JAN

ORIGINAL RESEARCH

Intention to leave the profession: antecedents and role in nurse turnover

Julianne Parry
Accepted for publication 4 June 2008

Correspondence to J. Parry:
e-mail: julianne_parry@health.qld.gov.au
Julianne Parry PhD RN Grad Dip (Psych)
Nursing Research Fellow
Mount Isa Base Hospital, Queensland,
Australia

P A R R Y J . ( 2 0 0 8 ) Intention to leave the profession: antecedents and role in nurse

turnover. Journal of Advanced Nursing 64(2), 157167
doi: 10.1111/j.1365-2648.2008.04771.x

Abstract
Title. Intention to leave the profession: antecedents and role in nurse turnover.
Aim. This paper is a report of a study to examine the relationship between intention to
change profession and intention to change employer among newly graduated nurses.
Background. Few studies of the worldwide nursing workforce shortage consider the
contribution of changing professions to the shortage. Organizational behaviour
research has identified that professional commitment and organizational commitment
have an important role in organizational turnover and that professional commitment
and intention to change professions may have a greater role in organizational turnover
than is presently understood.
Method. A model of the relationships between affective professional commitment job
satisfaction, organizational commitment, intention to change professions and organizational turnover intention was developed through review of the organizational
behaviour literature and tested using path analysis. The sample was drawn from all
nurses in Queensland, Australia, entering the workforce for the first time in 2005.
Results. The model was tested with a final sample size of 131 nurses in the initial period
of exposure to the workplace. Affective professional commitment and organizational
commitment were statistically significantly related to intention to change professions.
Job satisfaction, organizational commitment and intention to change professions were
statistically significantly related to intention to change employer.
Conclusion. Turnover research in nursing should include intention to change professions as well as intention to change employer. Policies and practices that enhance
the development of affective professional commitment prior to exposure to the
workplace and support affective professional commitment, job satisfaction and
organizational commitment in the workplace are needed to help reduce nurse turnover.
Keywords: intention to leave, management, nursing, nursing shortage,
organizational behaviour, path analysis, workforce issues

Introduction
The presence of a worldwide shortage in the nursing
workforce is well-documented. Buchan and Calman (2005)
identify that in many developed countries there is an
abundance of qualified nurses, but a shortage of nurses who

are available to the workforce. The problems associated with

the supply of nurses in developed countries also include an
increasingly ageing nursing population (Smith & Seccombe
1999, Sochalski 2002, Australian Institute of Health and
Welfare 2003) decreasing numbers of new entrants to the
profession (Buerhaus et al. 2000, Johnstone & Stewart 2003)

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J. Parry

and professional turnover, that is, nurses who leave nursing

to work in other professions or occupations (Hodges et al.
2002, Duffield et al. 2004).
There is a considerable volume of research literature in
relation to nurse turnover (e.g. Aiken et al. 2001, Kleinman
2004, Bowles & Candela 2005, West et al. 2005). Such
studies usually report intention to leave the current job.
However, they rarely distinguish between changing employer
and changing profession. That is, they do not indicate
whether participants leave the current job to go to another
job in nursing or leave the current job because they intend to
leave the profession.

Background
Nurses leave the nursing workforce for a variety of reasons,
which may be either temporary (such as while engaged in fulltime parenting) or permanent. Some reasons for permanently
leaving the nursing workforce are unavoidable (such as
retirement due to age). However, nurses also leave the
nursing workforce because they choose to work in other
professions or occupations. Those who leave the profession
to work in other fields (changing professions) have been
educated at a cost, are highly skilled and through experience
have developed clinical judgment abilities. These skills are
not transferred to another healthcare organization, as occurs
in the situation of organizational turnover, but are lost to the
nursing workforce.
A large number of qualified nurses in Australia have left the
profession to work in other occupations (Karmel & Li 2002).
From February 1999 to February 2000, 31% of those who
left nursing did so to work or to seek work in other
occupations (Shah & Burke 2001). Furthermore, 20% of
recent graduates from baccalaureate nursing degrees in
Australia leave after just 1 year of employment (Armstrong
2004). Newman et al. (2001) identified that in the United
Kingdom 10% of newly qualified nurses leave the National
Health Service (NHS) within 12 months of qualifying, and
that one-third of nurses of working age are no longer working
as nurses. In the United States of America, Berliner and
Ginzberg (2002) noted that in 2000 almost 500,000 nurses
were not working in nursing.
When nurses leave one organization to work in another the
perception of the shortage of nurses is intensified because of
the time taken to fill the positions vacated. Furthermore,
effectiveness and productivity of the delivery of care are
reduced, labour costs are increased and there is a negative
effect on the cohesiveness of remaining staff (Tai et al. 1998)
which may also result in decreased morale and more staff
losses (Borda & Norman 1997). Thus, the issue of nurses
158

leaving organizations presents its own problems to employers

because it magnifies the apparent lack in the supply of nurses.
It does not, however, deplete the number of nurses available
to the nursing workforce. On the other hand, changing
profession contributes directly to the shortage of nurses and
implies all the costs of organizational turnover in both human
and economic resources, and more.

