The roles of unit leadership and nurse-physician collaboration on nursing turnover intention

Aim: To report a study of the relationship between variables at the group and individual level with nurses' intention to leave their unit. Background: Workplaces are collective environments where workers constantly interact with each other. The quality of working relationship employees develop at the unit-level influences both employee outcomes and unit performance by shaping employee attitudes. Design: The study was a cross-sectional design with self-administered questionnaires. Methods: A questionnaire including measures of leader-member exchange and nurse-physician collaboration analysed at group-level and affective commitment and turnover intention analysed at individual level, was administered individually to 1018 nurses in five Italian hospitals. Data were collected in 2009. Results: A total of 832 nurses (81·7% response rate) completed questionnaires. The results showed that affective commitment at individual level completely mediated the relationship between leader-member exchange at group-level and nursing turnover intention. Furthermore, the cross-level interaction was significant: at individual level, the nurses with high levels of individual affective commitment towards their unit showed low levels of turnover intention and this relationship was stronger when the nurse-physician collaboration at group-level was high. Conclusion: This study showed the importance for organizations to implement management practices that promote both high-quality nurse-supervisor and nurse-physician relationships, because they increase nurses' identification with their units. Individual affective commitment is an important quality for retaining a workforce and good nurses' relationship at group-level relationships with both supervisors and physicians are instrumental in developing identification with the work unit. Thus, the quality of relationship among staff members is an important factor in nurses' decision to leave.