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Turnover intention among nurses poses a significant threat to both workforce stability and the overall quality of healthcare delivery. However, few studies have comprehensively examined the associations between turnover intention and nurses' individual and team-level resources within a multilevel framework. Our study aims to provide an in-depth exploration of the relationship between turnover intention and nurses' individual and team-level resources.
The multicenter cross-sectional study adopted a stratified convenience sampling approach to enroll 773 clinical nurses from 62 teams across eight hospitals in Shandong Province, China.
We used the 10-item Connor-Davidson Resilience Scale for psychological resilience, the Perceived Social Support Scale for perceived social support, the 51-item Analyzing and Developing Adaptability and Performance in Teams to Enhance Resilience Scale for team resilience, and a single-item turnover intention measure. Multilevel logistic regression modeling was conducted to examine the simultaneous impacts of individual-level (psychological resilience and perceived social support) and team-level (team resilience) factors on turnover intention, while controlling for key demographic and organizational covariates.
The multilevel analysis revealed several key findings: (1) The prevalence of turnover intention reached 35.6%, indicating a substantial workforce stability challenge; (2) Multilevel modeling demonstrated significant between-team variance (ICC = 0.19), confirming the importance of examining nested data structures; (3) At the individual level, both psychological resilience (OR = 0.78, CI: 0.62–0.99) and perceived social support (OR = 0.75, CI: 0.60–0.94) showed significant negative associations with turnover intention; (4) At the team level, higher team resilience predicted lower turnover intention (OR = 0.73, CI: 0.56–0.94). These results were obtained after controlling for key demographic and organizational covariates, highlighting the robust protective effects of multilevel resources against nurses' turnover propensity.
The prevalence of turnover intention was relatively high in this study. Nurses with higher psychological resilience, perceived social support, and team resilience exhibited lower turnover intention. Healthcare administrators need to increase investments in nurses' multilevel resources to stabilize the nursing workforce and ensure the sustainability of the healthcare system.
Understanding the multi-level factors influencing nurses' turnover intention can help nursing managers develop targeted strategies from multiple perspectives in clinical settings, thereby reducing nurses' turnover intention.
To estimate the longitudinal predictive relationships between anxiety, depression and post-traumatic stress disorder symptoms in nurses exposed to horizontal violence and identify the most influential symptom using cross-lagged panel network analysis.
A longitudinal cross-lagged panel network analysis study.
Data were obtained from a short longitudinal survey conducted at four tertiary hospitals in Shandong Province, China. Two follow-up surveys spaced 7 weeks apart were conducted on 298 nurses with horizontal violence exposure using the General Information Scale, the Negative Acts Questionnaire, the seven-item Generalised Anxiety Disorder scale, the nine-item Patient Health Questionnaire and the four-item SPAN. Unique longitudinal relationships between symptoms were estimated using cross-lagged panel network analysis.
The results showed that the out-expected influence of A2 (Uncontrollable worry) and P2 (Physiological arousal) was highest and they were the most predictive symptoms in the network. The bridge out-expected influence of A2 (Uncontrollable worry) was also highest and it was the key bridge symptom within the network.
A2 (Uncontrollable worry) and P2 (Physiological arousal) were the top risk factors contributing to mental health deterioration in nurses with horizontal violence exposure.
This study precisely identified the predictive mechanisms and core symptoms among psychological symptoms in nurses exposed to horizontal violence, which is expected to play a significant role in improving the mental health of this group. The results showed that “Uncontrollable worry” and “Physiological arousal” were the core symptoms with the strongest predictive effects on other symptoms. Additionally, “Uncontrollable worry” was also the bridge symptom driving the mutual transmission and development of anxiety, depression and post-traumatic stress disorder. Nursing managers should prioritise “Uncontrollable worry” and “Physiological arousal” as intervention targets, optimising mental health interventions to effectively enhance the psychological well-being of nurses exposed to horizontal violence.
No patient or public contribution.
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