Conceptual Relationships and Assumptions
In Weeks 3 and 4, you conducted a concept analysis. As Walker and Avant (2019) explain, concepts allow us to classify our experiences in a meaningful way both to ourselves and others….The ability to express a relationship between two or more concepts is even more useful and efficient (p. 63). In this Discussion, you create statements about the relationships between two or more concepts, which are critical for developing your theoretical foundation for a program of research.
In this Discussion, you also examine assumptions that may influence your program of research. Assumptions are another type of statement; these statements are considered true, even when they have not been tested. They often go unrecognized because they are deeply embedded in thinking and behavior, so it is important to engage in critical reflection to identify them.
In addition, during this Discussion you consider how nursings metaparadigm relates to the theoretical foundation you are developing.
To prepare
Continue to review the literature that features concepts related to your phenomenon of interest. As you read each article, consider the relationships between and among concepts. Also identify assumptions that are implicit or explicit in the research.
Select one article from your literature review and apply the seven steps of statement analysis that Walker and Avant (2019) present in Chapter 11 of their text. What insights does this give you about the relationships described in the article, as well as for your own work?
Think more deeply about the conceptual relationships that may distinguish the theoretical foundation for your future program of research. Also, analyze assumptions that may influence your research (McEwen and Wills, 2019, p. 81).
Review the information on nursings metaparadigm in McEwen and Wills (2019, pp. 4145). Consider how the metaparadigm concepts of patient, health, nurse, and environment relate to your theoretical foundation.
By Day 3
Post a synopsis of an article that features conceptual relationships related to your phenomenon of interest, and explain the insights you gained by applying Walker and Avants steps for statement analysis. Compare the information in the article with your current thinking about your own theoretical foundation for research, including relationships between and among concepts, and assumptions. Describe implications of nursings metaparadigm for your theoretical foundation.
Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Groves the practice of nursing research: Appraisal, synthesis, and generation of evidence(8thed.). St. Louis, MO: Saunders Elsevier.
Review Chapter 8, Frameworks (pp. 138-154)
McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.) Philadelphia, PA: Wolters Kluwer Health.
Review Chapter 2, Overview of Theory in Nursing
Section, Nursings Metaparadigm (pp. 4145)
Review Chapter 4, Theory Development: Structuring Conceptual Relationships in Nursing (pp. 7292)
Nursings metaparadigm, described in Chapter 2, presents four core concepts (i.e., patient, health, nurse, and environment), which you consider in this weeks Discussion. Chapter 4 presents information on conceptual relationships and assumptions.
Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall.
Chapter 5, Statement Derivation (pp. 88-98)
Chapter 8, Statement Synthesis (pp. 127-148)
Chapter 11, Statement Analysis (pp. 194-206)
Review Chapter 13, Assessing the Credibility and Scope of Nursing Knowledge Development: Concepts, Statements, and Theories (pp. 237-239) D I S C U S S I O N P A P E R
Nursing theory and concept development: a theoretical model of clinical
nurses intentions to stay in their current positions
Tracy L. Cowden & Greta G. Cummings
Accepted for publication 10 December 2011
Correspondence to G.G. Cummings:
e-mail: [emailprotected]
Tracy L. Cowden PhD RN
Practice Consultant
Health Professions Strategy and Practice,
Alberta Health Services, Cold Lake, Alberta,
Canada
Greta G. Cummings PhD RN FCAHS
Professor
Faculty of Nursing
University of Alberta, Alberta, Canada
C O W D E N T . L . & C U M M I N G S G . G . ( 2 0 1 2 )C O W D E N T . L . & C U M M I N G S G . G . ( 2 0 1 2 ) Nursing theory and concept develop-
ment: a theoretical model of clinical nurses intentions to stay in their current
positions. Journal of Advanced Nursing 68(7), 16461657. doi: 10.1111/j.1365-
2648.2011.05927.x
Abstract
Aim. We describe a theoretical model of staff nurses intentions to stay in their
current positions.
Background. The global nursing shortage and high nursing turnover rate demand
evidence-based retention strategies. Inconsistent study outcomes indicate a need for
testable theoretical models of intent to stay that build on previously published
models, are reflective of current empirical research and identify causal relationships
between model concepts.
