JOURNAL OF ORGANIZATIONAL BEHAVIOR, VOL.

19, 305±320 (1998)

Explaining nursing turnover intent:

job satisfaction, pay satisfaction,
or organizational commitment?*
LILLIE LUM 1 , JOHN KERVIN 2 KATHLEEN CLARK 3 , FRANK REID 2
AND WENDY SIROLA 4
1
Health Services Innovation Group, Toronto, Canada
2
Centre for Industrial Relations, University of Toronto, Canada
3
Quality of Nursing Worklife Unit, McMaster University, Canada
4
Hospital for Sick Children, Toronto, Canada

Summary A number of models have been developed to explain nurses' turnover behavior. The
common theme that emerges from these models is that turnover behavior is a multistage
process that includes attitudinal, decisional, and behavioral components. The purpose of
this study was to assess both the direct and indirect impact of certain pay policies upon
the turnover intentions of paediatric nurses. The two major questions addressed were:
What was the relative impact of job satisfaction, pay satisfaction, and organizational
commitment upon the turnover intentions of paediatric nurses eligible for these pay
policies? What model accurately portrays the relationship among these three independ-
ent variables and turnover intentions? Exploration of the causal pathways among these
variables and demographic factors revealed complex models of association. The results
suggest that job satisfaction has only an indirect in¯uence on the intention to quit,
whereas organizational commitment has the strongest and most direct impact. A further
®nding that pay satisfaction had both direct and indirect e€ects on turnover intent was
consistent with administrators' assumptions underlying the pay policies. Control vari-
ables such as having a degree, having children, and working 12-hour shifts were found
to have both direct and indirect in¯uences upon pay satisfaction and turnover intent.
# 1998 John Wiley & Sons, Ltd.

J. Organiz. Behav. 19: 305±320 (1998)

Introduction

In the early 1990s, the shortage of experienced registered nurses in teaching hospitals prompted
renewed interest in nursing retention. The issue was not a generalized shortage of nurses but
rather an acute and chronic maldistribution of nurses in certain geographic regions and in
particular areas of specialized nursing practice. Bed closures and cancellation of surgeries were
directly related to the lack of sucient numbers of nurses quali®ed to care for acutely ill patients.
One very important question which continues to puzzle both administrators and quality of

* This project was funded by the Ontario Ministry of Health, Hospital Incentive Fund (Ontario, Canada).

CCC 0894±3796/98/030305±16$17.50 Received 1 September 1994

# 1998 John Wiley & Sons, Ltd. Accepted 23 July 1996
306 L. LUM ET AL.

worklife researchers is whether certain human resource strategies, such as increased pay, have any
e€ect upon nurses' attitudes regarding turnover.
Pay is viewed as part of the sanction system used by the organization to motivate compliance
with its rules and regulations (Mueller and Price, 1990). For the individual employee, pay is
viewed as an important reward or outcome. In human resources management, Meltz and
Marzetti (1988) proposed the use of salary di€erentials as economic incentives to enhance
nursing job satisfaction and retention for `dicult to sta€' areas. A negative relationship between
pay levels and turnover has been frequently reported in the literature. Yet in spite of this evidence,
little is known about a€ective and cognitive variables which mediate this relationship
(Motowidlo, 1983). There is little doubt that pay in¯uences turnover but the underlying
dynamics are in need of further investigation.
The purpose of this paper is to present the results of the ®rst phase of a program evaluation
study designed to assess the impact of pay policies upon the turnover intentions of paediatric sta€
nurses at a metropolitan teaching hospital. The issue is: Are nurses more likely to stay within an
organization if given a salary supplement? Under the pay policy examined here, two types of
tenure-based payments were made: bonuses o€ered to intensive care sta€ nurses only, and a 5 per
cent salary di€erential above union scale for all sta€ nurses. The major objective of these
supplements was to reduce the annual rate of turnover, which was 31.9 per cent in the intensive
care units and 26.9 per cent in other clinical areas. (These ®gures include three categories: quits,
layo€s, and other reasons such as retirement). By comparison, Picot and Baldwin (1990b) have
shown that for a large sample of employees in the national labor force the overall turnover rate
was about 21 per cent per year, roughly equally split between the three categories: quits (7.7 per
cent), layo€s (6.9 per cent), and other reasons (6.8 per cent).
The anticipated success of these pay policies was based upon two major assumptions. First, the
supplements were assumed to be suciently high in value and structured in such a way as to have
the most favorable in¯uence upon the senior sta€ nurses who were presumed to be the most
experienced, and thus most valuable and committed employees. A second assumption was that
these pay policies would `neutralize' the impact of attractive job opportunities in other hospitals.
Indeed, during this period there were high vacancy rates in a variety of paediatric settings.
Although the relationship between job alternatives and turnover has not received much attention,
Motowidlo (1983) has suggested that pay satisfaction predicts turnover decisions only when
employees perceive that they are likely to improve their pay through changing employers.
A number of models have been developed to explain employee turnover behavior (for example,
Price and Mueller, 1981; Parasuraman, 1989; Weisman, Alexander and Chase, 1980). The
common theme that emerges from these models is that such turnover behavior is a multistage
process that includes attitudinal, decisional, and behavioral components. Three major classes of
determinants include individual factors, economic opportunity, and work-related factors. The
last category includes factors such as job satisfaction and organizational commitment. The desire
to remain in an organization was ®rst discussed in the context of models of voluntary turnover
and was seen largely as a function of job satisfaction (March and Simon, 1958). Commitment, on
the other hand, is seen as a more global attitude serving as a stabilizing force that acts to maintain
behavioral direction when expectancy/equity conditions are not met (DeCoutis and Summers,
1987). In other words, job satisfaction is seen to be an intervening variable between environ-
mental and personal characteristics and organizational commitment. In an alternate model,
Bateman and Strasser (1984) propose that organizational commitment is rationalized by
subsequent job satisfaction attitudes. In the research reported here, both the direct and indirect
in¯uence of job satisfaction and organizational commitment, as well as pay satisfaction, were
assessed in terms of their impact upon intended turnover.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
 EXPLAINING NURSING TURNOVER INTENT 307

