A concept analysis of turnover intention: Implications for nursing management

Collegian (2010) 17, 3—12

available at www.sciencedirect.com

A concept analysis of turnover intention: Implications for nursing management Miyuki Takase, RN, Ph.D. ∗ Hiroshima University, School of Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima 734-8551, Japan Received 12 February 2009; accepted 4 May 2009

KEYWORDS Concept analysis; Turnover intention; Management; Organisational behaviour

Summary This paper provides a review and concept analysis of turnover intention. The aim was to promote Nurse Managers’ understanding of the meanings and mechanisms of turnover intention, which could help them counteract nurse turnover. Sixty-six papers published between January 1998 and August 2007 were collected from CINAHL, PubMed, and PsycINFO databases, and were subjected to Rogers’ concept analysis. The results showed that turnover intention is a multi-stage process involving the voluntary departure of employees from their current position, and is triggered by negative psychological responses to internal/external job context. These psychological responses evolve into withdrawal cognition and behaviours, and lead to actual turnover. To prevent nurse turnover, Nurse Managers should closely observe the internal and external causes of turnover, and the stage of nurses’ turnover intention. © 2009 Royal College of Nursing, Australia. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

Introduction Personnel turnover poses a significant problem through loss of trained employees and is even more problematic when the supply of such skilled and knowledgeable employees is limited, thus leading to a permanent loss of productivity. This is the case in nursing, in which a shortage of staff has been reported in many Western countries and is becoming an important issue (Goodin, 2003; Mullen, 2003; Wickett, McCutcheon, & Long, 2003). Turnover rates of nurses are reported to be as high as 10—20% in the US, the UK and Japan (American Organisation of Nurse Executives, 2002; Japan Nursing Association, 2006; Review Body for Nursing

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and Other Health Professions, 2007). A much higher rate of 27.1% was observed among first-year nurses in the US (PricewaterhouseCoopers’ Health Research Institute, 2007). Moreover, the turnover rate was reported to have been increasing in many countries since the late 1990s (Mrayyan, 2007). Staff turnover can be particularly detrimental to nursing, as the profession is facing the departure of many baby-boomer nurses who are approaching retirement age. The demand for nursing is also expected to increase because the world population is ageing. The need to alleviate nurse turnover has prompted many studies that have attempted to identify why and how nurses leave their jobs. A similar line of studies has also been carried out in other disciplines in order to promote the general understanding of how employees proceed to resigning from their current positions. The wide array of studies has produced a substantial amount of knowledge on why employees leave their jobs, which has contributed to the refinement

1322-7696/$ — see front matter © 2009 Royal College of Nursing, Australia. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

doi:10.1016/j.colegn.2009.05.001

4 of the concept of turnover intention itself. Nevertheless, few studies have synthesised this type of knowledge in a way accessible to Nurse Managers. The provision of a global picture and clarification of the mechanisms of turnover intention would enhance Nurse Managers’ understanding of nurse turnover. Moreover, nurse turnover would be better managed if Nurse Managers were equipped with such knowledge. The aim of this study was, therefore, to illuminate the meanings and the mechanisms of turnover intention based on a literature review and analysis of the concept of turnover intention. It does not seek to establish scientific evidence relating to the causes and the consequences of turnover intention. Rather, its purpose is to describe how turnover intention has been conceived and framed in recent literature.

Methods To achieve the study purpose, Rogers’ method of an evolutionary concept analysis was utilised to identify the concept of turnover intention. Rogers’ concept analysis involved the following five procedures (2000, p. 85): 1. Identify the concept of the interest and associated expressions. 2. Identify and select an appropriate realm for data collection. 3. Collect data relevant to identify: a. The attributes of concept; and b. The contextual basis of the concept, including . . . temporal (antecedents and consequential occurrences) variations. 4. Analyse data regarding the above characteristics of the concept. 5. Identify implications, hypotheses, and implications for further development of the concept.

Identification of the concept of interest, associated expressions, and the realm for data collection The concept of interest for the analysis was turnover intention. Turnover intention is expressed in many forms, including the intention to quit, leave, and turnover. Thus, these associated words were also subject to investigation. The realm of data collection was not restricted to nursing literature, but also extended to literature on other allied health professions, as well as psychological and organisational studies. This was because a limited amount of nursing literature was available for this study (see below). It was also because knowledge of turnover intention has been developed extensively in the areas of organisational studies and vocational psychology. Thus, including literature in these areas would provide a more comprehensive picture of what turnover intention means.

