Nursing and Health Sciences (2011), 13, 184–191

Research Article

Turnover intention among Italian nurses: The moderating

roles of supervisor support and organizational support nhs_596 184..191

Maura Galletta, msc, phd,1 Igor Portoghese, msc, phd,1 Maria Pietronilla Penna, msc,1
Adalgisa Battistelli, msc, phd3 and Luisa Saiani, rn, bnsc, mnsc2
1
Department of Psychology, University of Cagliari, Cagliari, 2Department of Public Health and Community Medicine,
University of Verona, Verona, Italy and 3Laboratory Epsylon – Dynamics of Human Abilities and Health Behaviors,
University of Paul Valéry Montpellier, Montpellier, France

Abstract The purpose of this study was to examine the variables that are related to person–environment fit in Italian
nurses, highlighting the role of supervisor support and organizational support in the relationship between
nurses’ perceptions of care adequacy, job satisfaction, and turnover intention. Therefore, 1240 nurses from
three hospitals completed a self-administered questionnaire. The results showed that supervisor support and
organizational support act differently as moderators of the care adequacy–job satisfaction–turnover intention
relationship. Finally, job satisfaction was a mediating variable between care adequacy and turnover intention.
These findings have important implications for hospitals because they help to promote effective work envi-
ronments and to reduce turnover intention.

Key words care adequacy, Italy, job satisfaction, nurses’ turnover intention, organizational support, retention of nurses,
supervisor support.

INTRODUCTION individuals’ satisfaction, organizational functionality, and the

recruitment and retention of health workers (Schneider et al.,
Nurses’ retention is one of the main concerns in the health-
2000). Exploring the relationship between nurses’ percep-
care system, especially in times of chronic nursing shortages.
tions of their working environment and their professional
In the last 10 years, many countries have invested heavily in
needs, little research has been done on the predictor role of
resolving this phenomenon and shifted towards evidence-
care and resource adequacy (care adequacy) and the poten-
based practice, which has resulted in the need to study the
tial intervening factors that are related to turnover intention.
relationships among staffing turnover, nurse satisfaction,
Particularly, in the context of inadequate care and resources,
quality, and adequacy of care (Melnyk & Fineout-Overholt,
there are risks of errors, absenteeism, and high levels of
2010). Wagner (2010) asserted that nursing turnover is a dan-
staff turnover (Stone et al., 2006). Aiken et al. (2008), in their
gerous outcome because it is linked to the loss of individual
research on magnet hospitals, showed that perceptions of the
and organizational performance, a significant reduction in
quality and adequacy of care are important variables among
the quality of care, an increase in the workload of the staff
the numerous factors that influence nurses’ satisfaction. Spe-
members who survived the turnover, and a loss in morale
cifically, they suggested that nurses’ job satisfaction is linked
and further turnover. Actually, in Italy, a worrisome nursing
to their ability to provide high-quality care. This research
shortage has been observed and the Italian Federation of
highlights how care adequacy is related to both job satisfac-
Nurses has estimated a current shortage of 40,000 nurses
tion and turnover intention and examines the important role
(Destrebecq et al., 2009). There has been growth in the
of social exchange constructs (e.g. perceived support) in the
research that seeks to identify the most important predictors
above-mentioned relationships.
of nurses’ retention (Beecroft et al., 2008). However, accord-
ing to Takase et al. (2005: 211–212), researchers “tend to
examine the effects of environmental characteristics and LITERATURE REVIEW
nurses’ needs separately and assume that each or both of the
factors individually contribute to nurses’ work behavior.” In Theoretical perspectives
this regard, the work environment’s characteristics affect In this study, the Person–Environment (P–E) Fit Theory
(Schneider et al., 2000) was considered as the theoretical
framework. The central tenet of much of this work is that a
Correspondence address: Maura Galletta, Department of Psychology, University of
Cagliari, Via Is Mirrionis 1, 09123 Cagliari, Italy. Email: maura.galletta@gmail.com good fit between the person and the situation will generate
Received 24 February 2011; accepted 4 April 2011. positive outcomes, whereas a mismatch will produce negative

