Abstract
Objectives
This study aimed to determine the relationship between self-assessed environmental factors, organizational commitment, and turnover intention among frontline nurse managers of internationally accredited private hospitals in Metro Manila from February to March 2024.
Methods
A descriptive correlational study among frontline nurse managers of internationally accredited private hospitals in Metro Manila utilizing total enumeration sampling was employed. Data were obtained using three adopted instruments namely: Nurse Leader Environmental Support Survey (NLESS), Three-Component Model (TCM) Employee Commitment Survey, and the Expanded Multidimensional Turnover Intention Scale (EMTIS). Data analysis was done using descriptive and inferential methods.
Results
A total of 195 frontline nurse manager respondents participated in this study with a response rate of 97%. The study reported environmental factors overall mean score of 7.41 generally interpreted as “Always Supportive” and organizational commitment mean score of 3.45 inferred that frontline nurse managers have “Strong Commitment” to their organization. On the other hand, frontline nurse managers reported “Low Turnover Intention” to their organization, with an overall mean score of 2.52. Furthermore, multiple regression analysis revealed that environmental factors and organizational commitment collectively predicted 34.2% of the variance in turnover intention (R²=0.342, F=50.0, p=<0.001). The environmental factors emerged as a very influential predictor of turnover intention as indicated by β=0.545, p=<0.001.
Conclusion
The results of the study found a strong positive correlation between environmental factors, organizational commitment, and turnover intention. Higher levels of both environmental factors and organizational commitment were linked to reduced turnover intention. Furthermore, multiple linear regression analysis showed that both environmental factors and organizational commitment were significant predictors of turnover intention.
Keywords: nurse manager, environmental factors, turnover intention, organizational commitment
INTRODUCTION
The current healthcare landscape has witnessed a notable surge in the need for nurse managers. Consequently, ensuring the long-term viability of nursing leadership has emerged as a critical concern.1 Skilled and experienced nurse managers are crucial to the success and sustainability of any healthcare organizations worldwide, since they are directly involved in the organization's patient care services and business operations.2 Based on the findings of the Nursing Solutions Inc. (NSI) 2023 National Healthcare Retention and RN Staffing Report, the turnover rate for nurse managers in the United States exhibited a range of 11.8% to 10.9% throughout the consecutive years of 2021 and 2022, respectively.3 According to reports, nurse managers in Asia, especially in South Korea and Indonesia, have turnover rates of 25% and 15%, respectively.4,5 According to the findings of the Nurse Leader Survey that was carried out by the American Organization for Nursing Leadership (AONL), the top three issues that nurse leaders face are the retention of employees, furloughs, and layoffs. In addition to these findings, twenty percent (20%) of nurse leaders surveyed stated that they intend to leave their current positions.6 In this study, the nurse manager turnover rate for the selected locality in Quezon City and Global City, Philippines was reported to be at 17% and 32%, respectively in 2022.
Cognizant of the foregoing concerns, the objective of this study is to investigate the relationship between environmental factors, organizational commitment, and turnover intentions among frontline nurse managers. Furthermore, the findings of this study have the potential to make a significant contribution to the field of nursing in understanding how the environmental factors and organizational commitment may influence the turnover intentions among frontline nurse managers of internationally accredited private hospitals in Metro Manila and to contribute supplementary insights with the limited body of literature pertaining to the research issue.
MATERIALS AND METHODS
Study Design
This study utilized a descriptive correlational design. It aims to describe and examined association between two or more variables in a single group using quantitative methodology that does not include experimentation.7 The correlational analysis was used to identify the degree of strength and kind of relationship between two variables, whether positive or negative.8 Hence, a descriptive correlational design was used by the researcher to identify the relationship between the variables, including organizational commitment, environmental factors, and turnover intention of frontline nurse manager respondents of internationally accredited private hospitals in Metro Manila.
Setting and Participants
The research setting of this study are the two internationally accredited private hospitals in Metro Manila. The first healthcare facility is a Level III Private Hospital located in Quezon City. This facility has a capacity of 509 beds and accredited by the Joint Commission International (JCI) since November 22, 2003. The second healthcare facility is a 540-bed capacity Level III Private Hospital located in Global City, Taguig. Accredited by the Joint Commission International (JCI) since December 1, 2012. Both hospitals, successfully achieved the gold seal of approval as JCI-accredited entities specifically for the JCI Accreditation Hospital Program category.