Data collection/search methods Literature on turnover intention and its associated terms was collected from CINAHL, PubMed, and PsycINFO

M. Takase databases, and those published between January 1998 and August 2007 were retrieved. The following keywords were used to identify relevant papers: turnover intention*, intent* & quit, intent* & leave, intent* & turnover, and turnover & model/theory. As the keyword search screened both the titles of papers and their abstracts, a large volume of irrelevant material was identified. Consequently, the search was limited to titles only. As the focus of this study was personnel turnover, other forms of turnover — such as smoking cessation, skin turnover, and business turnover — were excluded during the search process. As a result, 156 papers were identified and retrieved. After reviewing all these papers, 90 papers were excluded from the analysis as they provided neither the authors’ own conceptual definitions nor interpretations of the concept nor the cited definitions. The final number of papers subjected to the analysis was, therefore, 66. A total of 10 papers were extracted from nursing journals, and the others were from journals relating to psychological/behavioural studies, organisational journals, social/sociological journals, other health-related journals or other sources. These papers are indicated with asterisks in the reference list. From these papers, data regarding the attributes, antecedents and consequences of turnover intention (and the associated terms) were extracted in an information sheet.

Analysis The extracted attributes, antecedents, and consequences of turnover intention were clustered using a thematic analysis, as suggested by Rogers (2000). The clustered information was then reconstructed to formulate a conceptual map elucidating the structure of turnover intention. Based on this map, the implications for nursing management and future research areas were identified.

Results Attributes The review of the literature showed that turnover intention was defined as employees’ willingness or attempts to leave the current workplace voluntarily (e.g., Sablynski, Lee, Mitchell, Burton, & Holtom, 2002; Vigoda-Gadot & Ben-Zion, 2004). The literature review also indicated that turnover intention is a multi-stage process consisting of three components, which are psychological, cognitive, and behavioural in nature. Various forms of adjectives and adverbs were also used to characterise the intensity of turnover intention. Psychological A small amount of the literature saw turnover intention as psychological responses to negative aspects of organisations or jobs (Chiu, Lin, Tsai, & Hsiao, 2005; Susskind, 2007). Further, these psychological responses were believed to trigger employees’ emotional and attitudinal withdrawal reactions. These emotions and attitudes included frustration and dissatisfaction with organisations (Houkes, Janssesn, de Jonge, & Bakker, 2003; Vigoda-Gadot & Ben-Zion, 2004). Moreover, they included an affectively neutral form of organisational

A concept analysis of turnover intention attachment (McDuff & Mueller, 2000), and employees’ evaluation of future organisational commitment (Robison & Pillmer, 2007; Sturges & Guest, 2001). Overall, the psychological component of turnover intention was seen as the starting point of the multi-stage turnover reaction. Cognitive While the psychological component was seen as the starting point of turnover intention, the cognitive component was seen as the core of turnover intention. Many researchers framed turnover intention as a cognitive manifestation of the decision to leave (Chang, Du, & Huang, 2006). Hence, the term was used interchangeably with withdrawal cognition (e.g., DeConinck & Stilwell, 2004). In a narrower sense, turnover intention was defined as the final cognitive step leading to actual turnover (e.g., Bigliardi, Petroni, & Dormio, 2005; Hang-yue, Foley, & Loi, 2005; Lambert, Hogan, & Barton, 2001). This cognitive component of turnover intention has two subcomponents. The first is ‘‘intention’’, and the other is the verbs immediately following it (i.e., intention to ‘‘∼’’). In some literature, the ‘‘intention’’ was interpreted or operationalised as a desire (Harris, James, & Boonthanom, 2005; Susskind, 2007) or thought (e.g., Castle, Engberg, Anderson, & Men, 2007; Chiu, Chien, Lin, & Hsiao, 2005; Van Dick et al., 2004), which could activate behaviours leading to turnover. Thus, the intentions were considered hypothetical in nature (Allen, Weeks, & Moffitt, 2005). In other literature, ‘‘intention’’ had stronger connotations. For example, ‘‘intention’’ was thought of as a decision (determination) (Blau & Lunz, 1998; McCarthy, Tyrrell, & Lehane, 2007) or a plan to leave the current position (e.g., Cunningham & Sagas, 2003; Karsh, Booske, & Sainfort, 2005). The verbs following ‘‘intention’’ (i.e., intention to ‘‘∼’’) were also conceptualised or operationalised in various forms. Perhaps the most popular verb following ‘‘intention’’ had the meaning of job withdrawal such as quitting (Rambur, Palumbo, McIntosh, & Mongeon, 2003), giving up (Flinkman, Laine, Leino-Kilpi, Hasselhorn, & Salanterä, 2008), terminating (Hart, 2005) or leaving (Alexandrov, Babakus, & Yavas, 2007; Houkes, Janssesn, de Jonge, & Nijhuis, 2001; Kidd & Green, 2006) a position. Other forms of behavioural intentions were expressed in a more future-oriented fashion. These were the intention to search for (e.g., Herrbach, Mignonac, & Gatignon, 2004; Lum, Kervin, Clark, Reid, & Sirola, 1998) and to apply for another job (Arnold & Davey, 1999). In summary, the cognitive component of turnover intention has been conceptualised and operationalised in the combinations of diverse forms of ‘‘intention’’ and to ‘‘∼ (verb)’’. Behavioural Another component that formed the core of the process of turnover intention was withdrawal behaviour. As in the intention to ‘‘∼’’ of the cognitive component, withdrawal behaviours were also categorised into two groups: withdrawal from the current job, and actions oriented to future opportunities. The manifestations of withdrawing from jobs were behavioural and/or verbal. The behavioural manifestations included employees daydreaming during work (Chiu, Lin, et al., 2005; Susskind, 2007), being less enthusiastic at work (Chen & Francesco, 2000), coming in late