© 2011 Blackwell Publishing Asia Pty Ltd. doi: 10.1111/j.1442-2018.2011.00596.x

Nursing turnover intention
outcomes. Schneider et al. (2000) proposed a person-based
framework to explain the process by which individuals are
attracted to, selected by, and either leave or remain in orga-
nizations. The main characteristic of the P–E Fit Theory is its
focus on the interaction between employees and their job or
organization, rather than on the individual effects of personal
or organizational characteristics, to explain the employees’
work behavior. According to Schneider (1983: 35), “people
are attracted to organizations because of organizational
goals, organizations select people who appear to be able to
help the organization achieve its goals, and people who
achieve their own goals there will tend to remain in the
organization.” However, a misfit can motivate workers to try
to change the organizational characteristics to meet their
job needs, adjust themselves to the organization, or quit
the organization to search for another compatible organiza-
tion (Takase et al., 2005). Therefore, a misfit between the job
and environmental supplies can lead to employees’ turnover
intention (Takase et al., 2008). For example, a misfit can occur
when nurses perceive that, in their unit, the main (profes-
sional and organizational) mission to offer adequate care to
patients is not ensured. In fact, studies on staff nurses in
magnet hospitals identified the perceived care adequacy as
one of the principal elements of a healthy, satisfying, and
productive work environment, which increased nurses’ reten-
tion (Kramer & Schmalenberg, 2002). Furthermore, in defin-
ing the quality of the relationship between the individual and
the organization, a growing body of work recognizes the
important role of support from both a supervisor and the
organization in decisions to stay (Maertz et al., 2007).
Perceived supervisor and organizational support
An important factor in defining the essence of social
exchange in employment relationships is supervisory and
management support. In fact, employees develop general
views regarding the degree to which supervisors and the
organization value their contributions and care about their
well-being (Eisenberger et al., 1986; Kottke & Sharafinski,
1988; Rhoades & Eisenberger, 2002), which are called “per-
ceived supervisor support” (PSS) and “perceived organiza-
tional support” (POS), respectively. As supervisors act on
behalf of the organization because they evaluate the employ-
ees’ contribution and manage the reward systems, the treat-
ment that employees receive from their supervisor can
impact on their turnover intention (Eisenberger et al., 1986;
Tekleab et al., 2005). In the healthcare context, a nursing
supervisor is the person who directly works with the nursing
staff in the unit and therefore has an impact on both the
staff’s working life and quality of care (Failla & Stichler,
2008). They play a key role in coping daily with major
challenges, as well as in demanding efficiency (Abdelrazek
et al., 2010), and they can affect the quality in different ways,
including the effect that they have on job satisfaction or staff
well-being (Hannan et al., 2001). In fact, a lack of support
from the direct supervisor could prompt nurses’ dissatis-
faction and burnout. According to Tourangeau and Cranley
(2006), supervisor support is an important organizational
factor that indirectly affects the intention to remain
185
employed, mediated through job satisfaction. Nurses who
perceived their managers as supportive (e.g. recognition,
encouragement, flexible work schedules, and positive feed-
back) reported greater scores in both job satisfaction and the
intention to remain employed (Sourdif, 2004). Moreover, per-
ceptions of supervisory support were related to perceptions
of the quality of care in the unit (Raikkonen et al., 2007).
Based on these considerations, PSS is likely to act specifically
on the relationship between care adequacy and job satisfac-
tion, which in turn is related to turnover intention. Perceived
organizational support is activated by a social exchange
process and through a norm of reciprocity, which can produce
a sense of employee obligation to aid the organization. This
might generate attitudinal and behavioral outcomes that
reciprocate favors, which lead to lower turnover (Tekleab
et al., 2005). As job satisfaction is a relevant antecedent of
turnover intention (Lambert et al., 2001), POS is likely to act
specifically on the relationship between job satisfaction and
turnover intention. Thus, supervisory and organizational
support can act as facilitators in the process of “matching” the
employee with the work environment. Even though the lit-
erature has shown the importance of PSS and POS in the
relationship between job satisfaction, quality of care, and
turnover intention, how PSS and POS can act differently as
moderating variables in the care adequacy–job satisfaction–
turnover intention relationship has not been analyzed.
AIM AND HYPOTHESES
The aim of the study was to examine the relationship
between the principal variables that are related to turnover
intention. Specifically, the moderating role of PSS on the
relationship between care adequacy and job satisfaction and
the moderating role of POS on the relationship between job
satisfaction and turnover intention were examined. Based on
the literature, the following hypotheses were tested:
• Hypothesis 1a: care adequacy shows a positive relation-
ship with job satisfaction
• Hypothesis 1b: PSS shows a positive relationship with
job satisfaction
• Hypothesis 2: PSS moderates the positive relationship
between care adequacy and job satisfaction, such that the
relationship is stronger when PSS is higher
• Hypothesis 3a: Job satisfaction shows a negative rela-
tionship with turnover intention
• Hypothesis 3b: POS shows a negative relationship with
turnover intention
• Hypothesis 4: POS moderates the negative relationship
