, and (5) most agreeable.
876 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878
motivation to work was NOT for money
(estimate=0.344, Wald w2 ¼ 3:44; p ¼ 0:06), this nurse
would have higher intention to quit (the Nagelkerke
Pseudo R2 ¼ 0:283).
Model 3 was the final ordinal regression model for
testing the research hypothesis. Institution (Hospital B)
(estimate=1.035, Wald w2 ¼ 7:15; p ¼ 0:01), age of the
youngest child (estimate=0.068, Wald w2 ¼ 2:97;
p ¼ 0:09), holding a diploma (estimate=1.790, Wald
w2 ¼ 4:28; p ¼ 0:04), holding an associate degree
(estimate=1.639, Wald w2 ¼ 4:00; p ¼ 0:05), salary
and promotion (estimate=0.430, Wald w2 ¼ 4:41;
p ¼ 0:04), general job satisfaction (estimate=0.862,
Wald w2 ¼ 22:89; p ¼ 0:00), and general job happiness
(estimate=0.788, Wald w2 ¼ 17:55; p ¼ 0:00) were
proved to be significant predictors of nurses’ intention
to quit (when p was set at 0.10). The Nagelkerke Pseudo
R2 for Model 3 was 41%.
6. Discussion and conclusion
The research hypothesis (the higher nurses’ levels on
general job satisfaction, overall satisfaction with profes-
sional roles, and general job happiness, the lower
their intention to quit would be, after controlling
for demographic characteristics and working motivation
first, and following by nine job satisfaction subscales)
was tested in this project. This hypothesis was not
fully supported (when p was set at 0.10), however. In
these three ordinal regression models, different demo-
graphic characteristics (such as working hospital,
number of children, age of the youngest child, and
motivation to work as a nurse) demonstrated statisti-
cally significantly predicting power toward nurses’
intention to stay. In Model 2, as compared to direct
working environment and salary and promotion,
challenge in work was the strongest job satisfaction
predictor of intention to quit. However, in Model 3,
general job happiness and general job satisfaction had
higher values in estimates than the one of salary and
promotion. These results showed the sophisticated
association and predicting power among included
variables and nurses’ intention to quit.
In the final (third) ordinal regression model, only two
primary explanatory variables (general job satisfaction
and general job happiness) were statistically significant
predictors of nurses’ intention to quit. Compared to
general job satisfaction, general job happiness was
seldom used in predicting outcome variables. Here,
job happiness was quantified as a general item to
measure nurses’ overall perceptions towards their jobs
when they are doing their jobs in the levels of happiness.
Tzeng and Ketefian (2002) and Tzeng et al. (2001)
studies suggested a significant relationship between
nurses’ general job happiness and patient satisfaction
with nursing care. In addition, Tzeng’s (2002) confirmed
that nurses’ job satisfaction and job happiness were two
distinct concepts. Muller-Smith (1999) reported that the
potential for growth rather than fear of loss invented
energy and excitement, which led to a joyful workplace
and a strong sense of accomplishment. In conclusion,
this study provided strong evidence that job satisfaction
and job happiness are two discrete concepts and
explained a significant amount of variance of nurses’
intention to quit. Future research might investigate
whether employees’ job happiness is a predictor of the
other outcome indicators (e.g., work performance,
service attitudes). At the mean time, it would be
imperative to further investigate the possible differences
on employees’ perceptual levels on job happiness
between female and male and employees’ personality
characteristics.
Ordinal regression results also demonstrated that
working motivation (for money, no other choice,
and family expectation) were significant predicators of
intention to quit in Model 1. Three job satisfaction
aspects (challenge in work, salary and promotion,
and direct working environment) were significant pre-
dicators of nurses’ intention to quit in Model 2, but the
effects of work motivation (only working for money left)
were washed out. The variance of nurses’ satisfaction
with challenge in work and direct working environment
was washed out after entering general job-related
indicators as seen in the final (third) model, where
salary and promotion was still a significant predictor.
Previously reviewed literature also emphasized the
importance of building a support environment
with appreciated reward systems (Edgar, 1999; Healy
and McKay, 1999; Kangas et al., 1999; Adams and
Bond, 2000; Dunham-Taylor, 2000). Kivimaki et al.
(1995) provided a different insight that the nurses,
who are occupying highly enriched jobs, reported
significantly higher job satisfaction and work motiva-
tion. Observing the organizational cultures of current
working places, building an environment emphasizing
affiliation and recognition is a norm. However,
creating challenging works is still a hard-to-approach
matter to nursing executives. Different administration
initiatives (such as, implementing case management,
shared governance, work redesign, total quality manage-
ment) had been introduced to the healthcare organiza-
tions (Abbott et al., 1994; Kennerly, 1996). Thus,
the positive impact of these initiatives on nurses’
job satisfaction, especially with challenge in work, does
not seem to be considerable. For the purpose of
decreasing nurses’ intention to quit, it is suggested
to further explore extensively which factors matter to
nurses’ job satisfaction with challenging work, such as
achievement, autonomy at work, new challenge, stress
levels, and suitable work (workload, context, time,
emotional involvement). We believed that for increasing
 H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867–878
Table 4
Definitions 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
Interaction with and feedback from patients and
family members
Leadership style
Working atmosphere
Family support and religion
Intention to quit
General job satisfaction
Overall satisfaction levels with professional roles
General feeling when doing jobs (general job
happiness)
Working motivation
nurses’ commitment and loyalty to their working
hospital (decreasing their intention to quit), nurse
executives should consider various aspects of job
characteristics. Thus, some factors, like salary and
promotion, might not be as modifiable as the other job
characteristics.
Overall, this project provided an insight on the
influence of nurses’ working motivation, job satisfac-
tion, and general factors on nurses’ intention to quit in
Taiwan. The healthcare market in Taiwan might not
have immediate problems of nursing shortage and high
turnover rates. Nursing executives still need to reduce
nurses’ intention to quit and increase their job satisfac-
tion. The reasons are that high intention to quit and low
job satisfaction might lead to certain amount of decrease
in the quality and patients’ intention to return for future
use, and increase in the cost for patient care under this
cost-containment environment.
877
Definition
The following nine scales were described as nurses’ satisfaction levels with
predefined job characteristics, which are:
A hospital’s policies and benefits (including leisure activities, housing,
parking, and vacation)
Medical equipments, working environment, scheduling, rotation to other
wards, working hours, workflow, 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 decision-
making, 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 supervisor’s 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
Definitions of the variables: operationalized in
the Nurses’ Job Satisfaction and the Perceptual
Degree of its Importance Questionnaire is given in
Table 4.
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