In this study, we used `turnover intent' rather than `turnover' as the dependent variable. This
approach draws upon a number of recent studies that have assessed the role of intentions in
predicting and understanding turnover. Satisfaction is conceptualized as an a€ective or
emotional response, whereas intentions are statements about speci®c behaviors of interest.
Fishbein (1967) and Newman (1974) have demonstrated that behavioral intentions to stay or
leave are consistently related to turnover and that this relationship is generally stronger and
accounts for more variance in turnover than does the satisfaction±turnover relationship. Mobley,
Horner and Hollingsworth (1978) reported moderate to strong correlations between intention to
quit, job search and thinking of quitting, and turnover, among hospital employees. Mobley,
Gri€eth, Hand and Meglino (1979) suggest that intentions o€ers a better explanation since it
captures the individual's perception and evaluation of job alternatives.
The two major questions addressed in this study are: What was the relative impact of job
satisfaction, pay satisfaction, and organizational commitment upon the turnover intentions of
paediatric nurses eligible for these pay policies? What causal model accurately portrays the
relationship among these three independent variables and turnover intentions for this sample of
sta€ nurses?

Related Studies

In practical terms, turnover represents a major problem, particularly in terms of recruitment

costs and organizational continuity. For nursing and health care organizations, additional con-
cerns include the ability to care for patients and the quality of care given. As a consequence of its
importance, turnover has been the subject of an extensive number of studies in many disciplines.
The resulting models of turnover hypothesize numerous causes and consequences. Only those
studies which provide the basic background of these models and are relevant to nursing turnover
will be presented below.

Pay satisfaction and turnover intent

Numerous causes of pay satisfaction have been proposed. These include personal and job inputs,
monetary and nonmonetary outcomes, the comparison process, and pay policies and administra-
tion. Current models of pay satisfaction continue to have their basis in concepts of equity theory
(Adams, 1965). Equity theory emphasizes that pay satisfaction is caused by feelings regarding the
equity of one's pay. These feelings result from perceptual and comparative processes. The theory
holds that an employee formulates a ratio of outcomes (including pay) to inputs. This ratio is
then compared to the outcome/input ratio of some referent source. If the ratios correspond, pay
equity and satisfaction result. If an employee's pay is perceived to be less than another's, feelings
of being inequitably underpaid may ensue. Lawler (1971) o€ers a similar approach suggesting
that pay satisfaction or dissatisfaction is a function of the discrepancy between what one feels one
should receive and how much pay one does receive. Pay dissatisfaction is suciently common
that a ®nding of a lower rate of satisfaction with pay than with other job components can be
anticipated, and even predicted (Lawler, 1990).
Reported consequences of pay satisfaction include a variety of unwanted employee behaviors
such as turnover, absenteeism, willingness to strike, and lowered job performance (Heneman,

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
308 L. LUM ET AL.

1985a). Weiner (1980) assessed the pay satisfaction of blue- and white-collar employees in a
public sector organization. Pay satisfaction was found to be signi®cantly predictive of both
absenteeism and turnover, though the strength of the relationships was not particularly large.
Motowidlo (1983) used pay satisfaction to predict turnover intentions and actual turnover among
sales representatives. He concluded that pay has an impact on turnover only through its e€ects on
pay satisfaction which, in turn, impacts turnover only through its e€ects on turnover intentions.
Newman (1974) reported that satisfaction with pay was found to be a marginally signi®cant
predictor variable for intended turnover of nursing home sta€.
In nursing, a number of studies have included pay satisfaction as a component of a multi-
dimensional measure of job satisfaction (Frisina, Murray and Aird, 1988). Typically, nurses have
not rated pay as a high priority in their job satisfaction (Frisina et al., 1988). However, in recent
years nurses have expressed increasing concern about their salary and bene®ts. In 1988, Murray
and Smith explored the career, job, and hospital satisfaction of sta€ nurses in metropolitan
hospitals of a large Canadian city. They found only 10 per cent of the nurses were satis®ed with
their pay and 46 per cent were dissatis®ed. The signi®cance of this ®nding was not that so many of
the nurses were dissatis®ed with their pay, but that this was the single largest expression of
dissatisfaction of all the satisfaction rating scales in their study (Murray and Smith, 1988, p. 68).
Bateman and Strasser (1984) have reported that nurses' satisfaction with work, coworkers, and
supervision were strong predictors of commitment but not of pay satisfaction. As far as nurses
are concerned, there are no studies which report the concurrent e€ects of pay supplements upon
pay satisfaction and turnover intent.

Job satisfaction and turnover intent

Many studies conceptualize turnover to be a psychological response and rest on the belief that
turnover is an individual choice behavior. At the individual level, satisfaction with one's job is the
most frequently studied psychological variable in the satisfaction±turnover relationship (Mobley,
1979). Studies involving professional and nonprofessional employees indicate a negative relation-
ship between overall satisfaction and turnover although the variance accounted for is less than
14 per cent. When satisfaction is included in multiple regressions with variables such as intentions
and commitment, its e€ect on turnover may become nonsigni®cant (Marsh and Mannari, 1977;
Mobley et al., 1978).
Job dissatisfaction has been repeatedly identi®ed as the single most important reason why
nurses leave their jobs. Price and Mueller (1981) were able to conclude empirically that job
dissatisfaction had an indirect e€ect on turnover through its direct e€ect on formation of intent
to leave. Irvine and Evans (1992) reported signi®cant causal relationships between intent to
turnover, and both job satisfaction (beta ˆ ÿ0:53) and organizational commitment (beta ˆ
0:34). Both intrinsic factors such as autonomy, respect, and recognition and extrinsic factors such
as pay, shiftwork, and workload have been cited as variables related to job satisfaction. Cotton
and Tuttle (1986) found that overall job satisfaction, satisfaction with work itself, pay satis-
faction, satisfaction with supervision, and organizational commitment were negatively related to
turnover. Weisman et al., (1980) cited understang and in¯exible work schedules as important
contributors to job dissatisfaction.
In short, the relationship between satisfaction and turnover has been consistently found in
many turnover studies. However, it usually accounts for less than 16 per cent of the variance in
turnover (Porter and Steers, 1973). It is apparent that models of the employee turnover process
must move beyond satisfaction as the primary explanatory variable.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
 EXPLAINING NURSING TURNOVER INTENT 309

