Background Nursing turnover is considered a serious problem that by impacting on all the organizational levels (hospital, unit and individual), can reduce the ability to meet patients’ needs and the quality of care (Shields & Ward 2001). According to Sheridan and Abelson (1983), employees develop the decision to leave their organization following a sequence of stages. Starting with the initial dissatisfaction with the actual job, they gradually progress in successive steps that increase the probability to leave the workgroup, the organization and profession. At this regard, the unit can be considered the first place where nurses develop quitting cognitions. Unit is the environment where nurses work and interact daily and several studies showed that leaving intentions are associated with nursing work environment and unit characteristics (Beecroft et al. 2008). In the nursing unit, nurses develop working relationships with other nurses, supervisors and physicians and the quality of these relationships could impact significantly on both nurses’ attitudes and decision to leave the unit. Aim Based on the Person-Environment fit theory, this study analyzed nursing turnover intention from the unit adopting a multilevel approach in order to get a better understanding of how intention to leave is associated to both the individual and group-level variables. Methods The study was a cross-sectional design. A questionnaire including measures of nurses-physicians collaboration at group-level, and affective commitment and turnover intention at individual-level, was administered to nursing staff of five Italian hospitals. Participants voluntarily completed the questionnaire during working hours. As the data were multi-level, hierarchical linear modeling (HLM) was used to assess the relationships between the variables at group- and individual-level. Results A total of 1018 nurses (75.8%) completed questionnaires. We investigated whether the nurses-physicians collaboration (group-level) moderation of the affective commitment-turnover intention relationship constituted a cross-level or between-group interaction. The results showed that the between-group interaction was not significant (γ0 = .03, ns), whereas the cross-level interaction was significant (γ31= - .36, p< .05). The overall R2 of this moderation test was .38. Thus, at individual-level, the nurses with high levels of affective commitment towards their unit showed low levels of turnover intention and this relationship was stronger when the nurses-physicians collaboration at group-level was high. Conclusions This study showed that the negative relationship between affective commitment and turnover intention is moderated by nurses-physicians collaboration perceived at group-level. Organizations might promote retention strategies taking in to account the importance of the relationships within work unit to increase identification and reduce turnover desires.
Nurses-physicians relationship and turnover intention from unit: a multilevel analysis.
GALLETTA, MAURA;PORTOGHESE, IGOR;
2012-01-01
Abstract
Background Nursing turnover is considered a serious problem that by impacting on all the organizational levels (hospital, unit and individual), can reduce the ability to meet patients’ needs and the quality of care (Shields & Ward 2001). According to Sheridan and Abelson (1983), employees develop the decision to leave their organization following a sequence of stages. Starting with the initial dissatisfaction with the actual job, they gradually progress in successive steps that increase the probability to leave the workgroup, the organization and profession. At this regard, the unit can be considered the first place where nurses develop quitting cognitions. Unit is the environment where nurses work and interact daily and several studies showed that leaving intentions are associated with nursing work environment and unit characteristics (Beecroft et al. 2008). In the nursing unit, nurses develop working relationships with other nurses, supervisors and physicians and the quality of these relationships could impact significantly on both nurses’ attitudes and decision to leave the unit. Aim Based on the Person-Environment fit theory, this study analyzed nursing turnover intention from the unit adopting a multilevel approach in order to get a better understanding of how intention to leave is associated to both the individual and group-level variables. Methods The study was a cross-sectional design. A questionnaire including measures of nurses-physicians collaboration at group-level, and affective commitment and turnover intention at individual-level, was administered to nursing staff of five Italian hospitals. Participants voluntarily completed the questionnaire during working hours. As the data were multi-level, hierarchical linear modeling (HLM) was used to assess the relationships between the variables at group- and individual-level. Results A total of 1018 nurses (75.8%) completed questionnaires. We investigated whether the nurses-physicians collaboration (group-level) moderation of the affective commitment-turnover intention relationship constituted a cross-level or between-group interaction. The results showed that the between-group interaction was not significant (γ0 = .03, ns), whereas the cross-level interaction was significant (γ31= - .36, p< .05). The overall R2 of this moderation test was .38. Thus, at individual-level, the nurses with high levels of affective commitment towards their unit showed low levels of turnover intention and this relationship was stronger when the nurses-physicians collaboration at group-level was high. Conclusions This study showed that the negative relationship between affective commitment and turnover intention is moderated by nurses-physicians collaboration perceived at group-level. Organizations might promote retention strategies taking in to account the importance of the relationships within work unit to increase identification and reduce turnover desires.
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