Study participants were composed of frontline nurse managers or unit level managers working with internationally accredited private hospitals in Metro Manila. The daily management of a unit or area within a healthcare organization falls under the purview of frontline nurse managers. They are often in charge of managing finances and resources, ensuring that patients receive high-quality care, overseeing a group of nurses and other healthcare professionals, and upholding organizational standards and policies. Ward manager, head nurse, unit manager, section manager, shift manager, assistant unit manager, and charge nurse are other terms used internationally for frontline nurse managers.9
For the inclusion criteria, this study was limited to frontline nurse manager respondents working in an internationally accredited private hospitals in Metro Manila. Selection of respondents was limited to frontline nurse managers in their respective nursing unit/ward to establish their familiarity with the environment, institutional policies, and unit protocols. These nursing units are Emergency Department, General Nursing Units or Wards, Perioperative and Intensive Care Units. For the exclusion criteria, this study excluded the staff nurses, executive managers, and those who are on leave during the time of the study. The validity of the study was contingent upon the integrity, truthfulness, and sincerity of the participants. The selection of research locales was based on the proximity to work and home of the researcher.
Sample Size
This study utilized a total enumeration sampling technique. The sample frame covering the two internationally accredited private hospitals in Metro Manila is 201 frontline nurse manager respondents. Upon approval of the Institutional Ethics Review Committee of the selected research locales, there were 195 frontline nurse managers in total who participated in the study, with attrition rate of 3% or six respondents that did not meet the inclusion criteria at the time of the survey. Actual frontline nurse manager respondents from Quezon City totaled 105, while those from Global City totaled 90.
Instruments
The research instrument was divided into four parts: demographic profile of the study respondents, Nurse Leader Environmental Support Survey (NLESS), Three-Component Model (TCM) Employee Commitment Survey, and Expanded Multidimensional Turnover Intention Scale (EMTIS).
Nurse Leader Environmental Support Survey (NLESS) is a 14-item tool, utilizing 11-point Likert scale of 0 (Absolutely Disagree) to 10 (Absolutely Agree). The tool was subdivided into three dimensions; 1.) Congruence with Organizational Culture, 2.) Professional Vulnerability, and 3.) Workplace Relationship. More supportive and positive environments were reflected by those with higher scores on each of the subscales. Scores for the scales and subscales were obtained by calculating the mean of the items which comprised the subscale. The descriptive interpretations of the results were from Never Supportive (Absolutely Disagree) to Exceptionally Supportive (Absolutely Agree) Environment. The 14-item NLESS instrument reported a Cronbach's α of 0.851 for the overall NLESS tool. Exploratory factor analyses showed high reliability of the NLESS. The reliability and factor analysis for the NLESS according to its three dimensions were as follows: Congruence with Organizational Culture (0.8), Professional Vulnerability (0.7), and Workplace Relationships (0.8).10
The TCM Employee Commitment Survey is an 18-item tool with three dimensions: affective commitment, continuance commitment, and normative commitment with a 5-point Likert scale, ranging from 1-strongly disagree to 5-strongly agree.11 The descriptive interpretations of the results were from very low organizational commitment (Strongly Disagree) to very high organizational commitment (Strongly Agree). The assessment of the tool's validity and reliability revealed a Cronbach's alpha coefficient value of 0.88, this means that the tool has high reliability.12 Another study reported the tool having a high internal consistency, with a statistical value of 0.82 to 0.91 (Cronbach’s α). The researchers reported a Cronbach's α value of 0.91 for the full instrument in their investigation. The Cronbach's α coefficients for the three organizational commitment measures varied from 0.89 to 0.92, indicating strong internal consistency.13
Lastly, the Expanded Multidimensional Turnover Intention Scale (EMTIS) was composed of 25-item tool developed by Obinna et al.,. The EMTIS encompassed five distinct dimensions, namely: subjective social status factor, organizational culture, personal orientation, expectation, and career growth. The participants' responses were structured using a 5-point Likert scale, which encompassed a range of options from 1, indicating strong disagreement, to 5 indicating strong agreement. The descriptive interpretations of the results were from very low turnover intention (Strongly Disagree) to very high turnover intention (Strongly Agree). Cronbach's alpha values for the Expanded Multidimensional Turnover Intentions dimensions ranged from 0.82 to 0.93, representing satisfactory reliability.14
Data Collection
In obtaining data for this study, the researcher sought approval and ethical clearances from the private hospital institutions. The researcher adhered to the ethical safeguards in the conduct of the study. The study abided with the Principles of the Declaration of Helsinki (2013) and was conducted along the Guidelines of the International Conference on Harmonization-Good Clinical Practice (ICH-GCP). The Clinical Protocol and all relevant documents underwent review and approval by the research locale’s Institutional Ethics Review Committee. Eligible frontline nurse managers were identified per target nursing unit based on the list of nurse managers in the selected research locale. According to the list of eligible nurse managers, the inclusion and exclusion criteria were used to further assess the eligibility of the nurse manager to participate in the study.
