Journal of Korean Academy of Nursing

Review Paper

Effects of Leadership Styles of Nursing Managers on Turnover Intention of Hospital Nurses: A Systematic Review and Meta-Analysis: Cho, Yunjeong , Jeong, Seok Hee , Kim, Hee Sun , Kim, Young Man; J Korean Acad Nurs 2022;52(5):479-498. Published online October 31, 2022; DOI: https://doi.org/10.4040/jkan.22039

Purpose
This study aimed to examine effect sizes of leadership styles of nursing managers on turnover intention of hospital nurses.
Methods
A systematic review and meta-analysis were conducted in accordance with the PRISMA and MOOSE guidelines. Participants were nurses working in hospitals. The intervention involved nursing managers’ leadership styles; the outcome assessed was nurses’ turnover intention. This was an observational study design. Eleven databases were searched to obtain articles published in Korean or English. Of the 14,428 articles reviewed, 21 were included in systematic review and meta-analysis. Comprehensive Meta-Analysis and R software programs were used.
Results
The total effect size r (ESr) was - 0.25 (95% confidence interval: - 0.29 to - 0.20). Effect sizes of each leadership style on turnover intention were as follows: ethical leadership (ESr = - 0.34), transformational leadership (ESr = - 0.28), authentic leadership (ESr = - 0.23), transactional leadership (ESr = - 0.21), and passive avoidant leadership (ESr = 0.13). Ethical leadership was the most effective style in decreasing turnover intention of hospital nurses.
Conclusion
Positive leadership styles of nurse managers effectively decrease turnover intention of hospital nurses, and negative leadership styles of nurse managers effectively increase turnover intention of hospital nurses. The ethical leadership style is the most effective in decreasing turnover intention of hospital nurses; however, it requires careful interpretation as its effects are reported by only two studies. This study contributes to addressing the high turnover rate of hospital nurses and developing positive leadership styles of nurse managers in hospital settings.

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Research Paper

Relationships among Non-Nursing Tasks, Nursing Care Left Undone, Nurse Outcomes and Medical Errors in Integrated Nursing Care Wards in Small and Medium-Sized General Hospitals: Park, Ju-Young , Hwang, Jee-In; J Korean Acad Nurs 2021;51(1):27-39. Published online February 28, 2021; DOI: https://doi.org/10.4040/jkan.20201

Abstract PDF

Purpose
This study aimed to identify the degree of non-nursing tasks and nursing care left undone in integrated nursing care wards, and examine their relationships with nurses’ burnout, job satisfaction, turnover intentions, and medical errors.
Methods
A cross-sectional questionnaire survey was conducted. Data were collected using self-report questionnaires from 346 nurses working in 20 wards of seven small and medium-sized general hospitals, and analyzed using multiple regression and multiple logistic regression analysis with the SPSS WIN 25.0 program.
Results
The mean score for non-nursing tasks was 7.32±1.71, and that for nursing care left undone was 4.42 ± 3.67. An increase in non-nursing tasks (β = .12, p = .021) and nursing care left undone (β = .18, p < .001) led to an increase in nurses’ burnout (F = 6.26, p < .001). As nursing care left undone (β = .13, p = .018) increased, their turnover intentions also (F = 3.96, p < .001) increased, and more medical errors occurred (odds ratio 1.08, 95% confidence interval 1.02~1.15).
Conclusion
Non-nursing tasks and nursing care left undone are positively associated with nurses’ burnout, turnover intentions, and the occurrence of medical errors. Therefore, it is important to reduce non-nursing tasks and nursing care left undone in order to deliver high quality nursing care and in turn increase patient safety.

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Original Articles

The Influence of Grit on Turnover Intention of University Hospital Nurses: The Mediating Effect of Job Involvement: Ji Yeong Jeong, Youn Sook Seo, Jung Hoon Choi, Seong Hee Kim, Min Sook Lee, Sung Hwa Hong, Jung Suk Choi, Da Eun Park; J Korean Acad Nurs 2019;49(2):181-190. Published online April 30, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.2.181

Abstract PDF

Purpose

This study aimed to confirm the mediating effect of job involvement in the relationship between grit and turnover intention among nurses working at university hospitals.

Methods

Participants included 437 nurses from university hospitals located in C city, Gyeongnam. Data were collected from January 8 to 19, 2018, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Scheffe's test, Pearson's correlation coefficient, and multiple regression, with the SPSS/22.0 program. A mediation analysis was performed according to the Baron and Kenny, and bootstrapping methods.