Job satisfaction, organizational commitment,

and turnover intent
Commitment to the employing organization has been a topic of considerable research for the past
two decades (Blegen, 1993). Williams and Hazer (1986) make the distinction between commit-
ment and job satisfaction in that the former is an a€ective response to the whole organization,
whereas the latter represents an a€ective response to speci®c aspects of the job. Interest in
studying commitment has continued since it has been shown to be consistently related to
(1) employee behaviors such as turnover, absenteeism, and performance (Angle and Perry, 1981;
Bluedorn, 1982; Porter and Steers, 1973); (2) attitudinal, a€ective, and cognitive constructs such
as job satisfaction, job involvement, and job tension (Hall and Schneider, 1972; Hrebiniak and
Alutto, 1972; Porter, Steers, Mowday and Boulian, 1974); (3) characteristics of the employee's
job and role, and task identity (Steers, 1977); and (4) personal characteristics of the employee
such as age, gender, need for achievement, and job tenure (Angle and Perry, 1981; Hebriniak and
Alutto, 1972; Steers, 1977). Many studies have reported a signi®cant association between
organizational commitment and turnover intentions (Ferris and Aranya, 1983; O'Reilly and
Caldwell, 1980; Stumpf and Hartman, 1984; Weiner and Vardi, 1980). Satisfaction and commit-
ment have invariably been reported to be negatively related to turnover and intent to leave
(Arnold and Feldman, 1982; Bluedorn, 1982; Hollenbeck and Williams, 1986), and positively
correlated with one another (Bluedorn, 1982).
The major focus of these models and research ®ndings has been to identify antecedents of
commitment from a variety of categories. These have included personal characteristics, work
experiences, job characteristics, organizational factors, and role-related factors. The conceptual
turnover model that has received the most attention in the psychological literature was proposed
by Mobley (1977). Although this model considers organizational commitment as an attitude to
be related to satisfaction, no clear causal relation is hypothesized. Studies have either failed to
include both satisfaction and commitment or overlooked the causal relationship between the
two variables. Williams and Hazer (1986), through the use of structural equation methodology,
have concluded that commitment has a more important e€ect on intent to leave than does
satisfaction. Personal and organizational characteristics were found to have no direct impact
upon turnover intentions. However, they in¯uenced satisfaction directly, and in¯uenced
commitment indirectly through their impact upon satisfaction and its subsequent e€ect on
commitment.
Bateman and Strasser (1984) have argued that many of the earlier studies have limited
interpretability due to the tendency to use `static correlational analysis' of the relationship
between commitment and its presumed antecedents. The results of their longitudinal study of
nursing sta€ showed that personal characteristics played a minor role in explaining variation in
commitment. They also found that overall satisfaction is not a cause of commitment but rather a
result of it. They have suggested that commitment may be a construct that is neither simultaneous
with nor a consequence of job satisfaction. Sheridan and Abelson (1983) and Sheridan (1985)
similarly have suggested that the relationship between variables such as organizational commit-
ment and turnover is nonlinear, that is, termination represents a discontinuous change in
withdrawal behavior, occurring only after certain levels of tension and commitment are exceeded.
Shore and Martin (1989) and Mueller and Price (1990) concluded that although both satisfaction
and commitment are related to turnover, organizational commitment is more strongly related to
turnover intentions. Yet important discrepancies exist concerning the relative contribution of job
satisfaction and organizational commitment to the withdrawal process, suggesting the need for
further study.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
310 L. LUM ET AL.

Figure 1. Models derived from the literature

Models and hypotheses

Taken together, the ®ndings cited above suggest two di€erent models of the relationships
involving work and pay satisfaction, organizational commitment, and turnover intent, as shown
in Figure 1. The di€erence between the two models lies in the role of organizational commitment.
Some researchers see it as a component of job satisfaction (model A), while others see it as having
an independent e€ect of its own on turnover intent (model B).
In this paper we hypothesize a slightly di€erent relationship (Figure 2). In our model, all
job satisfaction factors are mediated by organizational commitment, except for pay satisfaction
which we postulate to have an additional direct e€ect on turnover intent. In short, we
hypothesize:
H1: Job satisfaction e€ects on turnover intent are mediated by organizational commitment.
H2: Pay satisfaction a€ects directly both job satisfaction and turnover intent.
The basis for the hypothesized mediating role of organizational commitment follows from the
work of DeCoutis and Summers (1987), Shore and Martin (1989), and Mueller and Price (1990),
who found the e€ect of job satisfaction less than that of organizational commitment. Our

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
 EXPLAINING NURSING TURNOVER INTENT 311

Figure 2. Hypothesized model

expectation of a direct e€ect of pay satisfaction on turnover intent stems from our belief that
economic factors have a separate impact on behavioral intentions, and is consistent with what
Mueller and Price (1990) have proposed. Indeed, for the pay policy initiatives described above,
hospital administrators implicitly assumed that pay bonuses would directly impact turnover
intentions, independently of any e€ect on job satisfaction.