The informed consent for the respondents included information on the nature and objectives of the study. Consent was secured from target population by integrating the intent to voluntary participate in the study to the first part of the survey questionnaire via google form. Once the target respondent consented, a link was provided to continue answering the survey form of the study. Respondents were instructed to enter a password to access the google form. Data was transmitted to the researcher’s secured/ password-protected drive. The consent also specified that respondents can anytime withdraw from answering the survey without giving any reason for their own protection and autonomy.
Ethical safeguards were observed throughout the study. The data collected were treated with the utmost confidentiality. The respondents answered anonymously to the survey questionnaire. Data collection forms have no personal identifier such as name or marks. Only the researcher and professional statistician have access to the data collected via this method. The possibility of incorrect interpretation of the questions in the survey tool was mitigated by ensuring that the participants can ask for clarification anytime that they feel or encounter difficulties in answering and interpreting any of the research questions. The contact details of the researcher were readily available anytime and included in the consent form. To prevent untruthful disclosure, respondents were assured the highest level of data privacy and confidentiality of their responses.
Data Analysis
Quantitative data was analyzed using Jamovi open statistical software with version number 2.3.28 (2023) solid version. Descriptive statistics to summarize the gathered data such as frequency and percentage were used to describe the demographic profile characteristics of the study respondents. Furthermore, mean scores were used to identify the overall self-assessed environmental factors, organizational commitment, and turnover intention. This study also utilized multiple linear regression to determine the significant relationship between the total self-assessed environmental factors, organizational commitment, and turnover intention among frontline nurse manager respondents of internationally accredited private hospitals in Metro Manila.
RESULTS
Table 1 shows that the demographic profile characteristics of frontline nurse managers of internationally accredited private hospitals in Metro Manila are predominantly females (71%), 31-40 years of age (61%), and BSN graduates (91%) with 8.7% finished their Master’s Degree. Furthermore, most of the respondents have been working in the organization for more than seven years (X̅=7.48, SD=4.66 ) and in the current position as frontline nurse managers for more than three years (X̅=3.08, SD=3.23).
Table 1.
Profile of Frontline Nurse Manager Respondents (N=195)
| Demographic Parameters | Frequency (%) | Mean (SD) |
|---|---|---|
|
Age (years) 21-30 31-40 41-50 51-59 |
61 (31.3) 119 (61.0) 14 (7.2) 1 (0.5) |
|
|
Sex Male Female |
56 (29) 139 (71) |
|
|
Educational Attainment BS Nursing Master’s Degree |
178 (91.3) 17 (8.7) |
|
| Length of Service in Organization (years) | 7.48 (4.66) | |
| Length of Service in Current Position (years) | 3.08 (3.23) |
Table 2 summarizes the overall results of self-assessed Environmental Factors of frontline nurse manager respondents in terms of congruence with organizational culture, professional vulnerability, and workplace relationship, with an overall mean score of X̅=7.41 and verbally interpreted as “Strongly Agree”. In general, the study findings can be interpreted that the organizational environment in internationally accredited private hospitals in Metro Manila is “Always Supportive” to frontline nurse managers. Workplace relationship (X̅=8.65) among its people resonates as the strength of the organization. Workplace relationships are one of the important aspects that each organization must focus on. The value of interpersonal relationships among colleagues plays a significant role in ensuring a healthy work environment that fosters collaboration and teamwork.
Table 2.