Results

There were significant relationships between grit and job involvement (r=.40, p<.001), grit and turnover intention (r=−.29, p<.001), and turnover intention and job involvement (r=−.52, p<.001). Job involvement showed partial mediating effects in the relationship between grit and turnover intention.

Conclusion

Grit increased job involvement and lowered turnover intention. Therefore, to reduce nurses' turnover intention, it is necessary to develop a program and strategies to increase their grit.

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The Effects of Hospitals’ Family Friendly Management on Married Female Nurses’ Retention Intention: Focused on the Mediating Effects of Work-Family Interface: Jin Hwa Lee, Jee-In Hwang; J Korean Acad Nurs 2019;49(4):386-397. Published online January 15, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.4.386

Abstract PDF

Abstract Purpose

This study examined the effect of hospitals’ family-friendly management on married female nurses’ retention intention. The focus was the mediating effects of the work-family interface (work-family conflict, work-family enrichment and work-family balance).

Methods

This study was a cross-sectional study. The participants were 307 nurses working at five public and five private hospitals with more than 200 beds in Seoul. Data were collected using structured questionnaires from September 10 to September 17, 2018 and analyzed with SPSS 24.0. Data were analyzed using an independent t-test, a one-way ANOVA, Pearson's correlation coefficients, and multiple regression following the Baron and Kenny method and Sobel test for mediation.

Results

There were significant correlations among family-friendly management, the work-family interface, and retention intention. Work-family conflict showed a partial mediating effect on the relationship between family-friendly management and retention intention. Work-family enrichment showed a partial mediating effect on the relationship between family-friendly management and retention intention. Work-family balance showed a partial mediating effect on the relationship between family-friendly management and retention intention.

Conclusion

These findings indicate that both hospitals’ family-friendly management and nurses’ work-family interface are important factors associated with nurses’ retention intention. Therefore, hospitals should actively implement family-friendly management for nurses and establish strategies to enhance nurses’ work-family interface for effective human resource management.

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The Effect of Nurse's Emotional Labor on Turnover Intention: Mediation Effect of Burnout and Moderated Mediation Effect of Authentic Leadership: Soo Yang Na, Hanjong Park; J Korean Acad Nurs 2019;49(3):286-297. Published online January 15, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.3.286

Abstract PDF

Abstract Purpose

To investigate the effect of nurses’ emotional labor on their turnover intention that was mediated by burnout and to examine the moderated mediation effect of authentic leadership.

Methods

A total of 227 nurses working at two general hospitals in Seoul were recruited from March 21 to May 6 in 2016. Emotional labor including surface acting and deep acting; burnout factors such as emotional exhaustion and personal accomplishment; and turnover intention were assessed. The data were analyzed using SPSS 22.0 and SPSS PROCESS macro.

Results

Surface acting significantly increased emotional exhaustion and reduced personal accomplishment. Deep acting significantly increased personal accomplishment. Emotional exhaustion significantly increased turnover intention. Conversely, personal accomplishment significantly reduced turnover intention. Surface acting had an indirect effect on turnover intention that was mediated by emotional exhaustion. Deep acting had an indirect effect on turnover intention that was mediated by personal accomplishment. Authentic leadership had a moderated mediation effect on the relationship between surface acting and turnover intention that was mediated by emotional exhaustion.

Conclusion

The findings of this study indicate that the establishment of strong authentic leadership by head nurses would help nurses reduce their burnout and turnover intention. Conducting intervention studies would be also important to promote better work environments that would enable nurses to fortify the positive aspect of emotional labor and to reduce their burnout levels.

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Patterns and Influential Factors of Inter-Regional Migration of New and Experienced Nurses in 2011~2015: Bohyun Park, Se Young Kim; J Korean Acad Nurs 2017;47(5):676-688. Published online October 31, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.5.676

Abstract PDF

Purpose

The purpose of this study was to analyze the migration patterns of new nurses and experienced nurses and to identify the factors influencing inter-regional migration for solving regional imbalances of clinical nurses in South Korea.

Methods

This study involved a secondary analysis of data from the Health Insurance Review and Assessment Service (HIRA). Data were analyzed using descriptive statistics and multiple logistic regression analysis.

Results

New nurses tended to migrate from Kyunggi to Seoul. However, experienced nurses tended to migrate from Seoul and Chungchung to Kyunggi. Significant predictors of inter-regional migration among new nurses were location and nurse staffing grade of hospitals. Significant predictors of inter-regional migration among experienced nurses were location, hospital type, nurse staffing grade, ownership of hospitals and age of nurses.

