Examining The Effect Of Nurses' Stress Factors,organizational Commitment,job Satisfaction,and Transformational Leadership On Turnover Intention Among Newly Recruited Nurses

Statistics show that there is a nurse shortage problem in all countries in the world.The U.S.Department of Health and Human Services has estimated that the shortage of nursing staff in the United States will reach 260,000 in 2025;the Canadian Nursing Association have projected that the need of nursing staff in Canada in 2022 will reach 60,000;the European Commission has predicted that the shortage of nursing staff in Europe would reach 590,000 personnel.In China,the overall allocation of nursing human resources is insufficient;besides,the number of registered nurses per thousand people is far below the international standard.The World Health Organization has projected a worldwide nursing shortage of about 7.2 billion by the end of 2035.One of the principal causes of the lack of primary healthcare workers is turnover.While a significant number of researchers have tried to address the nursing turnover issue,especially among experienced nurses,recent studies have overlooked newly recruited nurses,who constitute the future of this profession.Moreover,the turnover prevalence is higher among new nurses in comparison to their older colleagues.Newly recruited nurses enter the health profession with so much enthusiasm and anticipation.Still,after a few months,most green nurses wish to quit their jobs for a new or better one.Training nurses at high costs and not have them work in the health profession constitutes an enormous waste.No healthcare institution wishes their freshly recruited nurses to leave as it sends a lousy omen to prospective nurses.This study aimed to gain insight into the complex relationships between nurses' stress factors,organizational commitment,job satisfaction,transformational leadership,and turnover intention in a cohort of newly recruited nurses.To this aim,five main objectives were examined.The first objective investigated the extent to which nurses' stress factors influence newly recruited nurses' turnover intention.Secondly,it was a matter of looking at the degree to which nurses' stress factors influence job satisfaction and organizational commitment among newly recruited nurses.Thirdly,the study explored the extent to which job satisfaction and organizational commitment influence turnover intention among newly recruited nurses.The fourth objective accessed the degree to which job satisfaction and organizational commitment could mediate the relationship between nurses' stress factors and turnover intention.The last goal investigated if transformational leadership could moderate the relationship between the mediators(job satisfaction and organizational commitment)and turnover intention.This study employed a descriptive cross-sectional design.Experimental data were collected through an online survey questionnaire written in Chinese.The questionnaire was sent to twenty county hospitals with similar characteristics across Jiangsu province,China.A purposive random sampling method was used to target 700 newly recruited nurses from selected hospitals.A total of 660 valid responses were received from fresh nurses,representing 94.3% of the response rate.Different software packages were used to perform data analysis.SPSS version 26 was used to examine the characteristics of the respondents.The study performed both exploratory factor analysis(EFA)with SPSS version 26 and confirmatory factor analysis(CFA)with Amos version26 to examine the appropriateness of the data.Two statistical approaches were used to analyze the hypotheses for the study's various objectives,namely the structural equation model(SEM)using Amos version 26 and hierarchical regression analysis in SPSS version 26.Structural equation modelling was applied to analyze the first four objectives,while hierarchical regression analysis was carried out to examine the fifth objective.It was found that the average age of the nurses was 21.88.Regarding the respondents' educational level,the results showed that 157(24.0%)graduated from professional nursing schools,while 497(76%)were university graduates.Also,386(59.0%)of the respondents had been employed on a contract basis,while 268(41.0%)were formally hired.The majority of the respondents worked in the medical 196(30.0%)and the surgical 183(28.0%)wards.The results from the SEM analysis revealed that four stressors(stress from taking care of patients,stress from roles and workload,stress from coworkers and daily life,and stress from lack of professional knowledge and skills)from the perceived stress scale had a significant impact on turnover intention among nurses.Furthermore,the results highlighted that organizational commitment was significantly affected by five stressors(stress from taking care of patients,stress from unit managers,supervisors,and physicians,stress from roles and workload,stress from coworkers and daily life,and stress from lack of professional knowledge and skills)among the six of the perceived stress scales.At the same time,job satisfaction was negatively and significantly influenced by all six stressors(stress from taking care of patients,stress from unit managers,supervisors,and physicians,stress from roles and workload,stress from coworkers and daily life,stress from lack of professional knowledge and skills,and stress from the working environment).Regarding the effects of organizational commitment and job satisfaction on turnover intention,the study observed that both organizational commitment and job satisfaction have a significant negative influence on turnover intention among newly recruited nurses.Moreover,the results from the structural effect model using SEM revealed that both organizational commitment and job satisfaction partially mediated the relationship between two components of nurses' stress factors(stress from taking care of patients and stress from coworkers and daily life)and turnover intention.Additionally,both organizational commitment and job satisfaction acted as full mediators in the relationship between two components of nurses' stress factors(stress from roles and workload,stress from lack of professional knowledge and skills),and turnover intention.Finally,the hierarchical regression analysis outcomes revealed that transformational leadership moderated the relationship between job satisfaction and turnover but could not moderate organizational commitment and turnover intention.Newly recruited nurses are the future of the nursing profession,and their actual turnover rates are exceptionally high.This study findings make some innovative contributions to the literature.Firstly,only a few works have considered freshly recruited nurses and factors related to turnover in the preceding literature.Additionally,no study primarily designed for new nurses has been conducted in Jiangsu Province,China,in recent years.Thus,this study fills the gap in the extant literature and identifies the determinants of newly recruited nurses' turnover in Jiangsu Province,China.Secondly,as a significant precursor of nursing turnover,nursing stress has been widely addressed as a single construct with a few items in extant studies,providing only a relatively shallow analysis of the influence of stress on turnover intentions.Then,this dissertation provides a deeper analysis of the relationships between new registered nurses' stress dimensions and turnover intentions.Thirdly,no recent study has tested the role transformational leadership can play in retaining nurses in their early careers.Therefore,this dissertation tested a model linking transformational leadership to newly recruited nurse's stress,job satisfaction,and organizational commitment in the searching for leadership styles that can help curb their intentions to leave their profession and promote their retention.All the nursing stress dimensions,namely,stress from taking care of patients,stress from the interactions with managers,supervisors and physicians,stress from coworkers and daily life,and stress from lack of professional knowledge and skills,stress from the working environment,might have a considerable impact on new nurses' intention to leave.To better retain new nurses,coping strategies that address these stressors should be established.New nurses' commitment to the organization they work for and their professional satisfaction might significantly mediate the relationship between the stressors and their turnover intention.This suggests that new nurses' satisfaction and commitment may reduce the negative influence of stress factors on their intention to withdraw from their organization.Therefore,job satisfaction and organizational commitment are essential domains to consider by policymakers and hospital managers when designing the policies and perfection programs for nurses,especially in the early years of their career.The findings also highlighted that transformational leadership strongly influences the relationship between novice nurses' satisfaction and turnover intention,demonstrating that the practice of good transformational leadership in medical institutions may provide new nurses with appropriate mentorship,give them practical training,and help them cope with and handle the stress related to their profession.Thus,the transformational leadership style may facilitate new nurses' insertion in their working milieu,improve their well-being,and eventually guarantee retention,which is crucial for modern society where the demand for quality nurses is continually increasing.