Overall Mean and Interpretation of Self-assessed Environmental Factors
| Dimensions | Mean (SD) | Interpretation |
|---|---|---|
|
Congruence with Organizational Culture
Professional Vulnerability Workplace Relationship |
7.68 (1.87) 5.90 (2.83) 8.65 (1.30) |
Always Supportive Often Supportive Almost Exceedingly Supportive |
| Overall Mean | 7.41 (2.0) | Always Supportive |
According to Frederick Herzberg's Two-Factor Theory, work environment, positive interpersonal interactions, relationship with colleagues; the hygiene factors, influence how engaged and contented a person is at work. And lack of attention to these hygiene factors may result in turnover intention brought by dissatisfaction and disengagement in the organization.15
The results of this study corroborates the idea that the practice environment for nurse managers is the one that has been supported by hospital administration and has an impact on their ability to achieve the best results for their staff, patients, and organizations.16 It is imperative for nurse managers to establish a favorable work environment that fosters teamwork and mutual assistance, consequently facilitating the provision of peer and social support.17 In the hospital environment, the nurse managers particularly the frontline nurse leaders played a significant role in healthcare. In order to provide quality services, they are responsible for the management of nursing care and the implementation of administrative, training, unit function, and teaching-research measures.18
Table 3 shows the overall results of self-assessed Organizational Commitment of frontline nurse manager respondents in terms of Affective, Continuance, and Normative Commitment with an overall mean score of X̅=3.45 and verbally interpreted as “Agree”. Overall, the results of organizational commitment can be interpreted that frontline nurse manager respondents working in internationally accredited private hospitals in Metro Manila have “Strong Commitment” to their organization. Affective commitment was the strongest dimension (X̅=3.65), while continuance commitment was the weakest dimension (X̅=3.24).
Table 3.
Overall Mean and Interpretation of Self-assessed Organizational Commitment
| Dimensions | Mean (SD) | Interpretation |
|---|---|---|
|
Affective Commitment
Continuance Commitment Normative Commitment |
3.65 (0.90) 3.24 (0.98) 3.47 (0.98) |
Strong Commitment Moderate Commitment Strong Commitment |
| Overall Mean | 3.45 (0.95) | Strong Commitment |
Higher affective commitment subscale ratings revealed that nurses have a strong emotional attachment to both their organization and their employment13 which supported the results of this study. Organizational commitment refers to the degree to which employees form emotional connections and affiliations with their respective organizations.19 Accordingly, organizational commitment may be defined as a psychological condition that represents the employee's connection with the organization and influences their choice to either remain or terminate their affiliation with the company.20
Table 4 summarizes the overall self-assessed turnover intention of frontline nurse manager respondents in terms of subjective social status, organizational culture, personal orientation, expectation, and career growth. Overall, the results of turnover intention can be inferred that frontline nurse manager respondents have “Low Turnover Intention” to their organization, with an overall mean score of X̅=2.52 and verbally interpreted as “Disagree”. The strongest dimension was “Expectation” with an overall mean score of X̅=2.84 and verbally interpreted as “Neutral” or “Moderate Turnover Intention”. While, all the other dimensions organizational culture (X̅=2.42), personal orientation (X̅=2.41), career growth (X̅=2.55), and subjective social status (X̅=2.38) were verbally interpreted as “Disagree”/ “Low Turnover Intention”, the weakest dimension among them was the latter. The study findings depict that the frontline nurse manager respondents' professional social status and expectations about the job must be given importance for them to stay in the organizations such as respect, recognition, salary and compensation, job security, and healthcare package.
Table 4.