Workplace commitments and turnover intention

For many years the concept of commitment in relation to
work has been a topic of organizational-behavioural research
(Lee et al. 2000). Meyer and Herscovitch (2001, p. 301)
consider that Commitment is a force that binds an individual
to a course of action of relevance to one or more targets.
Cooper-Hakim and Viswesvaran (2005, p. 241) regard
commitment as being generally defined as a willingness to
persist in a course of action. When applied to the workplace,
the concept of commitment has been used to develop
knowledge in relation to a number of work-related outcomes,
which include employee turnover, job performance, organizational citizenship behaviour and attendance (Meyer et al.
2004). Research and theory in relation to work-related
commitment have identified that organizational employees
have multiple work-related commitments that have the
potential to complement or conflict with each other. These
targets of commitment in the workplace include the organization and the occupation or profession; however, the
relationships between the various targets of work-related
commitment are not fully understood (Meyer et al. 2004).
The position of organizational commitment as being the
better predictor of organizational turnover intention than job
satisfaction (Griffeth et al. 2000) is well-established in the
organizational-behaviour research literature. However, there
is a relative dearth of research in relation to nurse turnover
that considers the relationship between organizational commitment and organizational turnover intention or actual
organizational turnover (Lynn & Redman 2005). In addition,
changes in the global economy in recent decades have
prompted several authors (e.g. Meyer et al. 1998, Lee et al.
2000, Mir et al. 2002) to suggest that organizationalbehavioural research into workplace commitment should
place greater emphasis on the employees commitment to
their occupation as the means to understand turnover
intention in the workplace.
Affective occupational commitment is identified as the
persons desire to remain in the occupational role (Lee et al.
2000, p. 800) and relates to a persons feelings about the
occupation and their identification with it (Blau 2003).
Affective occupational commitment also relates to values

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JAN: ORIGINAL RESEARCH

and a desire to act in ways that are consistent with

membership of the occupation (Snape & Redman 2003, p.
153). Cross-sectional studies have indicated that affective
commitment to a professional or non-professional occupation is related to several work-related outcomes, such as
occupational turnover intention and organizational turnover
intention (Lee et al. 2000).
The status of job satisfaction as an antecedent of organizational commitment is long-established in the organizational
behaviour literature (Mathieu & Zajac 1990). Affective
commitment to the occupation has been linked to job
satisfaction (Irving et al. 1997) and organizational commitment (Meyer et al. 1993). Job satisfaction therefore, has the
potential to be related to commitment to both the occupation
and the organization. In two meta-analytic studies, organizational commitment and job satisfaction were considered to
be the two consistent predictors of organizational turnover
intention (Tett & Meyer 1993, Griffeth et al. 2000).
However, neither of these meta-analyses considered the role
of occupational commitment in organizational turnover
intention. Lee et al.s (2000) meta-analysis, which included
occupational commitment, found that it was statistically
significantly correlated with organizational turnover, both
intended and actual, even when the effects of job satisfaction
and organizational commitment were partialled out.
Furthermore, Lee et al. (2000) noted that for professional
employees there was a stronger association between affective
occupational commitment and occupational turnover intention as well as organizational turnover intention than for
non-professional employees.
Lee et al. (2000) point out that organizations generally
employ certain types of professionals, according to the nature
of the business that they conduct. Therefore, leaving a
profession to work in another profession or occupation
usually necessitates departure from employment in that
organization. They argue that among professional employees
occupational commitment is likely to have a greater role in
the process of organizational turnover than previously
thought, and that there is a need for clearer identification
of the role of occupational commitment in organizational
turnover (Lee et al. 2000). Thus, there is a need for research
that examines the relationships between affective professional
commitment, job satisfaction and organizational commitment and their relationships with professional turnover and
organizational turnover.
Beck and Wilson (2001) argue that employees pass through
stages in the development of work-related commitments and
contend that a developmental approach is needed to better
understand work-related commitment. They also point
out that, while the developmental process of a target of

Intention to leave the profession

work-related commitment such as organizational commitment or commitment to the profession might be similar, the
time at which the commitment begins to develop may vary
according to the target of commitment. They argue that
organizational commitment is expected to develop as a result
of experiences that occur after organizational entry, but that
development of commitment to an occupation begins after
initial contact with the occupation. This is because members
of professional occupations, such as nursing, are first exposed
to the profession during the period of their professional
preparation, which occurs prior to workplace entry (Beck &
Wilson 2001, Freidson 2001). Through the education that
prepares them for their role in the workplace, professionals
are socialized to the distinct cultural values of the profession
(Freidson 2001, Lui et al. 2003). A sense of commitment to
the profession is developed through the shared experiences of
their education and sense of professional community that is
cultivated during this initial period of exposure to the
profession (Freidson 2001). Therefore, since commitment to
the profession is developed prior to workplace entry among
professional employees, it may be seen as an antecedent to
other workplace outcomes.