Data Sources. Two systematic reviews of electronic databases of English language
published articles between 19852011.
Discussion. This complex, testable model expands on previous models and includes
nurses affective and cognitive responses to work and their effects on nurses intent
to stay. The concepts of desire to stay, job satisfaction, joy at work, and moral
distress are included in the model to capture the emotional response of nurses to
their work environments. The influence of leadership is integrated within the model.
Implications for nursing. A causal understanding of clinical nurses intent to stay
and the effects of leadership on the development of that intention will facilitate the
development of effective retention strategies internationally. Testing theoretical
models is necessary to confirm previous research outcomes and to identify plausible
sequences of the development of behavioral intentions.
Conclusion. Increased understanding of the causal influences on nurses intent to
stay should lead to strategies that may result in higher retention rates and numbers
of nurses willing to work in the health sector.
Keywords: concept analysis, desire to stay, empowerment, intent to stay, leadership,
theoretical model
Introduction
The global nursing shortage is resulting in the need to find
multiple solutions to providing adequate numbers of nursing
personnel. The shortage is exacerbated by nurses leaving the
profession (Tomblin Murphy et al. 2009) and their current
positions (Lavoie-Tremblay et al. 2008). Globally, nursing
turnover rates range from 1021% per year (El-Jardali et al.
1646 2012 Blackwell Publishing Ltd
J A N JOURNAL OF ADVANCED NURSING
2009), with countries such as the USA and Australia
reporting turnover rates of over 20% per year (Hegney et al.
2002, Hayhurst et al. 2005). Retaining nurses in their current
positions will reduce the magnitude of consequences associ-
ated with the nursing shortage.
Researchers generally endorse the decision to remain in
ones position as a multi-stage process (Lum et al. 1998)
resulting from reasoned reflection of the employees cognitive
assessment of their work environment and its alternatives
(Griffeth et al. 2005). A causal linkage has been consistently
reported from employee job satisfaction to withdrawal
cognitions and finally to turnover (Hom et al. 1992, Griffeth
et al. 2000). Behavioral intention statements have consis-
tently been the strongest indicators of retention and turnover
and account for more variance than any other predictor (Lum
et al. 1998, Tai et al. 1998). Intent to stay (ITS) is defined as
the stated probability of an individual staying with the
current organization (Boyle et al. 1999, Gregory et al. 2007).
Knowledge regarding the determinants of staff nurses
intentions to remain in their position is still limited, although
researchers have identified 1252% of the explained variance
in ITS (Taunton et al. 1997, Boyle et al. 1999, Mrayyan
2008). Understanding why nurses choose to stay in their
positions and identifying the causal sequences of the devel-
opment of behavioral intentions will enable nurse managers
to identify opportunities to influence intentions and develop
strategies to increase nurse retention rates.
The purpose of this paper is to describe a theoretical model
of clinical nurses intentions to stay in their current positions
and the influence of leadership practices on the development
of intentions. The model is built on previous models and
empirical evidence reported in the literature. An overview of
literature findings related to concepts associated with nurses
ITS is presented to illustrate the theoretical underpinnings in
the proposed theoretical model.
Background
Many theoretical models of staff nurses ITS have been
developed and studied; however, study outcomes have been
inconsistent. The majority of researchers have used regression
analytical techniques in their studies which are predictive in
nature. In addition, outcomes are dependent on the variables
used within the model. Only a few studies used statistical
techniques which test the causal effects of variables on ITS
(Cowden et al. 2011). When studying ITS, researchers have
focused primarily on cognitive (knowing) determinants of
behavioral intentions and not the affective (feeling) determi-
nants. Both affect and cognition have been identified as
contributing to the development of intentions (Trafimow
et al. 2004). Knowledge about the relationship between staff
nurses emotional responses to their work and factors in the
work environment that assist them to internalize, positively,
their reactions is limited. The causal sequence of the
development of nurses behavioral intentions is also limited.