Overall Mean and Interpretation of Self-assessed Turnover Intention
| Dimensions | Mean (SD) | Interpretation |
|---|---|---|
|
Subjective Social Status
Organizational Culture Personal Orientation Expectation Career Growth |
2.38 (1.04) 2.42 (1.09) 2.41 (1.07) 2.84 (1.20) 2.55 (1.09) |
Low Turnover Intention Low Turnover Intention Low Turnover Intention Moderate Turnover Intention Low Turnover Intention |
| Overall Mean | 2.52 (1.10) | Low Turnover Intention |
The study results support the claim that in the Philippines, the trend of attrition is attributed to several factors, such as an unfavorable work environment, organizational factors, excessive workloads, lack of career advancement opportunities, and inadequate implementation of the nursing law.21
Table 5 summarizes the interconnection between the environmental factors and organizational commitment to predict the turnover intention among frontline nurse managers of internationally accredited private hospitals in Metro Manila. The multiple regression analysis revealed that environmental factors and organizational commitment collectively predicted 34.2% of the variance in turnover intention (R²=0.342, F=50.0, p=<0.001). The environmental factors emerged as a very influential predictor of turnover intention as indicated by β=.545, p=<0.001. Environmental factors (B=-0.336, t=-8.42, p<0.001) is negatively associated with turnover intention. The coefficient -0.336 suggests that for every one-unit increase in the "Environmental Factors" the turnover intention is expected to decrease by 0.336 units, assuming all other variables are constant. The negative sign indicates a negative relationship, suggesting that a higher value of this predictor is associated with a lower turnover intention. Nevertheless, organizational commitment is not significantly related to turnover intention as an outcome variable (B=-0.151, t=-1.26, p=0.208). This suggests that frontline nurse managers working in an organization with more supportive and favorable environmental factors are more likely to report lower turnover intentions. The study findings are consistent with the conclusion that healthcare workers' attitudes might be affected negatively by their work environment. Unhealthy relationships can generate a negative work environment, which can lead to increased staff turnover, burnout, and poor patient outcomes.22
Table 5.
Summary of Multiple Linear Regression Analysis
| Predictors | B | SE | β | t | p |
|---|---|---|---|---|---|
|
Intercept
Environmental Factors Organizational Commitment |
5.530 -0.336 -0.151 |
0.393 0.039 0.119 |
– -0.545 -0.082 |
14.06 -8.42 -1.26 |
<0.001 <0.001 0.208 |
r=0.585, r2=0.342, F=50.0, p=<0.001
DISCUSSION
The internal environment of frontline nurse managers working in internationally accredited private hospitals in Metro Manila, is always supportive. Workplace relationship as the strongest dimension of environmental factors emerged as the most important aspect that each organization must focus on. This is because the value of interpersonal relationship among colleagues plays a significant role in ensuring positive and supportive work environment that fosters collaboration and teamwork. Positive interpersonal relationship and interactions among colleagues influence engagement and commitment of people in their roles15 and building a strong relationship can improve organizational outcomes23.
On the other hand, organizational commitment refers to the degree to which employees form emotional connections and affiliations with their respective organizations.19 This current study also shows a strong organizational commitment among frontline nurse managers that is highly influenced by their emotional attachment, loyalty, and profound sense of affiliation in the organization. The results of this study corroborates that affective commitment or the employees’ emotional connection to the organization is the strongest dimension of organizational commitment.13 Nurse managers’ likelihood of staying in the organization increases when individuals have an emotional investment in their work and share the organization's ideals. However, if they are simply remaining out of obligation and lack of motivational factors, sooner or later they may decide to go. Thus, to retain frontline nurse managers and establish a strong commitment with the organization, it is vital to invest also on their personal and professional needs.
Furthermore, in this current study, the reported turnover intention is low among frontline nurse managers working in internationally accredited private hospitals in Metro Manila. The study findings depict that the frontline nurse manager respondents role preparation and expectations about the job must be given importance for them to stay in the organization. Insufficient level of role preparation and training may influence turnover intention among newly appointed or promoted nurse managers.24 Expectations, on the other hand, pertains to respect, recognition, salary, job security, and healthcare package that are crucial in their decision to stay or leave the organization. These results further indicate that both environmental factors and organizational commitment are strong predictors of turnover intention. Hence, effectively resolving nurse manager turnover intention necessitates the implementation of a comprehensive and multidimensional solution that focuses on leadership training and career growth opportunities, cultivates a positive work environment, and implements competitive benefits and packages that will foster financial security. The more supportive the internal environment, the stronger the organizational commitment among frontline nurse managers that can result to a lesser turnover intention.