The study
Aim
The aim of the study was to examine the relationship between
intention to change profession and intention to change
employer among newly graduated nurses.
Four research questions were addressed:
What are the relationships between affective professional
commitment prior to workplace entry, job satisfaction
and organizational commitment?
What are the relationships between affective professional
commitment prior to workplace entry, job satisfaction,
organizational commitment and affective professional
commitment after a period of exposure to the workplace?
Which of these variables are related to intention to change
professions?
Which of these variables are related to intention to change
employer?

Design
A repeated-measures research design was used to examine the
relationships identified in the four research questions. A
theoretical model of the relationships was specified a priori
(Kline 2005) and tested using path analysis (See Figure 1). In
path analysis, variables may be modelled as independent

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J. Parry
Affective professional
commitment time 1

Organisational
commitment

Job satisfaction

Affective professional
commitment time 2

Intention to change
profession

Intention to change
employer

Figure 1 Theoretical model of the relationship between affective

professional prior to workplace entry and intention to change employer.

(exogenous) and dependent (endogenous) in the estimation of

regression equations (Kline 2005). The direction of the
arrows (from exogenous to endogenous variables) indicates
the direction of the regression estimation.
Certain relationships in the model can be clearly defined
because of obvious temporal precedence (Kline 2005).
Affective professional commitment prior to workplace entry
is temporally precedent in development and measurement to
all other variables in the model and is considered to be
exogenous to all other variables in the model (Figure 1). The
relationships between the remaining variables are defined
according to established theory and the interests of the
research (Kline 2005). Paths specified from affective professional commitment prior to workplace entry to job satisfaction and organizational commitment enable the relationships
between these variables to be estimated. Because job satisfaction is well-established as an antecedent to organizational
commitment in the research literature (Mathieu & Zajac
1990), a path from job satisfaction to organizational commitment is also specified. Job satisfaction is therefore
modelled as an intervening variable between affective professional commitment prior to workplace entry and organizational commitment. This enables the hypothesis that the
relationship between affective professional commitment prior
to workplace entry and organizational commitment is partially or fully explained by the relationship between affective
professional commitment prior to workplace entry and job
satisfaction to be tested.
Because its measurement is repeated, affective professional
commitment prior to workplace entry and the error term for
affective professional commitment after a period of workplace exposure are specified as being correlated. This
specification reflects the assumption that these two variables
160

will covary because they represent two administrations of the

same measure and allows any non-spurious part of the
relationship to be identified (Kline 2005).
Paths are specified from job satisfaction and organizational
commitment to affective professional commitment after
workplace exposure, to enable any change in affective
professional commitment after workplace exposure associated
with a change in these variables to be identified. Furthermore,
specification of paths from job satisfaction, organizational
commitment and affective professional commitment after a
period of workplace exposure, to intention to change professions and intention to change employer, the model enables the
proposition that there are relationships between these variables to be examined. Specification of the path from intention
to change professions to intention to change employer controls
for the relationships between the exogenous variables that are
common to both, enabling any non-spurious part of their
relationship to be identified (Kline 2005).

Participants
Both nursing professionals and nursing assistants are
employed in healthcare systems throughout the world (World
Health Organization 2006). Participants in this research were
nurses who were professionally prepared at tertiary education
institutions. All nurses who completed a preregistration
baccalaureate degree in nursing in the state of Queensland,
Australia, in 2004 were invited to participate in the research.

Measures
The affective commitment component of the Blau (2003)
occupational commitment measure, the job satisfaction
measure (Price 2001) and the revised Organizational Commitment Questionnaire (OCQ) (Bozeman & Perrewe 2001)
and the Organizational Turnover Intentions scale (Bozeman
& Perrewe 2001) were used to measure the variables in the
model. Intention to change professions was measured using
an adapted version of the Organizational Turnover Intentions
scale (Bozeman & Perrewe 2001). These measures have
demonstrated reliability levels of 0.76 or greater in previous
studies. For all measures the response scale provided was a
6-point Likert scale that ranged from very strongly agree (6)
to very strongly disagree (1). Two minor changes to the
wording of the affective commitment component of the Blau
(2003) occupational commitment measure were made to
adapt for use with nurses; the words medical technology
were replaced with the word nursing and the affective
commitment item I am proud to be in the field of medical
technology was re-worded I am proud to be a nurse.

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Data collection
Data were collected prior to or soon after workplace entry
(Time 1), and after approximately 6 months of exposure to
the workplace (Time 2). This may be considered to be a
relatively short period of workplace exposure; however,
Armstrong (2004) has indicated that up to 20% of nursing
graduates leave the profession after 1 year of employment.
Thus, it may be argued that 6 months was a justifiable period
of time to measure turnover intention. On each occasion the
questionnaires were sent to participants by mail.
The Time 1 data were collected via two rounds of
invitations to participate in the research. Initially in 2004,
students in the final months of their preregistration
baccalaureate degrees in nursing were contacted via the
universities. To improve the response rate, a second round
of data collection from the same nursing cohort was
conducted in April 2005 with the support of the professional registration body for nurses, the Queensland Nursing
Council (QNC).
The Time 2 data collection took place between July and
August of 2005. This round of data collection included the
measures of job satisfaction, organizational commitment,
intention to change employer and intention to change
professions as well as the affective commitment component of
the Blau (2003) occupational commitment measure.