between job satisfaction and turnover intention, such that the
relationship is weaker when POS is lower
• Hypothesis 5: Job satisfaction mediates the relationship
between care adequacy and turnover intention
Figure 1 represents the hypothesized relationships.
METHOD
Design, participants, and data collection
A cross-sectional survey was conducted. A convenience
sample of registered nurses was recruited for this study. For
© 2011 Blackwell Publishing Asia Pty Ltd.
186
Figure 1. Representation of the hypothesized relationships. H1a
and H1b indicate the direct relationships of care adequacy and PSS
on job satisfaction; H2 indicates the moderating effect of PSS on the
relationship between care adequacy and job satisfaction; H3a and
H3b indicate the direct relationships of job satisfaction and POS on
turnover intention; H4 indicates the moderating effect of POS on the
relationship between job satisfaction and turnover intention; H5
indicates the mediating effect of job satisfaction on the relationship
between care adequacy and turnover intention. H, hypothesis; POS,
perceived organizational support; PSS, perceived supervisor support.
the recruitment of the sample, hospitals within the public
sector and that were in urban areas were used. After contact-
ing the hospitals, the nurses for whom the administration
gave formal approval to participate in the study were con-
tacted and recruited. In total, this research involved 1938
registered nurses from three hospitals in the north of Italy. Of
these nurses, 1240 completed the questionnaire, yielding a
response rate of 64%. The data were collected by using a
paper questionnaire, which was distributed to the nurses
through the nurse supervisor of each unit. The participants
anonymously and voluntarily completed the questionnaire
during working hours. The nurses were given 3 weeks to com-
plete and return their questionnaire in locked boxes.
Instrument
The questionnaire included one part concerning personal
data (sex, age, and tenure) and another part containing the
measurement scale of the variables that were used in this
study. As not all the scales that were used had been validated
previously in Italian, the translation–back-translation proce-
dure (Brislin, 1980) was used for those scales. A panel that
was made up of two bilingual linguistic experts and two
Italian nurse academics translated the original structure of
the questionnaire independently from English into Italian.
After reviewing both translations, minimal changes were
made to the wording. A pilot study, involving 89 Italian
nurses, then was conducted to ensure further validity of the
instrument.
All the items were rated on a five-point scale, ranging
from 1 (“strongly disagree”) to 5 (“strongly agree”). To
measure POS, four high-loading items (loadings from 0.54–
0.67) from the Survey of Perceived Organizational Support
(SPOS) (Eisenberger et al., 1986) were used. The sample
items included “My department cares about my opinions.”
To assess PSS, the SPOS was adapted by replacing the word
“organization” with the term “supervisor”. Five high-loading
items (loadings from 0.78–0.87) were selected. The sample
© 2011 Blackwell Publishing Asia Pty Ltd.
M. Galletta et al.
items included “My supervisor really cares about my well-
being.” To measure care adequacy, four items that were
adapted from Nursing Work Index-Revised (Aiken & Patri-
cian, 2000) were used. The sample items included “Enough
time and staff to get the work done.” The Questionnaire of
Organizational Satisfaction from Cortese (2001) was used to
assess job satisfaction. Six high-loading items (loadings from
0.70–0.76) that related to satisfaction with job aspects were
selected. The sample items included “The personal growth
derived from my job” and “Quality of my job.” Turnover
intention was measured by two items that were adapted from
Hom et al. (1984). The sample items included “I am going to
seek a job in another hospital next year” and “I intend to
leave my unit to work in another unit in the same hospital
next year.”
Data analysis
All the analyses were carried out by using SPSS software
program version 17.0 (SPSS: An IBM Company, Chicago, IL,
USA). An exploratory factor analysis (EFA) for the con-
structs’ measurement was used and the assessment of the
internal consistency of the measures was conducted by Cron-
bach’s alpha (a). Relative to hypotheses 2 and 4, moderation
analyses were carried out via hierarchical regression analy-
ses. A moderator is a variable that alters the strength of the
relationship between an independent variable and a depen-
dent variable. Specifically, the authors believed that PSS
moderates the relationship between care adequacy and job
satisfaction. In the same manner, the authors expected to find
an interaction between job satisfaction and POS with respect
to their effect on turnover intention. Relative to hypothesis 5,
a mediation analysis was carried out by the joint significance
test (JST) (MacKinnon et al., 2002). A mediator (or interven-
ing) variable transmits the effect of an independent variable
to a dependent variable. The mediator causes variation in the
outcome variable and itself is caused by the predictor vari-
able. In this study, the authors supposed that job satisfaction
intervenes in the relationship between care adequacy and
turnover intention.
Ethical considerations
The study was approved by the ethical committee of the
Italian public health system. The participants were informed
that their anonymity was assured. Informed consent to par-
ticipate was assumed when the nurses returned a completed
questionnaire.
RESULTS
Descriptive characteristics
Table 1 shows the mean values, standard deviations (SDs),
Cronbach’s alpha coefficients, and correlations among the
variables that were analyzed in this study. They all were sig-
nificantly correlated. The magnitude and direction of these
correlations were consistent with the predictions. Most of the
sample was female (81.45%). The average age of the women
Nursing turnover intention 187

