Exploring Nurses' Quit Intentions: A Structural Equation Modelling and Mediation Analysis Based on the JD-R and Social Exchange Theories

Abstract

Background/objectives: Understanding how work environments affect nurses' turnover intentions is crucial for improving retention and organizational stability. Research on factors influencing nursing turnover intentions in Italy is limited despite its significant impact on healthcare sustainability today.

Aim: This study aims to identify the individual, interpersonal, and job-related factors influencing quit intentions among nurses, examining the mediating role of job satisfaction.

Methods: Guided by the Job Demands-Resources (JD-R) theory and Social Exchange Theory (SET), this cross-sectional study applied structural equation modelling (SEM) to analyse theoretical relationships. Researchers collected data between August 2022 and December 2023 via an online survey sent to nurses in different settings across Italy. This study tested a hypothesised mediation model using SEM analysis, demonstrating good fit indices.

Results: A total of 1745 nurses responded. The findings reveal that high job demands-physical, mental, and emotional workloads-were significantly associated with increased dissatisfaction and quit intentions. Conversely, job resources, including decision-making autonomy, inspiring leadership, and positive leader-member exchanges, were linked to greater job satisfaction and retention. Contrary to expectations, work satisfaction did not mediate the relationship between job demands/resources and turnover intentions. This could be explained by the strong direct effect of job satisfaction on turnover intentions. Additionally, younger nurses were more likely to report higher turnover intentions.

Conclusions: Identifying potential quitters at an early stage is essential for the sustainability of healthcare organizations. Understanding the factors contributing to nurse turnover is crucial for developing effective retention strategies. This study emphasizes the need for healthcare organizations to prioritize supportive work environments to enhance nurse job resources, well-being, and retention.

Keywords: LMX; autonomy; job demands–resources; mediation; nurses; quit intention; retention; social exchange theory; structural equation modelling; workload.

Figure 1

The hypothesis-based research model.

Figure 2

Results of the tested model: the mediation of job satisfaction. Note: the coefficients refer to standardized effects. ** p < 0.01; *** p < 0.001.