Ethical considerations
The research was approved by a university research ethics
committee. Initial contact with the participants was made via
a third party (either the universities or the QNC) to ensure
participant privacy. To ensure anonymity, respondents
generated a unique code identifier to enable their responses
to be matched across time.

Data analysis
The data were entered into SPSS 15 (SPSS Inc., Chicago, IL,
USA) for the univariate analyses. The model was estimated in
AMOS 7 using Maximum Likelihood. The total, direct and
indirect effects were requested in the output. In addition,
confidence intervals and tests of statistical significance of the
effects were estimated, using the bias-corrected bootstrap, as
recommended by MacKinnon et al. (2004) and were based on
1000 bootstrap samples. The alpha level was conservatively
set to less than 0.01 to minimize the risk of accepting
statistically significant effects when they are not truly
statistically significant (Type I error) in recognition of the
limitations of the small sample size.

Intention to leave the profession

Results
Response rate
The first round of the Time 1 data collection resulted in 172
responses with a further 97 responses in the second round,
resulting in a total sample size for Time 1 of 269 and a
response rate of 241%. This is considered a reasonable
response rate for mail surveys (Aldridge & Levine 2001). Ttests for independent samples for the mean of the affective
commitment component of the Blau (2003) occupational
commitment measure showed no statistically significant
differences between the two Time 1 subsamples, indicating
that both subsamples could be considered to be representative
of the same population (Pallant 2001).
Of the 154 responses to the Time 2 data collection
(5725% of Time 1 responses) 134 could be matched with
a Time 1 response. After identification of multivariate
outliers using Mahalanobis Distance (Tabachnick &
Fidell 2001), the sample was trimmed to a sample size of
131.

Participant characteristics
There were 122 females and nine males in the sample. Of
these, 80 (611%) were aged between 20 and 30 years, 40
(305%) were aged between 31 and 45 years and ten (76%)
were over 45 years of age. Twelve participants (92%)
indicated that they had previously worked as an Enrolled
Nurse. The proportion of males in the study is consistent with
the proportion of males within the Registered Nurse population in Australia. However, no population data on age or
previous experience as an Enrolled Nurse are available for
newly graduated Registered Nurses. Only nine (69%)
participants had been with their organization for 2 months
or less. Most (n = 72, 550%) had been with the organization
for 35 months, and 48 (387%) had been with the organization for 68 months.

Measures
Because path analysis uses only one observed variable, the
choice of items used to measure each construct is critically
important (Kline 2005). The benefits of removing items from
the scale needed to be balanced against the amount of
measurement error that including an item with low reliability
may introduce (Kline 2005). The decision to retain or exclude
items was made on the basis of inspection of the item-total
statistics generated using reliability analysis in SPSS. If the
Cronbachs alpha indicated that the reliability of the scale

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J. Parry

was increased by deletion of a particular item, then that item

was not included in the scale. As a result, one item was
removed from the job satisfaction scale and two items were
removed from the organizational commitment scale. No
items were removed from the other measures. The scale
reliabilities for each measure before and after the items were
removed, as well as the items that were removed from the
scales, are shown in Table 1.
The descriptive results for these measures are shown in
Table 2. Paired samples t-tests for the affective professional
commitment measure indicated that there was a statistically
significant difference in affective professional commitment at

Table 1 Scale reliabilities for all measures used in path analysis

(n = 131)

Scale
Affective professional
commitment (Time 1)
Affective professional
commitment (Time 2)
Job satisfaction
Organizational commitment
Intention to change profession
Intention to change employer

Reliability
(Cronbachs a)
with all items

Reliability
(Cronbachs a)
with removed
items

0.91

0.91*

0.93

0.93*

0.85
0.88
0.87
0.89

0.91
0.91
0.87*
0.89*

The items removed from the scales were:

Job Satisfaction Scale I like working here better than most other
people I know who work for this employer.
Revised Organizational Commitment Scale I am willing to put in a
great deal of effort beyond that normally expected in order to help
this organization be successful and I feel very little loyalty to this
organization. (Reverse scored).
*No items were removed.

162

The model
The model estimation results are provided in Figure 2.
Goodness-of-fit indices for the model are given in Table 4
and show that the model has very good fit to the data (Kline
2005). The statistically significant direct paths are indicated
by the heavy lines and the associated path coefficients are
bolded. The statistically significant indirect paths are indicated by the lighter lines and/or use of plain text for the path
coefficients. The standardized direct and indirect path coefficients are given. Direct paths indicate that a change in the
level of the exogenous (or independent) variable results in a
change in the endogenous (or dependent) variable (Cole &
Maxwell 2003). Indirect paths indicate that a change in
the level of the exogenous variable results in a change in the
endogenous variable by means of its relationship with
the intervening variable (Cole & Maxwell 2003). For each
of the endogenous variables, the proportion of variance
accounted for by its exogenous variable(s) is indicated in the
associated ellipse. These values indicate that the model has a
high level of explanatory power (Ho 2006).