Conclusion

Inter-regional migration occupied a small portion of total hospital movement among clinical nurses. The regional imbalances of nurses were not caused by the migration from non-metropolitan areas to Seoul. Nurse shortage problems in the small and medium hospitals of the non-metropolitan area can be solved only through improvement of work environment.

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Why newly graduated nurses in South Korea leave their first job in a short time? A survival analysis
Eunhee Lee
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Sun Ju You, Jong Kyung Kim, Myun Sook Jung, Se Young Kim, Eun Kyung Kim
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Turnover Experience of Male Nurses: Hyunsu Kim, Jeongseop Lee; J Korean Acad Nurs 2017;47(1):25-38. Published online February 28, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.1.25

Abstract PDF

Purpose

The aim of this study was to identify turnover experiences of men in nursing and to derive a substantive theory on the turnover experience of men who are nurses.

Methods

Data were collected through in-depth interviews with 13 men who had worked as a nurse for 1 year or more, and had a turnover experience during that period. Collected data were analyzed on the basis of Strauss and Corbin's grounded theory.

Results

The core category in the turnover experiences of the respondents was ‘seeking a stable place for me’. In the analysis of the core category, types of ‘contentment’, ‘seeking’, ‘survival’ and ‘confusion’ were identified. The sequential stages of these nurses’ turnover experience were ‘confrontation’, ‘incertitude’, ‘retrying’ and ‘realization’. However, when a problem arose in the process, they returned to the stage of confusion. Thus, these stages could occur in a circular fashion.

Conclusion

These findings provide a deep understanding of the turnover experience of men in nursing and offers new information about how they adapt to nursing practice. The findings should be useful as foundational data for men who hope to become nurses and also for managers responsible for nurses who are men.

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Association between Emotional Labor, Emotional Dissonance, Burnout and Turnover Intention in Clinical Nurses: A Multiple-Group Path Analysis across Job Satisfaction: Chi-Yun Back, Dae-Sung Hyun, Sei-Jin Chang; J Korean Acad Nurs 2017;47(6):770-780. Published online January 15, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.6.770

Abstract PDF

Abstract Purpose

This study was conducted to investigate the influence of emotional labor, emotional dissonance, and burnout on nurse's turnover intention and examine the effect of job satisfaction on the relationships among emotional labor, emotional dissonance, burnout, and turnover intention.

Methods

The sample consisted of 350 nurses recruited from 6 general hospitals in 2 cities in Korea. A multiple-group analysis was utilized. Data were analyzed using SPSS statistics 23 and AMOS 20.

Results

In the path analysis, turnover intention was directly related to burnout in clinical nurses who had a high job satisfaction (b=.24, p=.003), while it was indirectly related to emotional dissonance (b=.13, p=.002). In the multiple-group path analysis, turnover intention was directly related to emotional dissonance (b=.18, p=.033) and burnout (b=.26, p=.002) for nurses with low job satisfaction.

Conclusion

These results indicate that manuals and guidelines to alleviate the negative effects of emotional labor, emotional dissonance, and burnout, and to increase job satisfaction are strongly required to reduce turnover intention in nurses at the organizational level as well as at the individual level.

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Influences of Hospital Nurses' perceived reciprocity and Emotional Labor on Quality of Nursing Service and Intent to Leave: Mi-Aie Lee, Eunjeong Kim; J Korean Acad Nurs 2016;46(3):364-374. Published online June 30, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.3.364

Abstract PDF

Purpose

This study was performed to investigate the relationship among reciprocity, emotional labor, nursing service quality and intent to leave, and to identify factors influencing nursing service quality and intent to leave.

Methods

This study was a cross-sectional survey. Participants were 300 nurses working at five general hospitals in two provincial cities in Gyeongsang Province, Korea. From May 1 to June 30, 2014, data were collected using structured questionnaires and analyzed with SPSS/PC ver 20.0 programs.

Results

There were relationships between reciprocity and nursing service quality, and intent to leave, and between emotional labor and intent to leave. Participants' general characteristics, reciprocity and emotional labor explained 48.4% of variance in nursing service quality and participants' general characteristics and these two independent variables explained 31.9% of intent to leave.