5 (Harris, Kacmar, & Witt, 2005) and being absent from work (Krausz, Koslowsky, & Eiser, 1998). The verbal manifestation consisted of stated or expressed intentions to leave jobs (Freund, 2005). The future-oriented behaviours comprising the facets of turnover intention were the actualisation of employees’ cognitive intentions. These behaviours were operationalised as the actual job search (e.g., Brough & Frame, 2004; Castle et al., 2007; Takase, Maude, & Manias, 2005) and willingness to take an alternative job when available (Geurts, Schaufeli, & De Jonge, 1998; van Vianen, De Pater, & Van Dijk, 2007). These behaviours were often operationalised to explore employees’ turnover intention. Adjectives and adverbs Many researchers have conceived that turnover intention, especially the cognitive component of it, is not monotonic. Rather, turnover intention is thought to change over time (e.g., Geurts et al., 1998), and to vary in intensity according to time, magnitude, frequency, and uncertainty/probability. For instance, a question like ‘‘how soon do you intend to resign from the job? (e.g., 1 year)’’ was used to measure the intensity of turnover intention (e.g., Alexander, Lichtenstein, Oh, & Ullman, 1998; Chan & Morrison, 2000; Geurts, Schaufeli, & Rutte, 1999). Words like ‘to what extent’ and ‘a lot’ were also used to evaluate the magnitude of employees’ intentions (Carmeli & Weisberg, 2006; Kirschenbaum & Weisberg, 2002). In addition, researchers often explored ‘how often’ employees thought of quitting jobs (Mulki, Jaramillo, & Locander, 2006; Schwepker, 2001) as well as the probability (or uncertainty) of intended turnover (e.g., Chandrashekaran, McNeilly, Russ, & Marinova, 2000; Vandenberg & Nelson, 1999). The characteristics of turnover intention could also be distinguished in terms of employees’ intended destinations. In fact, inter-/intra-organisational and intra-professional mobility (e.g., Egan, Yang, & Bartlett, 2004; Kirschenbaum & Weisberg, 2002; Vigoda-Gadot & Ben-Zion, 2004) were the focus of several studies. Other remarks As turnover intention was believed to lead to actual turnover, some researchers referred turnover intention to the immediate antecedent or the mediator of actual turnover (e.g., Egan et al., 2004; Layne, Hohenshil, & Singh, 2004; Huffman, Adler, Dolan, & Castro, 2005; Schwepker, 1999). Other researchers saw it as a sign of organisational malfunctioning (Vigoda-Gadot & Ben-Zion, 2004) or an indicator of organisational ineffectiveness (Larrabee et al., 2003). In research, turnover intention had been used as a useful surrogate measure of actual turnover (e.g., Byrne, 2005; Firth, Mellor, Moore, & Loquet, 2004; Knudsen, Ducharme, & Roman, 2006).

Antecedents A range of factors were considered as the antecedents of turnover intention, and were studied extensively. These antecedents were categorised into organisational, work, employees, and external factors. Table 1 presents the summary of the antecedents identified in the literature.

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M. Takase Table 1

Antecedents of turnover intention.

Factor

Sub-category

Descriptions

Organisational factors

Organisational characteristics

This factor included such organisational characteristics as the teaching and magnet status of a hospital, hospital profitability (Stone et al., 2007), and organisational unionisation (Robison & Pillmer, 2007). This factor included the organisational ethical climate (Hart, 2005; Mulki et al., 2006; Schwepker, 2001), congruence between organisational and employees’ value systems (Vigoda-Gadot & Ben-Zion, 2004), and the degree of organisational support (e.g., Alexandrov et al., 2007; Chiu, Lin, et al., 2005). Organisational culture, which fosters employees’ professional growth, was also included in this category (Alexander et al., 1998; Flinkman et al., 2008). In addition, organisational justice such as employees’ equity in terms of power, information and benefit (e.g., Geurts et al., 1999; Knudsen et al., 2006) formed part of this factor. This factor encompassed good relationships with supervisors and colleagues (e.g., Robison & Pillmer, 2007) and being free of sexual harassment (Cunningham & Sagas, 2003).