Reported study outcomes on the influence of leadership
practices on clinical nurses behavioral intentions have not
been consistent. Research on variables that lead to emotional
responses to clinical nurses work, and the testing of causal
models of ITS, should result in greater understanding of the
development of nurses behavioral intentions and the influ-
ence that leadership has on the development of those
intentions.
Terms used in the literature to infer the same concept as
ITS are intent to leave (Lynn & Redman 2005, Tallman &
Bruning 2005, Kovner et al. 2009), turnover intention
(McCarthy et al. 2007), anticipated turnover (Shader et al.
2001), intent to work, desire to quit (Brewer et al. 2009),
intention to remain, intention to quit (Tallman & Bruning
2005), and behavioral intention (Gregory et al. 2007).
Theoretical models in the literature
Several theoretical frameworks have been used to explain
clinical nurses ITS. The models of Boyle et al. (1999) and
Tourangeau and Cranley (2006) are presented in detail as the
theoretical premise behind their models fits well with the
authors causal thinking in relation to the variables effecting
staff nurses ITS and are used as the foundation for our new
model. In addition, both of these models hypothesized a
relationship between leadership practices and staff ITS; a
relationship confirmed in a recent systematic review (Cowden
et al. 2011).
Boyle et al. (1999) developed the Conceptual Model of
Intent to Stay. They postulated that four sets of predictor
variables explain staff nurses ITS. These sets of variables are
manager characteristics, which include power, influence,
and leadership style; organizational characteristics, which
include distributive justice, promotional opportunity, and
control over practice, as well as the unit characteristics of
staffing and workload; nurse characteristics of age, educa-
tion, tenure expectations, years in position, hospital and
profession, and marital status; and work characteristics,
which include autonomy, instrumental communication, work
group cohesion, and routinization. Intervening variables
between the manager, organizational nurse and work char-
acteristics are job satisfaction, job stress, and organizational
commitment. Study outcomes of Boyle et al.s model
explained 52% of the variance in ITS among ICU nurses.
The study variables that were found to contribute directly to
JAN: DISCUSSION PAPER A conceptual model of nurses intent to stay
2012 Blackwell Publishing Ltd 1647
ITS were manager power and influence over work coordina-
tion, opportunity elsewhere, promotional opportunity, and
staff nurse satisfaction. Manager characteristics alone
accounted for 12% of the variance in ITS. Boyle et al. used
causal modeling and multiple regression techniques to ana-
lyze their theoretical model. They reported model variance,
but not model fit.
Tourangeau and Cranley (2006) developed the Determi-
nants of Nurse Intention to Remain Employed theoretical
model, building on Boyle et al. (1999) Conceptual Model of
Intent to Stay and relevant findings from the literature. They
proposed that job satisfaction, manager ability and support,
organizational commitment, burnout, work group cohesion
and collaboration, and personal characteristics of nurses
were predictors of nurses intent to remain employed. The
reported study outcomes did not support all of the previous
outcomes of Boyle et al. (1999), nor all of the model-
hypothesized relationships. Manager ability and support and
burnout did not have a direct relationship with ITS. Orga-
nizational commitment, job satisfaction, work group cohe-
sion and collaboration, and age were found to influence a
nurses intention to remain employed and explained 34% of
the variance in ITS. Tourangeau and Cranley (2006) used
multiple regression to test their model. Multiple regression
techniques, while predictive in nature, cannot truly test
relationships nor make statements of influence or the direc-
tionality of that influence (Hayduk 1987).
Data sources
The empirical evidence which supported the selection of
concepts postulated to effect clinical nurses intention to stay
in their current positions was chosen from the findings of two
systematic reviews of the literature that searched English
language published articles between 19852011. Reviews
were conducted using the Center for Reviews and Dissemina-
tion guidelines from the University of York in the UK (2009).
The first review examined the relationship between manager
leadership practices and nurses intentions to remain in their
positions. Key search terms for this review were leadership,
intent to stay, intent to leave, organizational commitment,
career commitment, and professional commitment. Data-
bases searched were CINAHL, Medline, PsychInfo, ERIC,
Embase, and SCOPUS. The second review used the key words
of intent to stay, intent to leave, nursing, nursing
position, and inten$ and searched the electronic databases
of CINAHL, Medline, PsychInfo, and SCOPUS. Searches also
included manual searches of the Canadian Journal of Nursing
Leadership, Journal of Nursing Administration, Nursing
Economics, and Journal of Nursing Management. Both
reviews used an inclusion tool that was modified from
previously published systematic reviews (Cowden et al.