Research question 1

Minimum

Maximum

Mean

SD

300

600

490

0.74

283

600

472

0.80

The results indicate that in this sample the relationships

between affective professional commitment prior to
workplace entry, job satisfaction and organizational commitment are statistically significant and positive. Therefore,
higher levels of affective professional commitment are
related to higher levels of job satisfaction and organizational commitment and, conversely, lower levels of affective
professional commitment are related to lower levels of job
satisfaction and organizational commitment. The statistically significant indirect relationship between affective
professional commitment prior to workplace entry and
organizational commitment indicates that the relationship
between these variables is explained by their relationships
with job satisfaction.

140
143

600
600

428
400

0.85
0.80

Research question 2

100

600

257

0.97

100

600

287

0.98

Table 2 Descriptive results for all measures used in path analysis

(n = 131)

Affective professional
commitment (Time 1)
Affective professional
commitment (Time 2)
Job satisfaction
Organizational
commitment
Intention to change
profession
Intention to change
employer

Time One (M = 490, SD = 0.74) and affective professional

commitment at Time Two [M = 471, SD = 0.80; t (130) =
340, P < 0.00]. The zero-order correlations between all
measures in the model are shown in Table 3.

The results indicate that affective professional commitment

prior to workplace entry and job satisfaction are statistically
significantly and positively related to affective professional
commitment after a period of workplace exposure.

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Intention to leave the profession

Table 3 Statistically significant zero order correlations for all measures used in path analysis (n = 131, P < 0.001)

APC
Time 1
APC Time 1
Job satisfaction
Organizational commitment
APC Time 2
Intention to change profession
Intention to change employer

Job
satisfaction

1
0.49
0.42
0.68
0.44
0.38

1
0.68
0.66
0.59
0.66

Organizational
commitment

APC
Time 2

1
0.48
0.58
0.63

1
0.57
0.53

Professional
turnover
intention

Organizational
turnover
intention

1
0.72

APC, affective professional commitment.

Affective professional
commitment time 1
060
049

031

024

047

Organisational
commitment

062

Job satisfaction

044
030
Affective professional
commitment time 2

fore, higher levels of organizational commitment or affective

professional commitment after workplace exposure are
related to lower levels of intention to change professions
and the converse. Interestingly, the relationship between job
satisfaction and intention to change professions is not direct,
but may be explained by their relationship to affective
professional commitment after workplace exposure and
organizational commitment, which are both intervening
variables.

039

Research question 4

032
020/014
031
014

063

024/036

046

Intention to change
profession

047

Intention to change
employer

Figure 2 Model estimation of the relationship between affective

professional prior to workplace entry and intention to change
employer.

The results of the model estimation indicate that in this

sample of nurses, job satisfaction and organizational commitment are statistically significantly and negatively related
to organizational turnover intention and that intention to
change professions is statistically significantly and positively
related to intention to change employer.

Discussion
Study limitations

Table 4 Goodness-of-fit indices for path analysis

v2

d.f.

CFI

RMSEA

0.77

0.68

100

000

CFI, comparative fit index; RMSEA, root mean square error of

approximation.

Research question 3
These results indicate that organizational commitment and
affective professional commitment after a period of workplace exposure are antecedents of intention to change
professions, and that they are statistically significantly and
negatively related to intention to change professions. There-

The sample size is a limiting factor of the research. To

accommodate this limitation, the alpha level was conservatively set to less than 0.01 in the path analysis to minimize the
risk of Type I error. Attempts were made to maximize
internal validity by minimizing selection bias through nonresponse and attrition, which is frequently a limiting factor of
repeated measures survey research designs. Participants were
not required to identify the organization in which they were
currently working, and any clustering effect from the
responses could not be identified. Such effects should be
considered and accounted for in future research. Construct
validity was maximized through the use of established
measures. Nevertheless, the measures were used with the
recognition that they constitute a provisional attempt to

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J. Parry

describe the phenomena under investigation and are thus

always subject to review and reformulation (Reed 2005).
Self-report measures were used as the only form of data
collection, implying the problems associated with common
method variance (Kline et al. 2000). Remedies to address
these problems were employed, such as using well-tested
measures, guaranteeing participant anonymity (Podsakoff
et al. 2003) and trimming items from scales that have obvious
overlap with conceptually distinct measures (Kline et al.
2000). A recognized limitation of path analysis is that the
results are evaluated using goodness-of-fit indices. Therefore,
a finding that there is no contradiction between the model
and the data is no guarantee that the model is true
(MacCallum & Austin 2000, Kline 2005). Finally, the
findings of this study can readily be generalized to Australian
nurses in the initial period of exposure to the workplace.
However, further research is needed to establish their
generalizability to other countries.