Organisational climate/culture

Interpersonal relations within organisations

Work-related factors

Role stress

Workload

Financial rewards Characteristics of working conditions

Employees’ access to power

Employee factors

Demographic factor

This emanates from role conflict, role ambiguity (e.g., Hang-yue et al., 2005), and the insufficient use of employees’ skills in jobs (McDuff & Mueller, 2000). Work overload was a concern frequently raised in organisational literature, and was found to have an adverse effect on employee retention in nursing (e.g., Alexander et al., 1998) as well as in other industries (e.g., Huang, Chuang, & Lin, 2003). This is the amount of financial rewards received for their work (e.g., Lambert et al., 2001). This factor included the existence of work hazards (e.g., lifting patients, which has the potential to cause injury in nurses) (Alexander et al., 1998), and shift work and working on weekends (Flinkman et al., 2008). A low degree of actual autonomy given at work was negatively associated with turnover intention of nurses (Alexander et al., 1998). Perceived discrepancies between the ideal and actual level of power to make patient treatment plans were also indirectly related to high turnover intention of employees in neuro-psychiatric hospitals (Lichtenstein, Alexander, McCarthy, & Wells, 2004). This factor included gender (Cunningham, Sagas, & Ashley, 2003), educational background (Chen & Francesco, 2000), and age (e.g., Lambert et al., 2001). Moreover, the years of experience (e.g., Lou, Yu, Hsu, & Dai, 2007), organisational tenure (Carmeli & Weisberg, 2006), the types of professions (Carmeli & Weisberg, 2006), and the area of work (Chan & Morrison, 2000) were also included. All of them were found to be correlated with employees’ turnover intention.

A concept analysis of turnover intention

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Table 1 (Continued) Factor

External factors

Sub-category

Descriptions

Employees’ behavioural/attitudinal responses

These responses included job performance, satisfaction, organisational commitment and burnout. For instance, employees’ self-evaluation of their job performance was negatively related to turnover intention (Carmeli & Weisberg, 2006). Absenteeism and lateness were also demonstrated to affect employees’ intents to leave (e.g., thinking of quitting, and searching for a job). The most frequently studied variables in this factor were job satisfaction (e.g., Firth et al., 2004) and organisational commitment (e.g., Chang, 1999; Chang, Chi, & Miao, 2007). The studies consistently found negative effects of these variables on employees’ turnover intention. These variables also represented employees’ psychological responses to work that could trigger the multi-stage process of turnover intention. Thus, they were also considered as the mediators between employees’ appraisals of their workplaces and turnover intentions (e.g., Chiu, Lin, et al., 2005; Krausz et al., 1998; Poon, 2004). Finally, burnout was also identified as contributing to the turnover intention of employees (e.g., Flinkman et al., 2008).

Work-life balance

The examples included role conflict between work and family (e.g., Hang-yue et al., 2005) and impaired personal life due to work (Sturges & Guest, 2001). These disturbing incidents were identified as a driving force for employees to consider leaving a job. A study by Lambert et al. (2001) showed that employees tended to express turnover intention when they perceived many external job opportunities. However, Huang et al. (2003) argued that employees could still intend to withdraw from jobs psychologically, even when there were a limited number of external jobs available.

External job market

Consequences In contrast to a number of studies which investigated the antecedents of turnover intention, only a small number of studies explored its consequences. These studies found that turnover intention had an impact on future turnover intention and actual turnover. For instance, studies showed that the intensity of the initial turnover intention was positively correlated to subsequent turnover intention measured 4 months (Brough & Frame, 2004) and 2 years later (Blau, Ward-Cook, & Edgar, 2006). Studies also showed that turnover intention was positively correlated to actual turnover 6 months (Huffman et al., 2005), 12 months (Allen et al., 2005) and 18 months (Alexander et al., 1998) after the initial turnover intention was measured. A study by Crossley, Bennett, Jex, and Burnfield (2007), however, found that turnover intention measured in the previous 12 months was not related to actual turnover.

Hypothesised relationships The literature review disclosed the complex nature of turnover intention, its antecedents, and the consequences. Based on the findings above, the following hypothetical relationships were formulated (see Fig. 1).

Fig. 1 shows that turnover intention can be triggered by the employees’ appraisal of their organisational and work factors. This appraisal can be affected by employees’ personal dispositions (e.g., demographic factors, value system, etc.) and/or external factors (e.g., family issues and the availability of other compatible jobs). Employees’ appraisal of their work is manifested by psychological responses. If the results of the appraisal are negative, psychological responses such as frustration with work may occur. This is called ‘‘shock to the system’’ in Mitchell and Lee’s unfolding model, and will be followed by employees’ job dissatisfaction and low organisational commitment. The negative psychological responses may initiate cognitive and behavioural withdrawal processes. In this regard, the psychological response can be viewed as the mediator between turnover intention and its antecedents. The cognitive withdrawal process encompasses ‘‘intention’’ and the following verbs, to ‘‘∼’’. The intention is described as a progressive determination to conduct certain acts, ranging from mere desire, to serious thoughts, decisionmaking and actual planning. These types of intention are, in turn, directed toward leaving the current job, searching for alternatives, and applying for new positions. In addition, the whole cognitive withdrawal process can be moderated by the intensity of ‘‘intention to ∼’’,