Table 1. Means, standard deviations, and correlations among the study variables (n = 1240)

Mean SD TurInt JobSat CareAd PSS POS

TurInt 1.830 1.221 0.850

JobSat 3.344 0.678 -0.233** 0.870
CareAd 2.373 0.772 -0.149** 0.358** 0.820
PSS 2.964 0.874 -0.187** 0.485** 0.345** 0.920
POS 2.773 0.771 -0.197** 0.546** 0.371** 0.715** 0.860

**P < 0.01. The Cronbach’s alpha values are shown in italics. CareAd, care adequacy; JobSat, job satisfaction; POS, perceived organizational
support; PSS, perceived supervisor support; TurInt, turnover intention.

Table 2. Hierarchical regression results for the moderating effect of perceived supervisor support (PSS) on the relationship between care
adequacy and job satisfaction

95% CI
Regression step b SE t-value Lower limit Upper limit

Step 1
Education 0.01 0.018 0.41 -0.03 0.040
Tenure -0.08** 0.003 -2.87 -0.01 -0.003
R2 = 0.004*
Step 2
Care adequacy 0.22*** 0.026 8.55 0.17 0.270
PSS 0.40*** 0.026 15.37 0.35 0.450
DR2 = 0.27***
Step 3
Care adequacy ¥ PSS 0.09*** 0.023 3.69 0.04 0.130
DR2 = 0.008***
F = 13.64
Total R2(adj) = 0.29

*P < 0.05, **P < 0.01, ***P < 0.001. Standardized b-values from the final step of the regression analysis are presented. CI, confidence interval.