Relationships identified in the model

The relationships between affective commitment to the
occupation, organizational commitment and job satisfaction
that have been previously found in cross-sectional research
(Meyer et al. 1993, Irving et al. 1997) might suggest that
professional employees may be assumed to be committed to
their organization because of their affective commitment to
their occupation. The findings of this study, however, suggest
that employers of nurses should not assume that their
affective commitment to the profession will automatically
result in their commitment to the organization, but rather
that it is dependent on the level of job satisfaction experienced within the organization.
The importance of the relationship between affective
professional commitment prior to workplace exposure and
job satisfaction in the workplace is highlighted in the findings
of this research. The relationship between affective professional commitment prior to workplace entry and job satisfaction suggests that, in the universities where nursing
professionals are prepared for the workplace, greater emphasis on professional socialization practices that promote the
affective professional commitment of students might assist in
the reduction of intention to change professions and consequently intention to change employer. The statistically
significant decrease in mean affective professional commitment, as well as the statistically significant relationship
between job satisfaction and affective professional commitment after workplace exposure and the statistically significant relationship between job satisfaction and organizational
commitment, emphasize the importance of job satisfaction to
164

the retention of nurses once they are exposed to the

workplace.
The findings of the model support Lee et al.s (2000)
proposition that affective professional commitment and
intention to change profession have an important role to
play in intention to change employer and should be
accounted for in models of organizational turnover intention
when the employees are professionals. Leaving the profession
to work in a different occupation means that the nursing
professional must also leave the organization; therefore the
relationship between intention to change professions and
intention to change employer is quite strong. It is, of course,
possible to leave an organization to work in another without
leaving the profession, but the strength of this relationship
emphasizes the statistically significant contribution of intention to change profession to intention to change employer. It
highlights the importance that employing organizations
should place on supporting the job satisfaction, organizational commitment and affective professional commitment of
nurses in order to increase their retention within the
organization as well as in the profession.
The importance of job satisfaction in the workplace is
highlighted in this research through its direct relationships
with affective professional commitment after workplace
exposure, organizational commitment and intention to
change employer and its indirect relationship with intention
to change profession. The literature identifies a range of
reasons for practising nurses satisfaction or dissatisfaction
with their jobs. These reasons relate to matters such as
relationships among nursing staff (Healy & McKay 1999,
Adams & Bond 2000, Chan & Morrison 2000, Cox 2003)
and relationships with management (Newman et al. 2002), as
well as feeling undervalued or feeling that their professional
status and worth is poorly recognized (Adams & Bond 2000,
Chan & Morrison 2000, Newman et al. 2002). Conflict with
the medical profession (Healy & McKay 1999) and matters
relating to maintaining work-life balance are also cited as
causes of job dissatisfaction among nurses (Tovey & Adams
1999, Chan & Morrison 2000, Newman et al. 2002, Burke
2003a). Moreover, the delivery of quality patient care is a
matter of importance to nursing professionals, and the
restraints imposed on their ability to deliver quality care,
due to excessive workloads, is an important contributor to
job dissatisfaction among nurses (Adams & Bond 2000,
Aiken et al. 2002, Burke 2003a,b, Frijters et al. 2003).
The job satisfaction measure used in this study is a global
measure and does not account for the many factors that may
contribute to job satisfaction or dissatisfaction among nurses.
However, it may well be that the numerous reasons for job
satisfaction or dissatisfaction among nurses may differentially

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JAN: ORIGINAL RESEARCH

What is already known about this topic

Leaving the nursing profession to work in another
contributes to the worldwide shortage in the nursing
workforce.
Job satisfaction and organizational commitment are
related to organizational turnover.
Affective professional commitment is related to intention to change profession and may contribute to
intention to change employer.

Intention to leave the profession

change employer among newly qualified nurses. Furthermore,

as well as focussing on job satisfaction, organizational
retention measures need to focus on professional retention
by supporting nurses affective commitment to the profession
as well as their commitment to the organization. In relation
to future research, a better understanding of nurse turnover is
likely to result if changing profession or intention to change
profession, affective professional commitment and organizational commitment are included in the research.

References
What this paper adds
Intention to leave the profession contributed statistically significantly to intention to change employer.
Nurturing affective professional commitment during
pre-workplace entry professional socialization and in
the workplace may help to reduce nurse turnover
intention.
Nurse turnover studies should distinguish the job satisfaction factors that contribute to intention to change
employer from those that contribute to intention to
change professions.
influence commitment to the organization or affective commitment to the profession. Organizational turnover results in
a short-term gap in an organizations workforce that may be
filled by recruiting already-qualified nurses. In contrast,
changing profession results in a permanent gap in the nursing
workforce that can only be filled by recruitment of new
entrants, with all of the associated costs. What is needed in
future research is for the aspects of job satisfaction that relate
to organizational commitment and organizational turnover
intention to be distinguished from those that relate to
affective professional commitment and then intention to
change profession. This would enable employing organizations to revise their policies and practices in relation to nurses
and adopt measures that support their job satisfaction and
commitment to the organization as well as their commitment
to the profession.