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M. Takase

Figure 1

Hypothetical relationships between the antecedents, attributes and the consequences of turnover intention.

as described by the adjectives and adverbs shown in Fig. 1. Parallel to the cognitive process, a behavioural withdrawal process can occur. This process may begin with employees’ verbal expression of intending to leave the job, and evolve into job lateness and absenteeism, which are the manifestations of decreased organisational commitment of employees. These behaviours may continue until employees arrive at a solid decision to leave. Once the decision has been made, employees start searching for alternative jobs. Finally, when an alternative job is considered appropriate by an employee, the process of turnover intention will be terminated. Then, the employees will take a new job and leave the current one. If a suitable alternative is not found, employees may still withdraw from their jobs psychologically, and develop further turnover intentions. Either way, turnover intention is detrimental to organisational function.

Discussion Study limitations The present study attempted to clarify the concept of turnover intention. However, it has several limitations. These limitations arise due to the study’s strategies in searching relevant literature. First, the present study used a title search to identify literature dealing with turnover intention. While this method was effective in limiting the number of papers to be retrieved, it could have contributed to excluding other important papers from the study. Second, setting study populations in diverse industries could make it difficult for nurse researchers and managers to iden-

tify nursing-specific attributes and the antecedent of nurses’ turnover intention.

Managerial implications As has been detailed above, turnover intention involves multiple processes. What is shown in Fig. 1 may seem complex or even alarming for some Nurse Managers. However, Nurse Managers can take advantage of this multiplicity in order to reduce nurse turnover. No Nurse Managers would like to learn of the turnover intention of their nursing staff after the staff’s decisions to leave have been firmly set and alternative jobs have been arranged. Thus, the key to reduce nurse turnover is to identify the early signs of intention to leave, and prevent nurses from moving along the turnover path. Fig. 1 suggests that the process of turnover intention starts with negative psychological responses of employees to their organisations and work. These negative responses can be manifested in the form of job dissatisfaction and low organisational commitment. Hence, constant assessment of nurses’ feelings about their jobs will enable Nurse Managers to identify the initial signs of the turnover sequence. Nurse Managers should be warned that job dissatisfaction and low organisational commitment can be expressed either overtly or covertly. Since covert expression makes it difficult to evaluate staff’s turnover intention, Nurse Managers should also be attentive to behavioural and cognitive reactions leading to staff turnover. Early signs of these reactions include verbal statements and actual planning of turnover, and absenteeism. Since these behavioural and cognitive reactions involve more overt expression of intention to leave a job than nurses’ feelings toward their jobs, it may be easier for Nurse Managers to identify them.

A concept analysis of turnover intention Once Managers have recognised these signs, the next step is to assess the causes of staff turnover intention. There are many factors that make employees consider leaving their jobs. Thus, in-depth interviews with a staff member may be necessary to identify these causes. This interview may require skills in carefully probing emotional and cognitive reactions of a nurse to the work environment. Empathic attitudes and a good understanding of general causes of staff turnover usually enhance this cause-probing process. It is also essential to gather specific information that may have led a certain nurse to turnover intention, prior to the interview session. In summary, careful preparation is necessary for the interview to be successful. The interview sessions can also be used to negotiate feasible solutions to staff turnover intentions. Some Nurse Managers also wish to utilise research findings to alleviate staff turnover intentions. Before doing so, however, it is advisable to examine what type and stage of turnover intention researchers focused on in each study. Turnover intention involves a range of attributes with different degrees of intensity. As such, researchers usually focus on certain aspects of turnover intention. Scales to measure staff turnover intention are also not capable of evaluating the wide range of attributes reviewed in this paper. This is because these scales typically consist of 5—10 items. Poor utilisation of research findings may further precipitate staff turnover intention, thus it should be avoided. After the remedial solutions have been agreed on between a nurse and the Manager, and implemented, Nurse Managers need to evaluate whether the implementation of the solutions has been successful. This can be done by following up whether the employees has made any further advances on the path to turnover (such as actual searching for and applying for a new job). Nurse Managers should be aware that some nurses do not physically leave their jobs, but they may withdraw from their jobs psychologically if they are still dissatisfied with their work. Thus, nurse’s emotional and psychological reactions to work should also be constantly monitored.