was 36.95 years (SD = 7.91) and the average age of the men
was 37.31 years (SD = 8.19) (range: 21–60 years). The mean
experience levels were 14.16 years (SD = 8.88) in the profes-
sion (range: 1–38 years) and 7.84 years (SD = 6.92) in the unit
(range: 1–38 years). Table 1 shows that the Italian nurses per-
ceived moderate levels of care adequacy, job satisfaction,
POS, and PSS and had low scores of turnover intention, on
average (mean = 1.83, SD = 1.22).
Exploratory factor analysis
The discriminant validity of the constructs was tested
via an EFA with the maximum likelihood extraction
method. The results showed five factors with Eigenvalues
> 1, explaining ~ 58% of the variance of the indicators.
The Keiser-Meyer-Olkin measure of sampling adequacy was
0.92 and the Bartlett’s test of sphericity was significant
(c2 [d.f. = 210] = 13,597.35, P < 0.001), indicating adequate
intercorrelations among the items in the questionnaire and
the suitability of the factor analysis (Hair et al., 2006). The
reliability coefficients of the measures were good (0.82–0.92),
revealing a strong internal consistency.
Hierarchical regression analyses
In order to test the interaction effects, two different regres-
sion models were carried out. Multiplicative terms for the
standardized independent variables were created, as sug-
gested by Cohen and Cohen (1983). Then, the standardized
independent variables were introduced into the equation in
three steps. Regression equations were computed by entering
two control variables (education and tenure) in the first step
of each regression analysis. Next, the independent variable
(job satisfaction or care adequacy) and the moderator (PSS
or POS) were introduced in step 2. The interaction term was
introduced in step 3 (see Tables 2 and 3 for the results).
Lastly, the significant interaction effects were represented
by figures. Independent lines of regression were generated
from the regression equation to represent the relation-
ship between the independent variable and the dependent
variable, defining the high values and the low values of the
moderator variable at relatively one SD above and below
the mean. A JST was carried out to test the mediation effect.
To assess the significance, three steps were carried out by
calculating: (i) the a path (care adequacy on job satisfaction);
(ii) the b path (job satisfaction on turnover intention),

© 2011 Blackwell Publishing Asia Pty Ltd.

188 M. Galletta et al.

Table 3. Hierarchical regression results for the moderating effect of perceived organizational support (POS) on the relationship between job
satisfaction and turnover intention

95% CI
Regression step b SE t-value Lower limit Upper limit

Step 1
Education 0.10*** 0.020 3.50 0.03 0.110
Tenure -0.26*** 0.003 -9.06 -0.04 -0.020
R2 = 0.09***
Step 2
Job satisfaction -0.19*** 0.032 -5.89 -0.26 -0.130
POS -0.01 0.033 -0.30 -0.07 0.050
DR2 = 0.04***
Step 3
Job satisfaction ¥ POS -0.05† 0.023 -1.93 -0.09 0.001
DR2 = 0.003†
F = 3.73
Total R2(adj) = 0.13

***P < 0.001. †P < 0.10. Standardized b-values from the final step of the regression analysis are presented. CI, confidence interval.

controlling for care adequacy effects in the equation; and (iii)

the mediated effect (the product of the a- and b-values [ab]).
If the ab product is significant (P = 0.05), mediation is
present. Furthermore, 95% confidence intervals were calcu-
lated in order to provide a range of estimates for the actual
mediated effect value.
Consistent with hypotheses 1a and 1b, care adequacy
and PSS were positively related to job satisfaction (b = 0.22,
P < 0.001 and b = 0.40, P < 0.001, respectively). When the
interaction term for care adequacy and PSS was entered in
step 3 of the first regression analysis, the positive effect of
care adequacy on job satisfaction was found to be moderated
by PSS. The interaction coefficient was significant (b = 0.09,
P < 0.001), with a significant increment in the explained vari-
ance (DR2 = 0.008, P < 0.001). In order to interpret the form
of interaction, the equation at the high and low levels of PSS Figure 2. Two-way interaction effect of care adequacy and per-
ceived supervisor support (PSS) on job satisfaction.
was plotted according to the procedure that was proposed by
Aiken and West (1991). The results showed that the form of
the interaction was in the expected direction. An increase in
the perceived care adequacy was significantly associated with
levels of POS were plotted. Figure 3 illustrates that the nurses
high job satisfaction; this relationship was attenuated by low
with high levels of job satisfaction showed low levels of turn-
PSS (Fig. 2). The nurses were more satisfied in response to
over intention and this relationship was stronger when the
higher levels of care adequacy when they had high PSS. Thus,
level of POS was high. Therefore, this study showed that the
hypothesis 2, about the moderating effect of PSS, also was
satisfied employees with a high perception of organizational
supported.
support had a lower desire to leave their unit. Thus, hypoth-
Relative to the second regression analysis, the results
esis 4 was supported.
indicated that job satisfaction was negatively related to turn-
Lastly, hypothesis 5, regarding the mediating effect of job
over intention (b = -0.19, P < 0.001), but POS showed an
satisfaction, also was supported. The coefficients of paths a
insignificant relationship with turnover intention (b = -0.02,
and b were statistically significant, as well as the ab indirect
not significant). Thus, hypothesis 3a was supported, but not
effect (Table 4).
hypothesis 3b. When the interaction term for job satisfaction
and POS was entered in step 3, it was marginally significant
(b = -0.05, P = 0.054). In fact, the job satisfaction ¥ POS inter-
DISCUSSION
action term explained a significant incremental portion of the
variance (DR2 = 0.003, P < 0.10). To examine the nature of the Driven by P–E Fit Theory, this study provides new insights
interaction, the regression lines for the relationship between into the constructs and their respective contribution to turn-
job satisfaction and turnover intention at the high and low over intention, the latter being considered historically as a

