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Abstract
Purpose
The purpose of this study was to conduct a systematically review of factors related to the reported intention of hospital nurses in Korea to leave their positions.
Methods
Appropriate studies in the recent ten years were selected from databases. A total of 263 studies were selected for the systematic review on the basis of the PRISMA flow. The correlational effect size of 35 studies was analyzed through meta-analysis using CMA 3.0.
Results
Through systematic review, 52 related factors were classified by ecological system: 18 individual, 12 microsystem, 11 mesosystem, 8 exosystem, and 3 macrosystem. The overall effect size of turnover intention was 3.26. The total correlational effect size of related factors was 0.28: 0.14 for individual, 0.50 for microsystem, 0.25 for mesosystem and 0.40 for exosystem. Among single factors with larger effect size, emotional labor, role conflict, and work-home conflict were classified into contributors whereas organizational commitment, job satisfaction, and internal marketing were classified as inhibitors.
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Table 1.
Characteristics of Selected Studies for Systematic Review (K=263/N=79,236)
| Characteristics | Categories | Number of studies (%) | Number of participants |
|---|---|---|---|
| Publication year | 2006~2010 | 58 (22.0) | 17,761 |
| 2011~2013 | 107 (40.7) | 45,290 | |
| 2014~2016 | 98 (37.3) | 16,185 | |
| Gender | All included | 127 (48.3) | 43,017 |
| Female only | 33 (12.6) | 7,718 | |
| Male only | 3 (1.1) | 424 | |
| Not reported | 100 (38.0) | 28,077 | |
| Career | New nurse only | 17 (6.5) | 4,360 |
| All included | 246 (93.5) | 74,876 | |
| Marital status | Married only | 9 (3.4) | 1,923 |
| All included | 254 (96.6) | 77,313 | |
| Hospital size | General | 166 (63.1) | 46,338 |
| Advanced general | 54 (20.5) | 13,056 | |
| General + Advanced general | 43 (16.4) | 19,842 | |
| Nursing units | Special units only† | 28 (10.6) | 5,554 |
| All units included | 188 (71.5) | 62,244 | |
| Not reported | 47 (17.9) | 11,438 | |
| Location | Metropolitan area | 85 (32.3) | 22,145 |
| Non-metropolitan area | 89 (33.9) | 22,835 | |
| Nationwide | 19 (7.2) | 16,437 | |
| Not reported | 70 (26.6) | 17,819 | |
| Publication type | Dissertation | 129 (49.0) | 36,585 |
| Journal article | 134 (51.0) | 42,651 | |
| Measurements for turnover intention | Lawler (1983) | 70 (26.6) | 19,555 |
| Mobley (1982) | 45 (17.1) | 11,933 | |
| Kim (2007) | 21 (8.0) | 4,899 | |
| Becker (1992) | 11 (4.2) | 2,562 | |
| Lee (1994) | 6 (2.3) | 1,378 | |
| Cook, Hepworth & Warr (1981) | 5 (1.9) | 1,349 | |
| Price & Mueller (1986) | 5 (1.9) | 1,454 | |
| Micheals & Specter (1982) | 5 (1.9) | 939 | |
| Yun & Kim (2013) | 4 (1.5) | 905 | |
| Others | 91 (34.6) | 34,262 | |
| Research design | Cross-sectional survey | 252 (95.8) | 78,910 |
| Interventional study | 4 (1.5) | 244 | |
| Qualitative study | 7 (2.7) | 82 |
Table 2.