Research implications The elaboration of the process, the attributes and the consequences of turnover intention allowed identification of directions for future studies. First, factors that precipitate and hinder the progress of turnover intention need to be investigated further. The review of the literature highlighted that only a small number of studies examined moderating or intervening factors of employees’ turnover intention. These factors include employees’ coping strategies (Layne et al., 2004), employees’ locus of control, self-esteem, supervisors’ support (Firth et al., 2004), and employees’ career commitment (Chang, 1999). Certainly, more studies are needed to consolidate these findings as well as to identify other factors. Second, it is of interest to find out how quickly employees’ psychological responses can be turned into withdrawal cognitions and behaviours. Equally important is to identify how quickly these withdrawal behaviours can be turned into actual turnover. Although challenging, such studies will

9 enable organisations to identify the timeframe in which to act on employees’ turnover intention. Third, investigation needs to be directed to why some people leave their jobs after expressing their intentions to do so, but others do not. The result of the evaluation of an alternative job is one possible answer to this question, and was tested in the previous studies (e.g., Hom & Kinicki, 2001). However, there may be other reasons for why employees leave or remain. Longitudinal studies often focus on those who expressed turnover intention and actually leave their jobs. Yet, they have rarely focused on why some people remained in their jobs after expressing their turnover intention. Such an investigation will lead to better understanding of turnover intention. Fourth, researchers need to work on the synthesis of study findings. In particular, the synthesis on the antecedents of turnover intention deserves significant attention. Studies tend to identify an increasing number of potential antecedents of turnover intention. In reality, however, no organisation can deal with all of them. The importance of the antecedents may also vary with occupational groups. Thus, meta-analysis of the antecedents by each profession could produce fruitful insights for organisations to assist them in dealing with staff turnover. In regard specifically to nursing, researchers should be encouraged more to develop and explore the various aspects of nurses’ turnover intention. Compared to other areas of studies, the number of papers on staff turnover intention in nursing is small. Moreover, among the small number of studies included in this analysis, most tended to focus on only the cognitive aspects of turnover intention. Indeed, few studies examined its behavioural aspects (in particular, such behaviours as lateness and absenteeism). In addition, none of the studies explored how nurses’ psychological responses to their jobs affected the relationship between the antecedents of turnover intention and the subsequent turnover process. Although such limitations may only be attributed to the studies included in this analysis, further investigation on nurses’ turnover intention is certainly required to alleviate the current nursing shortage. Nurse researchers are also advised to provide a clear set of definitions on turnover intention. This would enhance the communication of study findings among readers. Finally, the development and testing of interventions to reduce turnover intention are required in all disciplines. The review of the literature demonstrated that this area of investigation is either still in its infancy or under-reported. More collaborative works between researchers and organisations in developing and testing the intervention strategies are certainly encouraged.

Conclusions Turnover intention is a multi-stage process involving employees’ voluntary departure from their current position. Such intentions can be triggered by negative psychological responses to organisational, work, and external job situations in association with employees’ personal dispositions. These psychological responses evolve into withdrawal cognition and behaviours, which eventually lead to actual or psychological withdrawal from their jobs. Further research

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is necessary to provide a more comprehensive picture of the process of turnover intention. Future work is also necessary to identify remedial solutions for staff turnover. Nurse Managers need to understand the mechanisms of turnover intention in order to ameliorate nurse turnover. They should also be vigilant in keeping informed of research findings that could help them effectively deal with nurses’ turnover intention.

Acknowledgement This study was conducted when the author was at Tottori University in Japan. The study was funded by Tottori University.

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ysis.