Conclusion

These findings indicate that from the perception of hospital nurses, reciprocity and emotional labor are both very important factors to improve the quality of nursing service and decrease the intent to leave. So nursing managers should try to develop various personnel management programs focused on human emotions, and create a mutual respectable organizational culture and work environment.

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Structural Equation Modeling on Nursing Productivity of Nurses in Korea: Se Young Kim, Eun-Kyung Kim, Heon Man Lim, Mi Young Lee, Kwang-Ok Park, Kyoung A Lee; J Korean Acad Nurs 2013;43(1):20-29. Published online February 28, 2013; DOI: https://doi.org/10.4040/jkan.2013.43.1.20

Abstract PDF

Purpose

The purpose of this study was to propose and test a predictive model that could explain and predict nursing productivity.

Methods

A survey using a structured questionnaire was conducted with 360 nurses in Korea. The data were analyzed using SPSS Windows 18.0 and AMOS 19.0 program.

Results

Based on the constructed model, burnout and organizational commitment were found to have direct effects on nurses' turnover intention and nursing productivity. While nursing work environment was found to have indirect effects on nurses' turnover intention and nursing productivity.

Conclusion

This structural equational model is a comprehensive theoretical model that explains the related factors and their relationship with nursing productivity. Comprehensive organizational interventions to improve nursing productivity should focus on improving the nursing work environment. Findings from this study can be used to design appropriate strategies to decrease nurse turnover in Korea. Further studies are needed to prospectively verify these causal relationships with larger samples.

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Gwang Suk Kim, Layoung Kim, Mi-So Shim, Seoyoung Baek, Namhee Kim, Min Kyung Park, Youngjin Lee
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Effect of Job Embeddedness on Turnover Intention of Nurses in Long Term Care Hospitals: The Mediating Effect of Nursing Work Environment
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Mi Soon Ko, Hyunsook Zin Lee, Myung Suk Koh
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A Model on Turnover Intention of Chief Nurse Officers: Kwang-Ok Park, Jong Kyung Kim, Se Young Kim, Sunju Chang; J Korean Acad Nurs 2012;42(1):9-18. Published online February 29, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.1.9

Abstract PDF

Purpose

The purpose of this study was to test the turnover intention model for chief nurse officers in general hospitals. The variables for the study included job stress, social support, job satisfaction, and organization commitment.

Methods

A predictive, non-experimental design was used with a sample of 144 chief nurse officers from 144 general hospitals. Data were collected using self-administered questionnaires and analyzed using SPSS, AMOS program.

Results

The overall fitness of the hypothetical model to the data was good (χ²=16.80, p=.052, GFI=.96, AGFI=.90, NFI=.97, CFI=.99). Job stress, social support, job satisfaction, and organization commitment explained 59.0% of the variance in turnover intention by chief nurse officers. Both organization commitment and social support directly influenced turnover intention for chief nurse officers, and job stress and job satisfaction indirectly influenced turnover intention.

Conclusion

The results imply that chief nurse officers in hospitals need social support and management of job stress to increase job satisfaction and organization commitment, and lower turnover intention.

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The Effect of Assertiveness Training on Communication Related Factors and Personnel Turnover Rate among Hospital Nurses: Myung Ja Kang, Haejung Lee; Journal of Korean Academy of Nursing 2006;36(5):681-690. Published online August 31, 2006; DOI: https://doi.org/10.4040/jkan.2006.36.5.681

Abstract PDF

Purpose

The purpose of this study was to investigate the effects of assertiveness training on nurses' assertive behaviors, interpersonal relations, communication conflicts, conflict management style and personnel turnover rate.

Method

A non-equivalent control group pretest-posttest design was used in this study. Nurses were assigned into the experimental or control groups, each consisting of 39 nurses. Data was collected between January to March 2004. An ‘Assertiveness Training Program’ for Nurses developed by Park was used for the study. To emphasize assertiveness practice, 5 practice sessions utilizing ABCDE principles were added to Park's program. To examine the effects of the program, differences between the two groups in assertive behaviors, interpersonal relations, communication conflicts, conflict management style and personnel turnover rate were analyzed using ANCOVA.

Results

The assertiveness training was effective in improving the nurses' assertiveness behaviors, but was not effective in improving interpersonal relations, reducing the subjects' communication conflicts, changing the conflict management style or reducing their personnel turnover rate.

Conclusion

There have been many studies about factors affecting nurses' personnel turnover rates, but few have been done about methods of intervention to reduce the personnel turnover rate. Thus, this study provides a significant contribution in attempting such an intervention from nursing management perspectives.

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