Methodology
Sample
The target population included all full- and part-time registered sta€ nurses at the selected
hospital who were eligible for one or both of the two pay policies (a 5 per cent salary di€erential
above union scale for all sta€ nurses, and an additional bonus for intensive care sta€). A
nonproportional strati®ed sample was used with human resources sta€ ®les as the sampling
frame. All nurses in both the neonatal and paediatric intensive care units (NICU and PICU) were
surveyed. For the 32 remaining clinical units, one in four sta€ nurses were randomly selected. The
target sample consisted of 466 sta€ nurses; 222 from the general care areas and 244 from the
critical care units. Data were collected over a 4-month period. Each respondent received a
personalized envelope containing a 12-page questionnaire and a self-addressed, stamped return
envelope. Two follow-up mailings produced a usable return rate of 77.5 per cent (N ˆ 361).

Instrumentation

Scales to measure the three major independent variables (job satisfaction, pay satisfaction,
and organizational commitment) were developed or adapted from established existing scales.
A 5-point Likert scale was used for scoring each item.

Job satisfaction scale

A job satisfaction scale (JS) consisting of 25 items was derived from the original scale (37 items,
Cronbach's alpha ˆ 0:86) developed by Stamps, Piedmont, Slavitt and Haase (1978) for the
purpose of measuring job satisfaction among nurses. The modi®ed JS included questions about
work-related issues such as autonomy, task requirements, organizational policies, professional
interactions, and perceived job status. (We were concerned with creating a short instrument to
maximize response rates given nurses' time pressures, but we retained many items in this scale
because of its multidimensional nature).

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
312 L. LUM ET AL.

Pay satisfaction
Pay satisfaction (PS) was measured by a 4-item scale developed for the purposes of this study,
roughly modeled on the pay satisfaction items in the Minnesota Satisfaction Questionnaire. Our
scale contained general items seeking attitudinal information about pay level, adapted to the
speci®cs of our survey situation (i.e. speci®c references to nurses and the hospital). Additional
items (not analyzed here) were developed to assess respondents' attitudes towards each of the pay
policies.

Organizational commitment scale

A 5-item organizational commitment scale (OC) was adapted from the original 15-item
instrument originally developed by Mowday, Steers and Porter (1979), and primarily used in
industrial settings. They reported a reliability value (Cronbach's alpha) of 0.88 with a modi®ed
9-item scale tested with hospital-based workers. The items selected focused upon the respond-
ent's attitudes about the hospital as a desirable place in which to work (omitting those tapping
intent to stay (Angle and Perry, 1981), which would have confounded this measure with the
measure of turnover intent).

Intentions toward turnover

Intentions toward turnover (TI), that is, leaving the hospital, were measured by a 3-item index
which sought information about respondents' intention to look for another job. The measure is
an index in that each item represents a conceptually di€erent dimension of turnover. The items,
and their dimensions, are as follows: (1) `In the last few months have you ever thought seriously
about looking for a nursing job at another hospital?' (consideration of organizational but not
occupational exit), (2) `In the last few months have you ever thought seriously about looking for a
non-nursing job?' (consideration of occupational exit), and (3) `Taking everything into consider-
ation, how likely is it that you will make a serious e€ort to ®nd a new job within the next year?'
(consideration of other factors, such as the job market, potentially a€ecting exit).
As well as scales for the four principal variables, the survey questionnaire also incorporated
measures of a number of demographic and work-related control variables. The former included
age, gender, education, income, number of pre-school children living at home, other dependents,
and marital status. The latter included shift pattern most frequently worked, years of experience,
years of tenure on unit and at the hospital, type of unit (intensive care or other), and employment
status.

Results
Sample characteristics
The majority of the sample were female (96.9 per cent) with a mean age of 32.4 years (range 23±
63 years). Slightly more than half (53.8 per cent) reported being married or cohabiting. A large
proportion of the sample (71.2 per cent) did not have children; of those with children (N ˆ 91)
the mean number was 1.7. Of the respondents, 14 per cent reported having one or more adult
dependents. The most commonly reported range of annual nursing income was $30,000±$39,000.
A small proportion of the sample (21 per cent) possessed a baccalaureate degree. No attempt was

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
 EXPLAINING NURSING TURNOVER INTENT 313

made in this phase of the study to ascertain the type of degree obtained. The remainder (79 per
cent) had a diploma from a hospital or college nursing program.
The majority of the sample (76.4 per cent) worked full-time, 19.7 per cent worked half-time or
more but not full-time, and the remaining 3.9 per cent worked less than half time. Most respon-
dents reported self-scheduling although the sta€ were generally required to work predominantly
12-hour shifts. The mean years of paediatric experience was 7.8, with an actual range of 3 months
to 35 years. The mode was 2.5 years experience. The mean years of tenure at this hospital was 6.6
(range 51 to 40) years, although this may not represent one continuous period of work. The
average length of time spent working on the respondent's current clinical unit was 4.9 years with
a range of 2 months to 25 years.

Psychometric properties of the scales

(JS, PS, and OC)

The psychometric properties are reported in Table 1. Each scale item was scored from 1 to 5,
higher values indicating greater satisfaction or commitment. For the turnover intent index, the
mean and standard deviation (N ˆ 358) were 2.10 and 1.01 respectively; correlations among the
three index items ranged from 0.33 to 0.50.1

Table 1. Psychometric properties of the scales (JS, PS, and OC)

Number of items N Alpha Mean S.D.
PS 4 354 0.69 2.98 0.72
JS 9 323 0.75 3.61 0.56
OC 5 331 0.83 3.65 0.62
JS, job satisfaction scale; PS, pay satisfaction scale; OC, organizational commitment scale.