The literature with asterisks was included in the concept anal-

*Castle, N. G., Engberg, J., Anderson, R., & Men, A. (2007). Job satisfaction of nurse aides in nursing homes: Intent to leave and turnover. The Gerontologist, 47(2), 193—204. *Chan, E.-Y., & Morrison, P. (2000). Factors influencing the retention and turnover intentions of registered nurses in a Singapore hospital. Nursing and Health Sciences, 2, 113—121. *Chandrashekaran, M., McNeilly, K., Russ, F. A., & Marinova, D. (2000). From uncertain intention to actual behaviour: A threshold model of whether and when salespeople quit. Journal of Marketing Research, 37(4), 463—479. *Chang, C.-S., Du, P.-L., & Huang, I.-C. (2006). Nurses’ perceptions of severe acute respiratory syndrome: Relationship between commitment and intention to leave nursing. Journal of Advanced Nursing, 54(2), 171—179. *Chang, E. (1999). Career commitment as a complex moderator of organisational commitment and turnover intention. Human Relations, 52(10), 1257—1277. *Chang, H.-T., Chi, N.-W., & Miao, M.-C. (2007). Testing the relationship between three-component organisational/occupational commitment and organisational—occupational turnover intention using a non-recursive model. Journal of Vocational Behaviour, 70, 352—368. *Chen, Z. X., & Francesco, A. M. (2000). Employee demography, organisational commitment, and turnover intentions in China: Do cultural differences matter? Human Relations, 53, 869—886. *Chiu, C.-K., Chien, C. S., Lin, C.-P., & Hsiao, C. Y. (2005). Understanding hospital employee job stress and turnover intentions in a practical setting: The moderating role of locus of control. Journal of Management Development, 24(1), 837—855. *Chiu, C.-K., Lin, C.-P., Tsai, Y. H., & Hsiao, C.-Y. (2005). Modelling turnover intentions and their antecedents using the locus of control as a moderator: A case of customer service employees. Human Resource Development Quarterly, 16(4), 481—499. *Crossley, C. D., Bennett, R. J., Jex, S. M., & Burnfield, J. L. (2007). Development of a global measure of job embeddedness and integration into a traditional model of voluntary turnover. Journal of Applied Psychology, 92(4), 1031—1042. *Cunningham, G. B., & Sagas, M. (2003). Occupational turnover intent among assistant coaches of women’s teams: The role of organisational work experiences. Sex Roles, 49(3/4), 185—190. *Cunningham, G., Sagas, M., & Ashley, F. (2003). Coaching selfefficacy, desire to become a head coach, and occupational turnover intent: Gender differences between NCAA assistant coaches of women’s teams. International Journal of Sport Psychology, 34, 125—137. *DeConinck, J. B., & Stilwell, C. D. (2004). Incorporating organisational justice, role states, pay satisfaction and supervisor satisfaction in a model of turnover intentions. Journal of Business Research, 57, 225—231. *Egan, T. M., Yang, B., & Bartlett, K. R. (2004). The effects of organisational learning culture and job satisfaction on motivation to transfer learning and turnover intention. Human Resource Development Quarterly, 15(3), 279—301. *Firth, L., Mellor, D. J., Moore, K. A., & Loquet, C. (2004). How can managers reduce employee intention to quit? Journal of Managerial Psychology, 19(2), 170—186. *Flinkman, M., Laine, M., Leino-Kilpi, H., Hasselhorn, H. M., & Salanterä, S. (2008). Explaining young registered Finnish nurses’ intention to leave the profession: A questionnaire survey. International Journal of Nursing Studies, 45(5), 727—739. *Freund, A. (2005). Commitment and job satisfaction as predictors of turnover intentions among welfare workers. Administration in Social Work, 29(2), 5—21. *Geurts, S., Schaufeli, W., & De Jonge, J. (1998). Burnout and intention to leave among mental health-care professionals: A social psychological approach. Journal of Social and Clinical Psychology, 17(3), 341—362.

A concept analysis of turnover intention *Geurts, S. A., Schaufeli, W. B., & Rutte, C. G. (1999). Absenteeism, turnover intention and inequity in the employment relationship. Work & Stress, 13(3), 253—267. Goodin, H. J. (2003). The nursing shortage in the United States of America: An integrative review of literature. Journal of Advanced Nursing, 43(4), 335—350. *Hang-yue, N., Foley, S., & Loi, R. (2005). Work role stressors and turnover intentions: A study of professional clergy on Hong Kong. International Journal of Human Resource Management, 16(11), 2133—2146. *Harris, K. J., James, M., & Boonthanom, R. (2005). Perceptions of organisational politics and cooperation as moderators of the relationship between job strains and intent to turnover. Journal of Managerial Issues, 17(1), 26—42. *Harris, K. J., Kacmar, K. M., & Witt, L. A. (2005). An examination of the curvilinear relationship between leader-member exchange and intent to turnover. Journal of Organisational Behaviour, 26, 363—378. *Hart, S. E. (2005). Hospital ethical climates and registered nurses’ turnover intentions. Journal of Nursing Scholarship, 37(2), 173—177. *Herrbach, O., Mignonac, K., & Gatignon, A.-L. (2004). Exploring the role of perceived external prestige in managers’ turnover intentions. International Journal of Human Resource Management, 15(8), 1390—1407. Hom, P. W., & Kinicki, A. J. (2001). Toward a greater understanding of how dissatisfaction drives employee turnover. The Academy of Management Journal, 44(5), 957—987. *Houkes, I., Janssesn, P. P. M., de Jonge, J., & Bakker, A. B. (2003). Specific determinants of intrinsic work motivation, emotional exhaustion and turnover intention: A multiple longitudinal study. Journal of Occupational and Organisational Psychology, 76, 427—450. *Houkes, I., Janssesn, P. P. M., de Jonge, J., & Nijhuis, F. J. N. (2001). Specific relationships between work characteristics and intrinsic work motivation, burnout and turnover intention: A multi-sample analysis. European Journal of Work and Organisational Psychology, 10(1), 1—23. *Huang, I.-C., Chuang, C-H. J., & Lin, H.-C. (2003). The role of burnout in the relationship between perceptions of organisational politics and turnover intention. Public Personnel Management, 32(4), 519—531. *Huffman, A. H., Adler, A. B., Dolan, C. A., & Castro, C. A. (2005). The impact of operations tempo on turnover intention of army personnel. Military Psychology, 17(3), 175—202. Japan Nursing Association. (2006). Nurse demand—supply survey in hospitals in 2005: Overall results (a prompt report). News Release. Available at: http://www.nurse.or. jp/home/opinion/newsrelease/2006pdf/20060602.pdf (in Japanese). Karsh, B., Booske, B. C., & Sainfort, F. (2005). Job and organisational determinants of nursing home employee commitment, job satisfaction and intent to turnover. Ergonomics, 48(109), 1260—1281. *Kidd, J. M., & Green, F. (2006). The careers of research scientists: Predictors of three dimensions of career commitment and intention to leave science. Personnel Review, 35(3), 229—251. *Kirschenbaum, A., & Weisberg, J. (2002). Employee’s turnover intention and job destination choices. Journal of Organisational Behaviour, 23, 109—125. *Knudsen, H. K., Ducharme, L. J., & Roman, P. M. (2006). Counsellor emotional exhaustion and turnover intention in therapeutic communities. Journal of Substance Abuse Treatment, 31, 173—180. *Krausz, M., Koslowsky, M., & Eiser, A. (1998). Distal and proximal influences on turnover intentions and satisfaction: Support for a withdrawal progression theory. Journal of Vocational Behaviour, 52, 59—71. *Lambert, E. G., Hogan, N. L., & Barton, S. M. (2001). The impact of job satisfaction on turnover intent: A test of a structural mea-