© 2011 Blackwell Publishing Asia Pty Ltd.

Nursing turnover intention
Figure 3. Two-way interaction effect of job satisfaction and per-
ceived organizational support (POS) on turnover intention.
direct antecedent of the actual turnover (Waters & Roach,
2006). Previous studies have shown that a supportive envi-
ronment is related to job satisfaction among nurses that, in
turn, is related to turnover intention (Cai & Zhou, 2009).
Nevertheless, there is no sufficient study on the aspects that
are specifically related to work environments as impor-
tant factors relating to the turnover process, such as care
adequacy. The authors believe that this variable is important
to consider, specifically in the nursing context that is charac-
terized by different working units and different kinds of
activities, depending on the department. In several studies on
magnet hospitals, care adequacy was one important aspect
that was related to working quality, job satisfaction and
nursing retention (Aiken et al., 2001). Relative to this aspect,
it was found that care adequacy is related directly to job
satisfaction. Moreover, this research adds to previous studies
in relation to the importance of the moderating role of PSS
in the relationship between care adequacy and job satisfac-
tion and of POS in the relationship between job satisfaction
and turnover intention. Then, this study shows the different
contribution of these variables in the process related to turn-
over intention. The supervisor role is important in order to
promote the improvement processes of the unit, to take into
account nurses’ work-related needs, and to support the staff
members to perform better in their own work. A high or
low level of support varies the strength of the relationship
between care adequacy in the nurses’ own unit and job sat-
isfaction. Furthermore, it was found in this study that PSS is
an important determinant of job satisfaction, agreeing with
the result of McGilton et al. (2007). In contrast, POS concerns
the individual’s belief about the ability of the organization to
care for nurses’ well-being and to take into account their
values. Thus, the individual’s perception about what the unit
does for its nurses represents an essential element of the
social exchange relationship between the workers and the
unit. In fact, although it was found that POS is not related
directly to turnover intention, it does interact with nurses’
job satisfaction in relation to the desire to leave their unit.
Therefore, PSS and POS can help to define the quality of the
189
P–E relationship and to strengthen the relationship between
the analyzed predictors and variables. Although it is not pos-
sible to make causal inferences between the variables, this
research contributes to the identification of the relationship
between the individual and organizational variables that are
significantly related to the turnover intention process. In fact,
this study supports the findings of Aiken et al. (2001) that
care adequacy is related to job satisfaction and turnover
intention. Specifically, it was found that the nurses who per-
ceived the adequate care of patients and adequate resources
to provide for quality care in their own unit felt satisfied with
their activities and this satisfaction, in turn, was negatively
related to the desire to leave the unit. Moreover, it was found
that the role of the nurses’ supervisor significantly interacts
with care adequacy in relation to job satisfaction. The nurses
who perceived high care adequacy and who had high PSS
were more satisfied with their work. Yet, organizational
support moderates the relationship between job satisfaction
and turnover intention: the higher the nurses’ job satisfac-
tion, the lower is their turnover intention, but the strength of
this relationship decreases when POS is low.
Practical implications
The results of this research show the importance of develop-
ing organizational management practices that are necessary
for success and general organizational efficacy. In order to
control turnover intention, organizations should implement
strategies that facilitate the satisfaction of employees’ needs
by promoting both high-quality nurse–supervisor and nurse–
organization relationships, activating significant experiences
of autonomy and responsibility for employees, and feedback.
It was found that organizational support is a key element in
nurses’ retention, but the relationship with supervisors is
instrumental in job satisfaction. Ribelin (2003: 18) stated that
“nurses do not leave hospitals, they leave managers.” This
means that the relationship with supervisors might be an
important factor in nurses’ decision to leave, as much as the
relationship with the unit. Yet, the perceived care adequacy
can be improved by focusing on the clinical competence of
the staff, building cohesive teams, and promoting the staff’s