Classification of Related Factors according to Ecological System
| Eco-Systems | Categories | Related factors | Number of studies† (%) |
|---|---|---|---|
| Individual | Demographics characteristics | Age | 116 (44.1) |
| Gender | 7 (2.7) | ||
| Religion | 22 (8.4) | ||
| Education | 62 (23.6) | ||
| Military service | 1 (0.4) | ||
| Sex role identity | 2 (0.8) | ||
| Marital staus | 75 (28.5) | ||
| Subtotal | 285 (48.9) | ||
| Job-related personal characteristics | Position | 62 (23.6) | |
| Work experience | 106 (40.3) | ||
| Estimated duration of work | 9 (3.4) | ||
| Reason to work | 4 (1.5) | ||
| Working at requested unit | 3 (1.1) | ||
| Turnover experience | 14 (5.3) | ||
| Rotation experience | 6 (2.3) | ||
| Subtotal | 204 (35.0) | ||
| Personal characteristics | Emotional intelligence | 11 (4.2) | |
| Personality | 24 (9.1) | ||
| Physical・ mental health | 27 (10.3) | ||
| Positive psychological capital | 32 (12.2) | ||
| Subtotal | 94 (16.1) | ||
| Micro | Family characteristics | Number of children | 10 (3.8) |
| Parenting-related stress | 9 (3.4) | ||
| Work-home conflict | 7 (2.7) | ||
| Support from family | 2 (0.8) | ||
| Subtotal | 28 (6.9) | ||
| Occupational characteristics | Nursing professionalism | 24 (9.1) | |
| Organizational commitment | 59 (22.4) | ||
| Job commitment | 34 (12.9) | ||
| Burn out | 44 (16.7) | ||
| Job stress | 64 (24.3) | ||
| Job satisfaction | 117 (44.5) | ||
| Emotional labor | 29 (11.0) | ||
| Role conflict | 6 (2.3) | ||
| Subtotal | 377 (93.1) | ||
| Meso | Unit characteristics | Number of patients assigned | 1 (0.4) |
| Working unit | 41 (15.6) | ||
| Shift type | 70 (26.6) | ||
| Subtotal | 112 (43.2) | ||
| Work characteristics | Heavy workload | 4 (1.5) | |
| Unit work environment | 33 (12.5) | ||
| Subtotal | 37 (14.3) | ||
| Manager characteristics | Leadership | 27 (10.3) | |
| Supervisor's emotional experience | 1 (0.4) | ||
| Subtotal | 28 (10.8) | ||
| Unit culture | Organizational culture of working unit | 46 (17.5) | |
| Workplace violence | 19 (7.2) | ||
| Supervisor-subordinate relationship | 5 (1.9) | ||
| Communication | 12 (4.6) | ||
| Subtotal | 82 (31.7) | ||
| Exo | Hospital characteristics | Type of hospital | 8 (3.0) |
| Nursing manpower grade | 2 (0.8) | ||
| Subtotal | 10 (7.6) | ||
| Marketing | Career development system | 13 (4.9) | |
| Internal marketing | 80 (30.4) | ||
| Hospital work environment | 7 (2.7) | ||
| Subtotal | 100 (75.7) | ||
| Hospital culture | Ethical climate | 1 (0.4) | |
| Leadership of chief executive officer | 5 (1.9) | ||
| Inter-department communication | 16 (6.1) | ||
| Subtotal | 22 (16.7) | ||
| Macro | Health policy | Integrated nursing care service | 1 (0.4) |
| Hospital accreditation | 3 (1.1) | ||
| Subtotal | 4 (80.0) | ||
| Social welfare | Parenting support system | 1 (0.4) | |
| Subtotal | 1 (20.0) |
Table 3.
Comparison of Turnover Intention by Study Characteristics (K=35, N=11,885)
Table 4.
Effect size of Related Factors for Turnover Intention
Appendix 1.
List of Meta-Analyzed Studies
G=general hospital; AG=advanced general hospital; NR=not reported; M=metropolitan area; Non-M=non-metropolitan area; Nation=nationwide. Relates factors: 1=Age, 2=Sex, 3=Religion, 4=Marital status, 5=Positive personality, 6=Physical/mental health, 7=Positive psychological capital, 8=Work experience, 9=Turnover experience, 10=Rotation experience, 11=Work-home conflict, 12=Nursing professionalism, 13=Organizational commitment, 14=Burn out, 15=Job stress, 16=Job satisfaction, 17=Emotional labor, 18=Role conflict, 19=Shift type, 20=Heavy workload, 21=Unit work environment, 22=Leadership of the manager, 23=Unit organizational culture, 24=Workplace violence, 25=Internal marketing,
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