11 surement model using a national sample of workers. The Social Science Journal, 38, 233—250. *Larrabee, J. H., Janney, M. A., Ostrow, C. L., Withrow, M. L., Hobbs, G. R., & Burant, C. (2003). Predicting registered nurse job satisfaction and intent to leave. Journal of Nursing Administration, 33(5), 271—283. *Layne, C. M., Hohenshil, T. H., & Singh, K. (2004). The relationship of occupational stress, psychological stain, and coping resources to the turnover intentions of rehabilitation counsellors. Rehabilitation Counselling Bulletin, 48(1), 19—30. *Lichtenstein, R., Alexander, J. A., McCarthy, J. F., & Wells, R. (2004). Status differences in cross-functional teams: Effects on individual member participation, job satisfaction, and intent to quit. Journal of Health and Social Behaviour, 45(3), 322—335. *Lou, J.-H., Yu, H.-Y., Hsu, H.-Y., & Dai, H.-D. (2007). A study of role stress, organisational commitment and intention to quit among male nurses in southern Taiwan. Journal of Nursing Research, 15(1), 43—53. *Lum, L., Kervin, J., Clark, K., Reid, F., & Sirola, W. (1998). Explaining nursing turnover intent: Job satisfaction, pay satisfaction, or organisational commitment? Journal of Organisational Behaviour, 19, 305—320. *McCarthy, G., Tyrrell, M. P., & Lehane, E. (2007). Intention to ‘leave’ or ‘stay’ in nursing. Journal of Nursing Management, 15, 248—255. *McDuff, E. M., & Mueller, C. W. (2000). The ministry as an occupational labour market: Intentions to leave an employer (church) versus intentions to leave a profession (ministry). Work and Occupations, 27, 89—116. Mitchell, T. R., & Lee, T. W. (2001). The unfolding model of voluntary turnover and job embeddedness: Foundations for a comprehensive theory of attachment. Research in Organisational Behaviour, 23, 189—246. Mrayyan, M. (2007). Jordanian nurses’ job satisfaction ans intent to stay: Comparing teaching and non-teaching hospitals. Journal of Professional Nursing, 23(3), 125—136. *Mulki, J. P., Jaramillo, F., & Locander, W. B. (2006). Effects of ethical climate and supervisory trust on salesperson’s job attitudes and intentions to quit. Journal of Personal Selling & Sales Management, 26(1), 19—26. Mullen, C. (2003). Commentary: An English perspective. Journal of Advanced Nursing, 43(4), 335—350. *Poon, J. M. L. (2004). Effects of performance appraisal politics on job satisfaction and turnover intention. Personnel Review, 33(3), 322—334. PricewaterhouseCoopers’ Health Research Institute. (2007). What works: Healing the Healthcare Staffing Shortage. Available at: http://dwd.wisconsin.gov/healthcare/pdf/what works.pdf. *Rambur, B., Palumbo, M. V., McIntosh, B., & Mongeon, J. (2003). A statewide analysis of RNs’ intention to leave their position. Nursing Outlook, 51(4), 182—188. Review Body for Nursing and Other Health Professions. (2007). Twenty-second report on nursing and other health professions 2007. Available at: http://www.ome.uk.com/ downloads/361072 Cm7029 WEB.pdf. *Robison, J., & Pillmer, K. (2007). Job satisfaction and intention to quit among nursing home nursing staff: Do special care units make a difference? The Journal of Applied Gerontology, 26(1), 95—112. Rogers, B. L. (2000). Concept analysis: An evolutionary view. In B. L. Rogers, & K. A. Knafl (Eds.), Concept development in nursing: Foundations, techniques and applications (pp. 77—102). Philadelphia: Saunders. *Sablynski, C. J., Lee, T. W., Mitchell, T. R., Burton, J. P., & Holtom, B. C. (2002). Turnover: An integration of Lee and Mitchell’s unfolding model and job embeddedness construct and Hulin’s withdrawal construct. In J. Brett, & F. Drasgow (Eds.), The

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