Conclusion
The findings of this study have implications for the educational preparation as well as for employers of nursing
professionals. The recommendations of the study are that
professional socialization practices that further promote
affective professional commitment be developed as a means
to reduce intention to change profession and intention to

Adams A. & Bond S. (2000) Hospital nurses job satisfaction, individual and organizational characteristics. Journal of Advanced
Nursing 32(3), 536543.
Aiken L., Clarke S., Sloane D. & Sochalski J. (2001) Nurses reports on
hospital care in five countries. Health Affairs 20(3), 4349.
Aiken L., Clarke S., Sloane D., Sochalski J. & Silber J. (2002)
Hospital nurses staffing and patient mortality, nurse burnout, and
job dissatisfaction. Journal of the American Medical Association
288(16), 19871993.
Aiken L., Clarke S., Cheung R., Sloane D. & Silber J. (2003)
Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association 290(12),
16171623.
Aldridge A. & Levine K.. (2001) Surveying the Social World: Principles and Practice in Survey Research. Open University Press,
London.
Armstrong F. (2004) Can you hear us? Theres a nursing shortage.
Australian Nursing Journal 12(2), 2124.
Australian Institute of Health and Welfare (2003) Nursing Labour
Force 2001. AIHW Cat. No. HWL 26, Retrieved from http://
www.aihw.gov.au/publications/hwl/nurslf01/nurslf01-c00.pdf on
1 August 2003.
Beck K. & Wilson C. (2001) Have we studied, should we study, and
can we study the development of commitment? Methodological
issues and the developmental study of work-related commitment
Human Resource Management Review 11(3), 257278.
Berliner H.S. & Ginzberg E. (2002) Why this hospital nursing
shortage is different. Journal of the American Medical Association
288(21), 27422744.
Blau G. (2003) Testing for a four dimensional structure of occupational commitment. Journal of Occupational and Organizational
Psychology 76, 469488.
Borda R. & Norman I. (1997) Factors influencing turnover and absence of nurses: a research review. International Journal of Nursing
Studies 34(6), 385394.
Bowles C. & Candela L. (2005) First job experiences of recent RN
graduates. Journal of Nursing Administration 35(3), 130137.
Bozeman D. & Perrewe P. (2001) The effect of item content
overlap on organizational commitment questionnaire - turnover
cognitions relationships. Journal of Applied Psychology 86(1),
161173.
Buchan J. & Calman L.. (2005) Summary The Global Shortage of
Registered Nurses: An Overview of Issues and Actions. Retrieved
from http://www.icn.ch/global/#1 on 4 April 2005.

 2008 The Author. Journal compilation  2008 Blackwell Publishing Ltd

165

J. Parry
Buerhaus P., Staiger D. & Auerbach D. (2000) Implications of an
aging registered nurse workforce. Journal of the American Medical
Association 14(283), 29482954.
Burke R.J. (2003a) Hospital restructuring, workload, and nursing
staff satisfaction and work experiences. The Health Care Manager
22(2), 99107.
Burke R.J. (2003b), Nursing staff attitudes following restructuring:
the role of perceived organizational support, restructuring processes and stressors. The International Journal of Sociology and
Social Policy, 23(8/9), 129157.
Chan E. & Morrison P. (2000) Factors influencing the retention and
turnover intentions of registered nurses in a Singapore hospital.
Nursing & Health Sciences 2, 113121.
Cole D. & Maxwell S. (2003) Testing mediational models with longitudinal data: questions and tips in the use of structural equation
modelling. Journal of Abnormal Psychology 112(4), 558577.
Cooper-Hakim A. & Viswesvaran C. (2005) The construct of work
commitment: testing an integrative framework. Psychological
Bulletin 131(2), 241259.
Cox K.B. (2003) The effects of intrapersonal, intragroup, and
intergroup conflict on team performance effectiveness and
work satisfaction. Nursing Administration Quarterly 27(2), 153
163.
Duffield C., OBrien Pallas L. & Aitken L. (2004) Nurses who work
outside nursing. Journal of Advanced Nursing 47(6), 664671.
Freidson E. (2001) Professionalism: The Third Logic. University of
Chicago Press, Chicago.
Frijters P., Shields M. & Wheatly Price S. (2003) Investigating the
Quitting Decision of Nurses: Panel Data Evidence from the British
National Health Service. Retrieved from http://opus.zbw-kiel.de/
volltexte/2003/1030/pdf/dp794.pdf on 16 June 2006.
Griffeth R., Hom P. & Gaertner S. (2000) A meta-analysis of antecedents and correlates of employee turnover: update, moderator
tests, and research implications for the next millennium. Journal of
Management 26(3), 463488.
Healy C. & McKay M. (1999) Identifying sources of stress and job
satisfaction in the nursing environment. Australian Journal of
Advanced Nursing 17(2), 3035.
Ho R. (2006) Handbook of Univariate and Multivariate Data
Analysis and Interpretation with SPSS. Chapman & Hall/CRC,
Boca Raton.
Hodges L., Williams B. & Carman D. (2002) Taking responsibility
for nursings future. Medsurg Nursing 11(1), 1524.
Irving G., Coleman D. & Cooper C. (1997) Further assessments of a
three-component model of occupational commitment: generalizability and differences across occupations. Journal of Applied
Psychology 82(3), 444452.
Johnstone M. & Stewart M. (2003) Ethical issues in the recruitment
and retention of graduate nurses: a national concern. Contemporary Nurse 14(3), 240247.
Karmel T. & Li J. (2002) The Nursing Workforce 2010. Retrieved
from http://www.dest.gov.au/archive/highered/nursing/pubs/nurs
ing_worfforce_2010/nursing_workforce_1.htm on 8 July 2004
Kleinman C. (2004) Leadership: a key strategy in staff nurse retention. The Journal of Continuing Education in Nursing 35(3), 128
132.
Kline R. (2005) Principles and Practice of Structural Equation
Modeling. 2nd edn, Guilford Press, New York.