Relationships among turnover intent

and JS, PS, and OC

Our analysis involves two steps. The ®rst requires developing a set of structural equations
incorporating the four principal variables to produce and compare path-analytic models
representing the three models (A, B, and C) presented above. In the second step, demographic
and work-related variables are added to see whether they might substantially alter the ®ndings.
(No prior hypotheses were generated involving these variables).
Intercorrelations, means, and standard deviations for the principal variables are shown in
Table 2. (The means and standard deviations di€er slightly from those in Table 1 because of
listwise deletion of cases with missing values). These correlations are all moderate in size. Their
relative values suggest that organizational commitment may be the most important determinant
of turnover intent, as hypothesized above.
The 3-item index of turnover intent produced a non-normal distribution with a relatively high
concentration of cases at the lower values of the distribution (scores of 27 per cent of the
respondents fell at the lowest value of the index, re¯ecting de®nite lack of interest in exit on all

1
The index item measuring occupational exit did not behave di€erently from the item measuring organizational exit.
Their correlations with organizational commitment were ÿ0:28 and ÿ0:29 respectively.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
314 L. LUM ET AL.

Table 2. Zero-order correlations, means, and standard deviations (N ˆ 290)

PS JS OC TI Means S.D.
PS Ð Ð Ð Ð 2.99 0.71
JS 0.39 Ð Ð Ð 3.61 0.56
OC 0.25 0.40 Ð Ð 3.66 0.61
TI ÿ0:26 ÿ0:29 ÿ0:37 Ð 2.09 1.00
JS, job satisfaction scale; PS, pay satisfaction scale; OC, organizational commitment scale; TI, turnover intent.

Table 3. Comparison of models A, B, and C

A B C
Chi-square (df ) 41.6 (5) 27.4 (5) 7.6 (3)
Adjusted goodness-of-®t index 0.68 0.78 0.93
Root mean square residual 0.054 0.069 0.026

three items). To correct for this non-normality, the variable was adjusted using `PRELIS' soft-
ware (Joreskog and Sorbom, 1988), which produced a covariance matrix based on latent values of
turnover intent. The e€ect of this adjustment was to reduce slightly the correlations of turnover
intent with the other variables in the model (with pay satisfaction: from ÿ0:264 to ÿ0:261; job
satisfaction: from ÿ0:292 to ÿ0:286; organizational commitment: from ÿ0:365 to ÿ0:349). The
adjusted version was used for deriving coecients and testing goodness-of-®t for all three models.
The results of the ®rst step, comparing the three models, are presented in Figure 3, and the
relative goodness-of-®t of the three models is given in Table 3. The path coecients represent
standardized maximum likelihood solutions to the sets of structural equations. Table 3 con®rms
that model `C', generated from the above hypotheses, provides a superior ®t to the data com-
pared to the two models (`A' and `B') derived from the literature. The values of chi-square and the
root mean square residual are both substantially smaller for model `C', while the adjusted
goodness-of-®t index is noticeably greater.
Figure 4 shows the same model with demographic and work-related characteristic variables
added. Some of the original factors showed little or no impact on the principal variables, and
were dropped from the analysis (gender, income, marital status, type of unit, employment status).
Because of the high intercorrelations among four of the variables (age, years of paediatric
experience, years on unit, and years at the hospital) we selected years of experience as a proxy for
all four. Also, working predominantly 12-hour shifts and working predominantly night shifts
were correlated highly enough to prevent the iterations from converging, so the latter was
dropped from the analysis. Education was measured by whether the respondent possessed a
bachelor's degree. The number of pre-school children and number of other dependents were both
collapsed to dummy variables (one or more ˆ 1) because of excessive skewness. The result was
the ®ve control variables shown in Figure 4.
Using the inferential `theory trimming' technique (beginning with a full model and removing
weak paths) we investigated the relationships among control variables and the four principal
factors. As a consequence, the resulting coecients can only be regarded as descriptive of the
nursing population in the hospital studied and, unlike the model discussed above, are technically
not generalizable to other hospitals.
As the ®gure shows, the basic model of the four variables is highly stable. The path between
pay satisfaction and turnover intent increases slightly in absolute magnitude (from ÿ0:18 to
ÿ0:21), likely as a result of the removal of some weak suppressor e€ect.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
 EXPLAINING NURSING TURNOVER INTENT 315

Figure 3. Standardized path coecients for the three models

With respect to the control variables, an interesting pattern emerges. These factors exert direct
e€ects on either or both of pay satisfaction and turnover intent, but not on the intervening
variables of job satisfaction and organizational commitment. Further, all three of the factors that
a€ect both pay satisfaction and turnover intent show an inconsistent relationship (suppressor
e€ect). Although pay satisfaction is negatively related to turnover intent, having a bachelor's
degree increases both. On the other hand, having young children at home or working predomi-
nantly 12-hour shifts decreases both pay satisfaction and turnover intent.

Discussion and Implications

The ®ndings of this study contribute to current knowledge of the antecedents of turnover intent
of nurses, particularly the role of pay. Pay, as well as supply and demand issues in¯uenced by the
labor market and the employee's perception of the economy, have been previously identi®ed
as determinants of job satisfaction, organizational commitment, and behavioral intentions to

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
316 L. LUM ET AL.

