| Objective:The purpose of this study is to describe the status of nurses' turnover intention and job satisfaction and organizational commitment and work environment;To analysis the influencing factors of these factors and the correlation between them;A structural equation model was constructed for work environment,job satisfaction,organizational commitment and turnover intention.Meta analysis was conducted on the correlation between nurses' turnover intention and work environment and organizational commitment in mainland China.It provides a theoretical basis for nursing managers to formulate effective measures for stabilizing clinical nurses,reduce the turnover of clinical nurses,relieve nurses' shortage and improve the management of clinical nurses.Methods:In the cross-sectional survey,243 clinical nurses in a 3A hospital in Qingdao were selected by convenience sampling.Questionnaires were collected from general information questionnaire,job satisfaction scale,turnover intention scale,Chinese employees' organizational commitment questionnaire and work environment scale.Statistical software SPSS 18.0 was used to do descriptive statistics analysis,t test,ANOVA,Pearson correlation analysis,binary Logistic regression analysis and so on.Statistical data AMOS21.0 was used to construct,modify and evaluate the structural equation model.In Meta analysis,meta analysis was carried out using R software.Heterogeneity test conducted by Q test,when there is no heterogeneity between studies when using fixed effect model of Meta analysis,the heterogeneity of the random effect model of Meta analysis,inspection level =0.05.The combined effect valuer and 95%CI were calculated,and Egger's test was used to examine the publication bias.Results:In the cross-sectional study:1.turnover intention:243 nurses in a hospital in Qingdao City,the total turnover intention(16.19±3.57),divided into(2.70±0.59).The scores in descending order of turnover intention I(possibility of quit current job(5.84±1.46)and turnover intention II(looking for other work motivation)(5.77±1.63)and turnover intention III(the possibility of obtaining external work)(4.59±1.32).Turnover intention was at a "low" level of 0(0%),and the "low" level was 37(15.2%),while the "high" level was 145(59.7%),and"high" was 61(25.1%).Different personal characteristics(gender,highest degree,nursing age,work overtime every week,my hobbies and professional titles,nursing professional matches,my character and nursing department,and whether the number of beds)difference between the scores of the turnover intention of nurses was statistically significant(P<0.05).2.Job satisfaction:the total score(142.52±20.79),divided into(3.24±0.47).The scores in descending order tasks(3.57±0.64),interactive cooperation(3.39±0.52),occupation status(3.21±0.66),autonomy(3.13±0.72),organizational decision making(3.08±0.82),income(3.02±0.51).Different personal characteristics(gender,marital status,no children,nursing age,total monthly income)there was significant difference between the scores of nurses'job satisfaction(P<0.05).3.Organizational commitment:the organizational commitment is(86.23±16.25),divided into(3.45±0.65).The scores from high to low is normative commitment(3.85±0.92),ideal commitment(3.73±0.70),affective commitment(3.60±0.82),economy(3.12±0.84)commitment,opportunity commitment(2.93±0.84).Different personal characteristics(weekly working time,my personality characteristics and nursing professional matches and whether or not teaching teachers,departments of beds,where the Department of the number of nurses)there were statistically significant differences between the nurses' organizational commitment(P<0.05).4.The working environment score(114.39±17.02),divided into(3.01±0.45).Each dimension score from high to low is cultural sensitivity(3.73±1.54),internal work motivation(3.73±1.54),health care(3.73±1.54),the relationship between leadership and autonomy(3.32±1.14),with the exchange of information(3.22±0.54),conflict management(2.98±0.69),team cooperation(2.48±0.65),control of practice(2.47±0.58).Different personal characteristics(my hobbies and professional matches,I am nursing characteristics and nursing professional matches,whether teaching teachers,departments where the number of beds)showed significant differences between nurses' work environment(P<0.05).5.Correlation analysis of job satisfaction,organizational commitment,work environment,the score of turnover intention:job satisfaction and turnover intention have significant negative correlation(-0.151,P<0.05),organizational commitment and turnover intention have significant negative correlation(-0.340,P<0.001),the working environment and turnover intention was negatively correlated(-0.125,P<0.05),and organizational commitment the working environment was positively correlated(0.549,P<0.001).The higher the working environment,the higher the job satisfaction and organizational commitment,the lower the turnover intention.6.Binary Logistic Analysisof influencing factors and turnover intention:the results showed that conflict treatment,income,organizational commitment and opportunity commitment were the main reasons for nurses' turnover intention.Among them,the way of conflict treatment and opportunity commitment are the restraining factors of turnover intention,and the income and organizational commitment are the risk factors of turnover intention.7.The structural equation model fitting construction better,?2/df<5,CFI?NFI?IFI?GFI,close to 0.9,RMSEA,close to 0.1.The structure model shows that the work environment has a direct positive effect on job satisfaction,path coefficient is 0.26(P<0.05),the working environment has a direct positive impact on organizational commitment,path coefficient is 0.62(P<0.05),work environment through organizational commitment indirectly and working environment,working environment to directly predict turnover intention the role of(P<0.01)can also be through the mediating role of job satisfaction and organizational commitment have a negative impact on turnover intention.Results of Meta-analysis:8.China mainland nurses working environment and turnover intention is negatively related to moderate(r=-0.3151);the dimensions of the results of Meta analysis showed that the dimensions of the work environment and turnover intention was negatively correlated;the correlation of male nurses in nursing work environment and turnover intention(r=-0.2198)to weak female nurses nurses(r=-0.3151).Conclusion:The turnover intention of nurses in a three a hospital in Qingdao is at a high level,the job satisfaction is at the middle level,the organizational commitment is at a high level and the working environment is at a high level,and the job satisfaction of nurses,organizational commitment,working environment and turnover intention are all significantly related.Conflict handling,income,organizational commitment and opportunity commitment are the main reasons for nurses' turnover intention.Among them,conflict handling and opportunity commitment are the restraining factors of turnover intention.Income and organizational commitment are risk factors of turnover intention.The model of job environment,job satisfaction,organizational commitment and turnover intention built by this study has a good fitting index.The model shows that the working environment has a positive impact on job satisfaction and organizational commitment,which has a negative predictive effect on turnover intention,and can have a negative impact on turnover intention indirectly through job satisfaction and intermediary role of organizational commitment;the working environment of nurses in Chinese mainland is negatively correlated with turnover intention.(r=-0.3151)the various dimensions of the working environment were negatively correlated with turnover intention,and the correlation between the nursing work environment and turnover intention(r=-0.2198)of the male nurses was weaker than that of the nurses dominated by the female nurses(r=-0.3151).Nursing managers should pay attention to the influence of job satisfaction,organizational commitment and working environment on turnover intention,take appropriate measures according to the characteristics of different nurses,establish a good working environment,cultivate nurses" working values,improve job satisfaction and improve the level of organizational commitment,so as to reduce turnover tendency and make the nursing forces stable. |
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