Limitations
This study is limited to the subjective and objective nature of the self-assessment undertaken by the study participants, specifically the frontline nurse managers of internationally accredited private hospitals in Metro Manila. This limitation is inherent to the data collection process employed in this research. Participants in the study were requested to provide answers and responses to a predetermined set of questions. They were expected to demonstrate their comprehension and interpretation of the questions, as well as engage in self-assessment and self-rated their personal and subjective alignment with the given circumstances and statements. The study was entirely dependent on the respondents' objectivity, honesty, and truthfulness as they respond to the questionnaire using the instruments provided. Respondents sometimes provide a more socially acceptable response rather than being truthful. Hence, ensuring anonymity and confidentiality is of the utmost importance so that participants may be able to provide honest responses (their true feelings and thoughts) regarding the research inquiries.
While the current study is the first to include nurses in managerial roles that are employed in an internationally accredited private hospitals here in the Philippines, the sample size lowers the generalizability of the study. These limitations should be addressed in future related studies by having a larger sample size with adequate representations of different hospital organizations both in public and private sectors.
CONCLUSION
The results of the study found a strong positive correlation between environmental factors, organizational commitment, and turnover intention. Higher levels of both environmental factors and organizational commitment were linked to reduced turnover intention. Furthermore, multiple linear regression analysis showed that both environmental factors and organizational commitment were significant predictors of turnover intention.
Acknowledgments
The author would like to acknowledge St. Luke’s Medical Center for the opportunity. Special thanks to the research adviser, Dr. Leonora Collantes, and to the author’s family, Cyrine Sarmiento for the support and guidance. Lastly, the author would like to offer sincere thanks to all the nurse managers who participated in this study.
Statement of Authorship
The author certified fulfillment of ICMJE authorship criteria.
Author Disclosure
The author declared no conflicts of interest.
Funding Source
None.
REFERENCES
- 1.Wang BL, Batmunkh MU, Samdandash O, Divaakhuu D, Wong WK. Sustainability of nursing leadership and its contributing factors in a developing economy: a study in Mongolia. Frontiers in Public Health. 2022. May;10:900016. doi: 10.3389/fpubh.2022.900016. PMID: 35692313; PMCID: . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Warden DH. Exploring turnover among nurse managers, directors, and executives in acute care hospitals [Internet]. 2019. [cited 2024 May]. Available from: https://www.proquest.com/openview/5c5870d27598f415fa67c74d2049c179/1?pq-origsite=gscholar&cbl=51922&diss=y
- 3.Nursing Solutions Inc, National healthcare retention and RN staffing report [Internet]. 2023. [cited 2024 May]. Available from: https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.
- 4.Labrague L. Organisational and professional turnover intention among nurse managers: A cross‐sectional study. J Nurs Manag. 2020. Sep;28(6):1275-85. doi: 10.1111/jonm.13079. PMID: 32589761 [DOI] [PubMed] [Google Scholar]
- 5.Lee E. Why newly graduated nurses in South Korea leave their first job in a short time? A survival analysis. Human Resources for Health. 2019. Dec;17:1-9. doi: 10.1186/s12960-019-0397-x. PMID: 31358009; PMCID: . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.AONL nurse leader survey shows well-being, staff shortages as significant challenges AHA news [Internet]. 2021. [cited 2024 May]. Available from: https://www.aonl.org/news/headline/2021-09-08-aonl-nurse-leader-survey-shows-well-being-staff-shortages-significant
- 7.Polit D, Beck C. Essentials of Nursing Research: Appraising Evidence for Nursing Practice, 9th ed. Lippincott Williams & Wilkins; 2020. pp. 219-230. [Google Scholar]
- 8.Grove S, Cipher D. Statistics for nursing research. 3rd ed. Elsevier; 2020. pp 58. [Google Scholar]