Figure 4. Standardized path coecients for model C with additional variables

turnover. While pay is considered to be an important aspect of job satisfaction, the relationship
between pay attitudes and turnover intent has not been clear. By deriving and testing causal
inferences regarding pay satisfaction, job satisfaction, and organizational commitment, this
research has somewhat clari®ed the combined e€ects of these variables on turnover intent. The
results reveal a model of association which is more complex than assumed by previous
researchers, and by the initiators of the pay policies at the study hospital.
More speci®cally, two ®ndings deserve mention. First, these results provide additional evidence
that job satisfaction does not appear to a€ect turnover intentions directly. The path model shown
in Figure 2 is consistent with the assumed causal process of satisfaction a€ecting commitment,
which in turn a€ects turnover intent. Those models, found in the literature, that ignore the
mediating role of organizational commitment fail to ®t the data as well as the model proposed and
tested here.
A second important ®nding of this study is that pay satisfaction has both a direct and indirect
e€ect upon nurses' turnover intent. Although pay satisfaction was signi®cantly associated with
reducing intended turnover, its indirect e€ect upon turnover intent, mediated through job
satisfaction and organizational commitment, was weaker. One implication of the two-path result
is that organizational policies designed to reduce turnover by increasing pay satisfaction need not
attempt to increase job satisfaction and organizational commitment at the same time.
For the purposes of this study, pay satisfaction was treated as a unidimensional construct.
However, in a complex setting such as a hospital, more complex reactions to pay changes are
likely to occur. Heneman and Swab (1979) have indicated that the concept `pay' can be divided
into four distinct categories: level, structure, system, and form. In light of this, we recommend
future studies include multidimensional measures of reactions towards the pay system. From a
practical standpoint, putting pay satisfaction in multidimensional terms means that organiza-
tions should recognize that a change in pay practices in one of the pay dimensions may have few,
if any, e€ects in the others (Heneman, 1985b). In particular, the anecdotal data gathered as part
of this study (respondents' comments in an open-ended survey question) indicated that many of
the nurses felt less than satis®ed with the method with which the supplements were derived, that
is, intensive care nurses being rewarded more highly than the general sta€ nurses2 . Price and

2
For example, `It is unfair that the intensive care nurses get pay bonuses while we (general sta€ nurses) only get salary
di€erentials', and, `The salary di€erentials were o€ered just to buy us (general sta€ nurses) o€ so we don't complain
because the ICU nurses are the ones they want to keep'.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
 EXPLAINING NURSING TURNOVER INTENT 317

Mueller (1990) and Blegen (1993) have proposed that it is not only the actual salary o€ered to the
nurses which a€ects their attitudes, but also their perceptions of whether they are being paid
fairly for their work. In other words, a sense of distributive justice may be an important moder-
ating variable to consider in future studies.
The satisfaction-to-commitment mediation process found in this study is consistent with
Porter et al.'s basic model (1974) which proposes that commitment takes longer to develop and is
more stable than satisfaction. This model suggests that job satisfaction has only an indirect
in¯uence on the intention to quit and highlights the need to study the mechanisms through which
satis®ed nurses become committed to their organization.
As an attitude, organizational commitment di€ers from the concept of job satisfaction in
several ways. Commitment can be viewed as being more global, thus re¯ecting a general a€ective
response to the organization. Job satisfaction emphasizes the speci®c task environment in which
an employee performs his or her duties. Although day-to-day events in the workplace may a€ect
an employee's level of work satisfaction, transitory events should not cause an employee to re-
evaluate his or her attachment to the overall organization or clinical specialty.
Any retention strategy that is expected to have an e€ect upon turnover intentions must
supersede the daily variations in routines and policies. For example, additional attention needs to
be directed towards the work environment. DeCoutis and Summers (1987) concluded that
individuals do not become committed to an organization by virtue of some unique con®guration
of personal characteristics. Rather, individuals enter an organization with certain needs, desires,
and skills, and expect to ®nd a work environment in which they can utilize their abilities and
satisfy many of their basic needs. Organizations which meet these requirements are characterized
by participation in the decision-making process; clear communications about organizational
intentions, activities and performance; autonomy with respect to work de®nition and conduct;
and a sense of cohesion among organizational members.
Other factors also showed noteworthy e€ects. In particular, nurses with greater experience
were more satis®ed with their pay and less likely to leave, which was the anticipated e€ect of the
salary supplements. The reason may lie in the fact that more experienced nurses received sub-
stantially more money than junior nurses. The anecdotal data showed consistently that they
perceived the pay supplements to be an important recognition of their contribution to the
organization. Federico, Federico and Lundquist (1976) found that higher salary was associated
with longer tenure whereas the di€erence between expected and actual salary was associated with
shorter tenure. DeCoutis and Summers (1987) found that of the managerial employees they
studied, voluntary turnover occurred within the ®rst 8 months. Motowidlo (1983) has also
suggested increasing rewards to employees during high periods of turnover lessens the attractive-
ness of job alternatives at comparable organizations. The implication which emerges from these
data is that retention of senior nursing sta€ necessitates recognition of their skills through
e€ective pay strategies. As for the other control variables, having a degree both increases pay (the
positive relationship with pay satisfaction) and makes one more marketable (the positive
relationship with turnover intent). Young children at home increases demands for food, clothing,
and shelter (the negative relationship with pay satisfaction) and makes the insecurity of job
change more problematic (the negative relationship with turnover intent). Working 12-hour shifts
involves extended e€ort that may create perceived inequities that reduce pay satisfaction; it is not
clear why these shifts would reduce turnover intent3 .

3
We are indebted to an anonymous reviewer for suggesting some of the explanations for the ®ndings involving control
variables.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
318 L. LUM ET AL.