freedom to alter delivery systems (Schmalenberg & Kramer,
2009). Finally, enhancing job satisfaction through perceived
support and care adequacy can have important implications
for the individual, the organization’s well-being, and the
patient’s health.
Limitations of the study
This study had a few limitations that might be addressed
in future research. First, in order to collect the data, self-
report measures were used without the integration of further
objective measures (absenteeism and actual turnover). This
aspect could raise doubts about the validity of the obtained
data (Goffin & Gellatly, 2001). Furthermore, a truncated and
unvalidated version of a variety of measures from different
questionnaires was used. Despite the internal consistency of
the measures being good, it could be problematic to assess
the effective validity and reliability of the whole instrument.
© 2011 Blackwell Publishing Asia Pty Ltd.
190
Table 4. Mediation effect of job satisfaction on the relationship between care adequacy and turnover intention: results for the joint significance
effect
Care adequacy effect Mediator effect on
Mediator on the mediator (a) turnover intention (b)
Job satisfaction 0.36* (0.03) -0.23* (0.03)
Model summary
F R2(adj)
43.58 0.07
*P < 0.001. CI, confidence interval.
Second, for this study, a sample of nurses from the north of
Italy was used. Therefore, it is impossible to compare the
measures of this study with data from other regions of Italy,
which reduces the external validity of the research. In order
to obtain greater support for the model, it might be necessary
to replicate the study with nurses from different geographic
areas of Italy (e.g. nurses in central and southern areas).
Another limitation is that a longitudinal design was not used.
As this research was cross-sectional in nature, one should be
aware that it is not possible to explain the causal influence
(Mathieu & Taylor, 2006). Turnover is a result of dynamic
processes that need longitudinal-type studies to investigate
its evolution across time. Future studies should consider such
methods and test the long-term effects of perceived support,
care adequacy, and job satisfaction over outcomes such as
actual turnover and absenteeism.
Future directions and conclusions
This research highlights how PSS and POS can moderate
differently the strength of the relationship between care
adequacy and job satisfaction and between job satisfaction
and turnover intention, respectively; all the important ele-
ments are related to a high P-E fit. Moreover, this study
shows how the individual’s evaluation of care adequacy is
associated with higher job satisfaction that, in turn, is related
to low turnover intention. It also was found that job satisfac-
tion has a central role. Future guidelines can contribute
further to understanding the phenomenon and overcoming
the limitations highlighted above. First, Eisenberger et al.
(1986) proposed that employees who believe that they are
supported by the organization tend to reciprocate with posi-
tive work attitudes and behaviors. This is because the per-
ceived support is linked to a stronger commitment to the
organization and feeling of obligation to reciprocate the
organization’s support by caring about the organization’s
well-being (Rhoades & Eisenberger, 2002). Thus, future
studies should examine the role of organizational commit-
ment as an intervening factor, which can have a direct impact
on turnover. Commitment is a dynamic process by nature;
therefore, using a longitudinal method, including long-term
cause–effect influences, could be useful to understand better
the existing relationship with turnover behaviors. Yet, it
would be interesting to expand studies on the examination of
the antecedents of perceived support and turnover intention.
© 2011 Blackwell Publishing Asia Pty Ltd.
M. Galletta et al.
95% CI
Lower limit of Upper limit of the
Indirect effect (ab) the mediated effect mediated effect
-0.08* (0.01) -0.11 -0.06
P-value
< 0.001
Gagné and Deci (2005) stated that the extent to which orga-
nizations support their employees by satisfying their psycho-
logical needs could influence the employees’ behavior. They
documented that the need for job autonomy is associated
with high motivational autonomy as it assigns responsibility
and stimulates personal growth and it can determine higher
job satisfaction and commitment to the unit and lower turn-
over. In conclusion, the results of this study add new knowl-
edge on more effective strategies to improve nurses’ quality
of work life and to reduce the likelihood of dysfunctional
turnover by creating work environments that support nursing
practice and the actual demands of nurses.
ACKNOWLEDGMENTS
The authors thank all the nurses who participated in this
research.
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