Spiritual Climate Plays A Mediator Role In Relationship Among Transformational Leadership,Nurse Burnout And Turnover Intention

BackgroundA newly released brief nurse retention policy from the International Centre on Nurse Migration in 2018 said "It is imperative for nursing managers to provide adequate support and a safer,more conducive working environment for nursing professionals and encourage them to join the nursing profession".Nurse leaders should find ways to attract,motivate and promote her fellows.It is spiritual climate in the workplace that individuals could find meaning of their job and cooperate with others,nourish their spirituality,and result in low nurse leaving Spirituality is popular in enterprise and western countries' management and has just on the beginning process in Chinese health care management.Compared to what we usually did in improving salary and work structure seldom did we pay attention to nurses' spirituality.We intended to find what is spirituality in workplace by translate it into a Chinese version and to explore how possible influence could work on it.We did also want to explore how is the relationship among transformational leadership,spiritual climate,nurses'burnout and turnover intention.Aims1.Verify the reliability and validity of the Chinese version spiritual climate scale;2.Analyze nurses' perception to spiritual climate in their workplace and find out essential influence factors;3.Explore spiritual climate playing a mediate role in relationship between transformational leadership,nurses' burnout and turnover intention.Methods1.Test the reliability and validity of the Chinese version spiritual climate scale by conducting a questionnaire research among clinical nurses;2.Cross-sectional study with Chinese version Spiritual Climate Scale,Maslach Burnout Inventory,Turnover Intention Inquiry and Multifactor Leadership Questionnaire in Two tertiary hospitals.T-test,one-way ANOVA,correlation analysis and regression analysis were conducted to figure out possible influence factors.3.Mediator factor analysis and Structure equation model were used to explain the relationship among transformational leadership,spiritual climate,nurse burnout and turnover intention.Results1.Reliability and Validity test of the Chinses version:The reliability of the Chinese version is good,Cronbach's ?=0.833(P<0.05).The retest reliability is 0.834(P<0.05)two weeks after the first investigation.I-CVI of each item was 0.800-1.000 with the content validity was 0.915.The correlation coefficient between each item and the total score were from 0.455 to 0.609,0.753 to 0.847.The Bartlett test statistics for exploratory factor analysis was 318.708(df=6,P<0.01)and KMO index was 0.782.The factor loads of each item were all over 0.5.One common factor was extracted and the cumulative contribution rate was 66.794%.The scale has one dimension.The confirmatory factor analysis had a good fit model with index:CMIN/DF=1.979<3,NFI=0.913>0.9,IFI=0.955>0.9,TLI=0.926>0.9,CFI=0.954>0.9,RMSEA=0.069<0.8.There was a good calibration validity with correlation of job satisfaction(r=0.492).2.Current situation of nurses' perception of spiritual climate and some influence factors analysis:The score of spiritual climate scale was 69.70+17.18.72.5%of participants agree with item 4 "A diverse set of spiritual views are accepted in this clinical area" and the lowest 59.3%agreement with item 1 "I am encouraged to express spirituality in this clinical area".Different bands have different perception of the spiritual climate especially the higher bands and the higher income individuals.The one who was new in this area could experience more encouragement.Nurses working in ICU,Pediatrics and Emergency departments perceived low spiritual climate compared to other departments.Nurses who perceived transformational leadership hold positive views with spiritual climate(?=0.328).Those who had burnout and turnover intention negatively perceived spiritual climate in their workplace(?=-0.278,?=-0.134,respectively)3.Mediator effects and Structure equation model to explain relationship among transformational leadership,spiritual climate,nurses' burnout and turnover intention:Spiritual climate plays a mediator role in the relationship among transformational leadership,burnout,turnover intention.Transformational leadership had effects on nurse burnout and turnover intention through the indirect effect of spiritual climate(indirect effect=-0.182 and-0.185,respectively).Conclusion1.The Chinese version spiritual climate scale hold good reliability and validity.It provided a tool to assess clinical nurses'perception of spiritual climate in workplace2.Interventions and support should be provided in ICU,Pediatrics,and Emergency departments since they have lower spiritual climate than other departments.Transformational Leadership support spiritual climate in workplace whilst feeling of burnout or having intention to leave have negative effects on spiritual climate3.Spiritual climate plays a mediator role in the organization relationship.Transformational Leadership could bring in high level spiritual climate and help nurses find meaning of their work,which would attract nurses to devote into nursing career.This finally contributes to reduce burnout and retain nurses in health organizations.