A potential limitation of this study may be the lack of distinction between commitment to the
organization and commitment to a paediatric specialty. This di€erence might explain the presence
of individuals with high commitment scores who nevertheless have thoughts about turnover
should the opportunity arise. Despite the fact that the satisfaction scores were generally high, the
results showed that 39 per cent of the general care nursing sta€ and 28 per cent of the critical care
nurses were considering looking for a new job in the near future. Several other possible explana-
tions exist for these ®ndings. Measures of overall job satisfaction by virtue of their greater
vagueness may evoke a response bias known as the halo e€ect (Irvine and Evans, 1992). Murray
and Smith (1988) have suggested that career satisfaction might be a more appropriate measure
than job satisfaction. Perhaps by virtue of their professional socialization, nurse turnover
decisions are not as strongly in¯uenced by conditions of the job as are nonprofessional employees'
decisions. Several human resource management implications emerge. Based upon the multiple
facets of pay satisfaction proposed by Heneman (1985b), the use of pay supplements to in¯uence
turnover intent might have a more signi®cant and longer impact if they included additional
features such as performance merit or recognition of outstanding contributions to the profession
of nursing and not simply tenure.
To what extent might these ®ndings apply to other occupations? While the model tested
above has wide theoretical applicability, there are speci®cs of our testing situation that may limit
generalizability. Nursing is a predominantly female profession. Further, these nurses were
involved in pediatric care, which suggests the possibility of higher-than-usual levels of nurturing.
Also, many worked in the highly technical environment of intensive care. Testing the model with
other populations will help to answer the question of generalizability.
In conclusion, the ®ndings of this study show that both personal and organizational factors
have an impact upon nurses' turnover intentions. Both simple and multivariate analyses indicate
that an association exists between turnover intent, as measured by job seeking behavior, and the
variables job satisfaction, pay satisfaction, and organizational commitment. This supports the
basic assumption underlying this study, that, when nurses are satis®ed with their jobs and pay,
and feel committed to the organization, they are less likely to terminate employment voluntarily.
Further, pay attitudes, unlike job satisfaction generally, a€ect turnover intent directly.

References

Adams, J. S. (1965). `Injustice in social exchange'. In: Berkowitz, L. (Ed.) Advances in Experimental Social
Psychology, Academic Press, New York, 267±299.
Angle H. L. and Perry, J. L. (1981). `An empirical assessment of organizational commitment and
organizational e€ectiveness', Administrative Science Quarterly, 26, 1±13.
Arnold, H. J. and Feldman, D. C. (1982). `A multivariate analysis of the determinants of job turnover',
Journal of Applied Psychology, 67, 350±360.
Bateman, T. S. and Strasser, S. (1984). `A longitudinal analysis of the antecedents of organizational
commitment'. Academy of Management Journal, 27(1), 95±112.
Becker, T. E. and Billings, R. S. (1993). `Pro®les of commitment: An empirical test', Journal of
Organizational Behavior, 14, 177±190.
Blegen, M. A. (1993). `Nurses' job satisfaction: A meta-analysis of related variables', Nursing Research,
42(1), 36±41.
Bluedorn, A. C. (1982). `A uni®ed model of turnover from organizations', Human Relations, 35, 135±153.
Cavanaugh, S. J. (1989). `Nursing turnover: Literature review and methodological critique', Journal of
Advanced Nursing, 14(1), 587±596.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
 EXPLAINING NURSING TURNOVER INTENT 319

Cotton, J. and Tuttle, J. (1986). `Employee turnover: A meta-analysis and review with implications for
research', Academy of Management Review, 11(1), 55±70.
Dear, M. R., Weisman, C. S., Alexander, C. S. and Chase, G. A. (1982). `The e€ect of intensive care
nursing role on job satisfaction and turnover', Heart & Lung, 11(6), 560±565.
DeCoutis, T. A. and Summers, T. P. (1987). `A path analysis of a model of the antecedents and
consequences of organizational commitment', Human Relations, 40(7), 445±470.
Federico, J. M., Federico, P. and Lundquist, G. W. (1976). `Predicting women's turnover as a function of
extent of met salary expectations and biodemographic data', Personnel Psychology, 29, 559±566.
Ferris, K. and Aranya, N. (1983). `A comparison of two organizational commitment scales', Personnel
Psychology, 36, 87±98.
Fishbein, M. (1967). `Attitude and the prediction of behaviour'. In: Fishbein, M. (Ed.) Readings in Attitude
Theory and Measurement, Wiley, New York.
Frisina, A., Murray, M. and Aird, C. (1988). What do Nurses Want? A Review of Satisfaction and Job
Turnover Literature, The Nursing Manpower Task Force of the Hospital Council of Metropolitan
Toronto Report, Toronto, Ontario.
Hall, D. T. and Schneider, B. (1972). `Correlates of organizational identi®cation as a function of career
pattern and organizational type', Administrative Science Quarterly, 17, 340±350.
Heise, D. R. (1970). `Problems in path analysis and causal inference'; In: Borgatta, B. F. (Ed.) Sociological
Methodology, Jossey-Bass, San Francisco.
Heneman, H. G. (1979). `Work and rewards theory'. In: Yoder, D. and Heneman, Jr., H. G. (Eds),
ASPA Handbook of Personnel and Industrial Relations, Bureau of National A€airs, Washington.
Heneman, H. G. (1985a). `Pay satisfaction', In: Rowland, K. M. and Ferris, G. R. (Eds)
Research in Personnel and Human Resources Management, Vol. 3, JAI Press, Greenwich, CT,
pp. 115±139.
Heneman, H. G. (1985b). `Pay satisfaction', Research in Personnel and Human Resources Management, 3,
115±139.
Hrebiniak, L. G. and Alutto, J. G. (1972). `Personal and role-related factors in the development of
organizational commitment', Administrative Science Quarterly, 17, 555±573.
Hollenbeck, J. R. and Williams, C. R. (1986). `Turnover functionality versus turnover frequency: A note on
work attitudes and organizational e€ectiveness', Journal of Applied Psychology, 71, 606±611.
Irvine, D. and Evans, M. (1992). Job Satisfaction and Turnover Among Nurses: A Review and Meta-
Analysis, Quality of Nursing Worklife Research Unit Monograph, 10, Faculty of Nursing, University of
Toronto, Toronto.
Joreskog, K. G. and Sorbom, D. (1988). PRELIS: A Preprocessor for LISREL, 2nd edn, Scienti®c
Software, Inc., Mooresville, IN.
Lawler, E. E. (1971). Pay and Organizational E€ectiveness, McGraw-Hill, New York.
Lawler, E. E. (1990). Strategic Pay: Aligning Organizational Strategies and Pay Systems, Jossey Bass,
San Francisco.
March, J. G. and Simon, H. A. (1958). Organizations, Wiley, New York.
Marsh, R. M. and Mannari, H. (1977). `Organizational commitment and turnover: A prediction study',
Administrative Science Quarterly, 221, 57±75.
McCloskey, J. and McCain, B. (1987). `Satisfaction, commitment and professionalism of newly employed
nurses', Image, 19(1), 20±24.
Meltz, N. M. and Marzetti, J. (1988). The Shortage of Registered Nurses: An Analysis in a Labour Market
Context, Registered Nurses Association of Ontario, Toronto, Ontario.
Mobley, W. H., Horner, S. O. and Hollingsworth, A. T. (1978). `An evaluation of precursors of hospital
employee turnover', Journal of Applied Psychology, 63, 408±414.
Mobley, W. H., Gri€eth, R. W., Hand, H. H. and Meglino, B. M. (1979). `Review and conceptual analysis
of the employee turnover process', Psychological Bulletin, 36(3), 493±521.
Motowildo, S. J. (1983). `Predicting sales turnover from pay satisfaction and expectation', Journal of
Applied Psychology, 68, 484±489.
Mowday, R., Steers, R. and Porter, L. (1979). `The measurement of organizational commitment', Journal
of Vocational Behaviour, 14, 224±247.
Mowday, R., Steers, R. and Porter, L. (1982). Employee±organizational Linkages: The Psychology of
Commitment, Absenteeism and Turnover, Academic Press, New York.
Mueller, C. W. and Price, J. L. (1990). `Economic, psychological and sociological determinants of
voluntary turnover'. The Journal of Behavioural Economics, 19(3), 321±335.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)
320 L. LUM ET AL.