166

Kline T.J., Sulsky L.M. & Rever-Moriyama S.D. (2000) Common

method variance and specification error: a practical approach to
detection. The Journal of Psychology, 134(4), 401421.
Lee K., Carswell J.J. & Allen N.J. (2000) A meta-analytic review of
occupational commitment: relations with person- and work-related
variables. Journal of Applied Psychology 85(5), 799811.
Lui S., Ngo H. & Tsang A. (2003) Socialized to be a professional: a
study of the professionalism of accountants in Hong Kong. International Journal of Human Resource Management 14(7), 1192
1205.
Lynn M. & Redman R. (2005) Faces of the nursing shortage. Journal
of Nursing Administration 35(5), 264270.
MacCallum R. & Austin J. (2000) Applications of structural equation modeling in psychological research. Annual Review of Psychology 51, 201226.
MacKinnon D., Lockwood C. & Williams J. (2004) Confidence
limits for the indirect effect: distribution of the product and
resampling methods. Multivariate Behavioral Research 39(1), 99
128.
Mathieu J. & Zajac D. (1990) A review and meta-analysis of the
antecedents, correlates and consequences of organizational commitment. Psychological Bulletin 108(2), 171194.
Meyer J. & Herscovitch L. (2001) Commitment in the workplace:
toward a general model. Human Resource Management Review
11(3), 299326.
Meyer J., Allen N. & Smith C. (1993) Commitment to organizations
and occupations: extension and test of a three-component conceptualization. Journal of Applied Psychology 78(4), 538551.
Meyer J., Allen N. & Topolnytsky L. (1998) Commitment in a
changing world of work. Canadian Psychology 39(12), 8393.
Meyer J., Becker T. & Vandenberghe C. (2004) Employee commitment and motivation: a conceptual analysis and integrative model.
Journal of Applied Psychology 89(6), 9911007.
Mir A., Mir R. & Mosca J.B. (2002) The new age employee: an
exploration of changing employee-organization relations. Public
Personnel Management 31(2), 187200.
Newman K., Uvanney M. & Chansarkar B. (2001) The nurse
retention, quality of care and patient satisfaction chain. International Journal of Health Care Quality Assurance 14(2), 57
68.
Newman K., Maylor U. & Chansarkar B. (2002) The nurse satisfaction, service quality and nurse retention chain: implications for
management of recruitment and retention. Journal of Management
in Medicine 16(4/5), 271291.
Pallant J. (2001) SPSS Survival Manual. Allen & Unwin, Sydney.
Podsakoff P., MacKenzie S., Lee J. & Podsakoff N. (2003) Common
method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of Applied Psychology 88(5), 879903.
Price J.L. (2001) Reflection on the determinants of voluntary turnover. International Journal of Manpower 22(7/8), 600626.
Reed M. (2005) Reflections on the Realist Turn in organization and
management studies. Journal of Management Studies 42(8), 1621
1644.
Shah C. & Burke G. (2001) Job Growth and Replacement Needs in
Nursing Occupations. Retrieved from http://www.dest.gov.au/
highered/programmes/nursing/reports.htm#research_reports on 9
July 2004.

 2008 The Author. Journal compilation  2008 Blackwell Publishing Ltd

JAN: ORIGINAL RESEARCH

Smith G. & Seccombe I. (1999) Changing Times: A Survey of Registered Nurses in 1998. http://www.employment-studies.co.uk/
summary/summary.php?id=351 on 13 June 2003.
Snape E. & Redman T. (2003) An evaluation of a three component
model of occupational commitment: dimensionality and consequences among United Kingdom human resource management
specialists. Journal of Applied Psychology 88(1), 152159.
Sochalski J. (2002) Nursing shortage redux: turning the corner on an
enduring problem. Health Affairs 21(5), 157164.
Tabachnick B. & Fidell L. (2001) Using Multivariate Statistics. 4th
edn, Allyn and Bacon, Boston.
Tai T., Bame S. & Robinson C. (1998) Review of nursing turnover
research, 1977-1996. Social Science & Medicine 47(12), 1905
1924.

Intention to leave the profession

Tett R. & Meyer J. (1993) Job satisfaction, organizational commitment, turnover intention and turnover: path analyses based on
meta-analytic findings. Personnel Psychology 46(2), 259293.
Tovey E. & Adams A. (1999) The changing nature of nurses job
satisfaction: an exploration of the sources of satisfaction in the
1990s. Journal of Advanced Nursing 30(1), 150158.
West E., Barron D. & Reeves R. (2005) Overcoming the barriers to
patient-centred care: time tools and training. Journal of Clinical
Nursing 14, 435443.
World Health Organization (2006) The World Health Report 2006:
Working Together for Health. Retrieved from http://www.who.int/
whr/2006/06_chap5_en.pdf on 20 June 2006.

The Journal of Advanced Nursing (JAN) is an international, peer-reviewed, scientific journal. JAN contributes to the
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