- 9.Gunawan J, Aungsuroch Y, Fisher M, McDaniel A. Comparison of managerial competence of Indonesian first-line nurse managers: a two-generational analysis. J Res Nurs. 2020. Feb; 25(1):5-19. doi: 10.1177/1744987119880237. PMID: 34394601; PMCID: . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Warden D, Hughes R, Probst J, Warden D, Adams S. Current turnover intention among nurse managers, directors, and executives. Nursing Outlook. 2021. Sep 1;69(5):875-85. doi: 10.1016/j.outlook.2021.04.006. PMID: 34148657. [DOI] [PubMed] [Google Scholar]
- 11.Meyer J, Allen N. TCM employee commitment survey academic users guide 2004. London, Ontario, Canada: The University of Western Ontario, Department of Psychology [Internet]. 2004. [cited 2024 May]. Available from: https://scholar.google.com/scholar [Google Scholar]
- 12.Asseeri R, El Seesy NA. Nursing practice environment and its relationship to organizational commitment. IJNRHN. 2019;6(1):326-35 [Internet]. 2019 [cited 2024 May]. Available from: https://www.researchgate.net/publication/372788654_Nursing_Practice_Environment_and_its_Relationship_to_Organizational_Commitment [Google Scholar]
- 13.Labrague L, McEnroe–Petitte D, Tsaras K, Cruz J, Colet P, Gloe D. Organizational commitment and turnover intention among rural nurses in the Philippines: Implications for nursing management. Int J Nurs Sci. 2018. Oct 10;5(4):403-8. doi: 10.1016/j.ijnss.2018.09.001. PMID: 31406855; PMCID: [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Obinna O, Ugwu L, Omeje O, Okonkwo E, Ifeanyichukwu C, Enwereuzor I. Expanded-multidimensional turnover intentions: Scale development and validation. Preprint. Posted online September 21, 2022. doi: 10.21203/rs.3.rs-2070386/v1 [DOI] [Google Scholar]
- 15.Chiat L, Panatik S. Perceptions of employee turnover intention by Herzberg’s motivation-hygiene theory: A systematic literature review. Journal of Research in Psychology. 2019. Aug;1(2):10-5. doi: 10.31580/jrp.v1i2.949 [DOI] [Google Scholar]
- 16.Tosun A, Yildirim A. Evaluation of nurse manager practice environment. Int J Caring Sci. 2021. May 1;14(2):1437. [Google Scholar]
- 17.Magbity JB, Ofei AM, Wilson D. Leadership styles of nurse managers and turnover intention. Hospital Topics. 2020. Apr 2;98(2):45-50. doi: 10.1080/00185868.2020.1750324. PMID: 32293228. [DOI] [PubMed] [Google Scholar]
- 18.Alcudia DM. Work empowerment and job satisfaction among nurse managers in military hospital in the Kingdom of Saudi Arabia [Internet]. 2019. [cited 2024 May]. Available from: https://repository.upou.edu.ph/items/f089b62b-cfbe-4a62-ba39-f90b56a04da9
- 19.Cioca I, Wietrak E, Barends E, Rousseau D. Organisational Commitment: an evidence review. London: Chartered Institute of Personnel and Development [Internet]. 2021. [cited 2024 May]. Available from: https://www.cipd.org/globalassets/media/knowledge/knowledge-hub/evidence-reviews/organisational-commitment-scientific-summary_tcm18-89566.pdf [Google Scholar]
- 20.Berberoglu A. Impact of organizational climate on organizational commitment and perceived organizational performance: empirical evidence from public hospitals. BMC Health Services Research. 2018. Dec;18:1-9. doi: 10.1186/s12913-018-3149-z. PMID: 29859066; PMCID: . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Bautista JR, Lauria PA, Contreras MC, Maranion MM, Villanueva H, Sumaguingsing R, et al. Specific stressors relate to nurses' job satisfaction, perceived quality of care, and turnover intention. Int J Nurs Pract. 2020. Feb;26(1):e12774. doi: 10.1111/ijn.12774. PMID: 31423700. [DOI] [PubMed] [Google Scholar]
- 22.Maryniak KD. The correlation between peer support and quality of life of nurses. University of Phoenix [Internet]. 2018. [cited 2024 May]. Available from: https://www.proquest.com/openview/7c43793894337a094c4941605727c285/1?pq-origsite=gscholar&cbl=18750 [Google Scholar]
- 23.Li H, Shi Y, Li Y, Xing Z, Wang S, Ying J, et al. Relationship between nurse psychological empowerment and job satisfaction: A systematic review and meta‐analysis. J Adv Nurs. 2018. Jun;74(6):1264-77. doi: 10.1111/jan.13549. PMID: 29473198. [DOI] [PubMed] [Google Scholar]
- 24.Robinson B. Nurse Turnover: A Crisis in Healthcare (Doctoral dissertation, Walden University) [Internet]. 2021. [cited 2024 May]. Available from: https://www.proquest.com/openview/a835d0be90c2223d36099167daf6a603/1?pq-origsite=gscholar&cbl=18750&diss=y