Murray, M. and Smith, S. (1988). Nursing Morale in Toronto: An Analysis of Career, Job and Hospital
Satisfaction Among Hospital Sta€ Nurses, The Nursing Manpower Task Force of the Hospital Council
of Metropolitan Toronto, Toronto.
Newman, J. E. (1974). `Predicting absenteeism and turnover: A ®eld comparison of Fishbein's model and
traditional job attitude measures', Journal of Applied Psychology, 59(5), 610±615.
O'Reilly, C. A. and Caldwell, D. F. (1980). `Job choice: the impact of intrinsic and extrinsic factors on
subsequent satisfaction and commitment', Journal of Applied Psychology, 65, 559±565.
Parasuraman, S. (1989). ``Nursing turnover: An integrated model', Research in Nursing and Health, 12(1),
267±277.
Picot, G. and Baldwin, J. (1990a). `Patterns of quits and layo€s in the Canadian economy, Part I', Canadian
Economic Observer, October, 5.1±5.21.
Picot, G. and Baldwin, J. (1990b). `Patterns of quits and layo€s in the Canadian economy, Part II',
Canadian Economic Observer, December, 4.1±4.28.
Porter, L. W. and Steers, R. M. (1973). `Organizational work, and personal factors in employee turnover
and absenteeism', Psychological Bulletin, 80, 151±176.
Porter, L. W., Steers, R. M., Mowday, R. T. and Boulian, P. V. (1974). `Organizational commitment,
job satisfaction, and turnover among psychiatric technicians', Journal of Applied Psychology, 59,
603±609.
Price, J. and Mueller, C. (1981). `A causal model of turnover for nurses', Academy of Management Journal,
24(3), 543±565.
Sheridan, J. E. (1985). `A catastrophe model of employee withdrawal leading to low job performance,
high absenteeism, and job turnover during the ®rst year of employment', Academy of Management
Journal, 28, 88±109.
Sheridan, J. E. and Abelson, M. A. (1983). `Cusp catastrophe model of employee turnover', Academy of
Management Journal, 26, 418±436.
Shore, L. and Martin, H. (1989). `Job satisfaction and organizational commitment in relation to work
performance and turnover intentions', Human Relations, 42(7), 625±638.
Stamps, P., Piedmont, E., Slavitt, D. and Haase, A. (1978). `Measurement of work satisfaction among
health professionals', Medical Care, 16(4), 337±352.
Stumpf, S. A. and Hartman, K. (1984). `Individual exploration to organizational commitment or
withdrawal', Academy of Management Journal, 27, 308±329.
Weiner, N. (1980). `Determinants and behavioral consequences of pay satisfaction: A comparison of two
models', Personnel Psychology, 33, 741±757.
Weiner, Y. and Vardi, Y. (1980). `Relationship between job, organization and career commitment to work
outcomes: An integrative approach', Organizational Behaviour and Human Performance, 26, 81±96.
Weisman, C. S., Alexander, C. S. and Chase, G. A. (1980). `Job satisfaction among hospital nurses: a
longitudinal study', Health Services Review, 15, 341±364.
Weisman, C. S., Dear, M. R., Alexander, C. S. and Chase, G. A. (1981). `Employment patterns
among newly hired hospital sta€ nurses: Comparison of nursing graduates and experienced nurses',
Nursing Research, 30(3), 188±191.
Wetzel, K., Berg, S. and Gallagher, D. (1989). `Nursing education and organizational commitment:
Degree versus diploma programs', Canadian Journal of Nursing Administration, Nov/Dec., 9±14.
Williams, L. J. and Hazer, J. T. (1986). `Antecedents and consequences of satisfaction and commitment in
turnover models: A reanalysis using latent variable structural equation methods', Journal of Applied
Psychology, 71(2), 219±231.

# 1998 John Wiley & Sons, Ltd. J. Organiz. Behav. 19: 305±320 (1998)