2011) and all titles and manuscripts were screened for
inclusion criteria. A quality assessment tool for correlational
studies was also amended and was used to assess the
methodological quality of retrieved quantitative studies. Both
the inclusion and quality assessment of studies were screened
twice by two different reviewers.
Discussion
Predictors of ITS
Many variables influence staff nurses intentions to remain in
their current positions. Predictors of nurses ITS include:
organizational commitment (Lum et al. 1998, Tourangeau
& Cranley 2006); job satisfaction (Borda & Norman 1997,
Tourangeau & Cranley 2006, Gregory et al. 2007); profes-
sional opportunity, pay and management style (Stone 2009);
group cohesion (Boyle et al. 1999, Hayhurst et al. 2005,
Yildiz et al. 2009); trust (Gregory et al. 2007); perceived
supervisor support (Hayhurst et al. 2005, Cho et al. 2009);
praise and recognition (Tourangeau & Cranley 2006,
Storey et al. 2009); perceived organizational support (Cho
et al. 2009); resources, access to supports, and information
needed to succeed in role (Wilson 2006); autonomy
(Hayhurst et al. 2005, Storey et al. 2009); and perceived
manager position influence and power (Boyle et al. 1999).
Organizational commitment
Organizational commitment is identified as one of the major
predictors of a nurses intention to stay or leave (Lum et al.
1998, Tourangeau & Cranley 2006). It is defined as the
strength of an individuals connection to the employer
(Mowday et al. 1979, Tourangeau & Cranley 2006), where
strength is observed in the degree of acceptance and support
of organizational goals and values, the employees effort on
behalf of the organization and the strength of the desire to
remain as part of the organization (Wagner 2007). Employees
who put more effort into organizational goal achievement
generally receive more rewards and, in turn, are more
satisfied and have greater intentions of remaining with the
organization (Chen et al. 2008). Commitment can be subdi-
vided into three distinct themes of affective, normative and
continued commitment (Allen & Meyer 1990). Individuals
remain with the organization either because they want to,
they feel obligated to, or perceive they would lose too much if
they left. Organizational commitment is a stabilizer that
serves to reinforce behavioral intentions (Wagner 2007).
T.L. Cowden and G.G. Cummings
1648 2012 Blackwell Publishing Ltd
Other factors that influence organizational commitment
are age (Ingersoll et al. 2002) and job satisfaction (Lum et al.
1998). Younger nurses exhibit lower levels of organizational
commitment (McNeese-Smith & van Servellen 2000),
whereas nurses 50 years of age or older tend to be signifi-
cantly committed to their organization (Ingersoll et al. 2002).
Job satisfaction is defined as an affective orientation or
overall positive feeling towards ones work (Price 2001,
Coomber & Barriball 2007).
Job satisfaction
Job satisfaction is a consistent predictor of ITS (Borda &
Norman 1997, McCarthy et al. 2007) and is an important
factor in nursing retention. Some researchers have reported
job satisfaction to be a better predictor of ITS than
organizational commitment (Boyle et al. 1999, Tourangeau
& Cranley 2006) and a mediator of turnover (Borda &
Norman 1997). Generally, low job satisfaction or dissatis-
faction results in an increased intention to leave (Taunton
et al. 1997, Coomber & Barriball 2007, Ma et al. 2009).
Nurses experiencing high levels of job satisfaction are less
likely to leave, express higher intentions of staying (Ingersoll
et al. 2002, Lynn & Redman 2005), and are more committed
to organizational goals (Ingersoll et al. 2002). Shields and
Ward (2001) reported that dissatisfied nurses are 65% more
likely to leave the organization than satisfied nurses. Age is
related to job satisfaction; younger nurses express more job
dissatisfaction while mature nurses express higher levels of
job satisfaction (Shader et al. 2001, Ingersoll et al. 2002,
Tourangeau & Cranley 2006). Quality of care is reported to
be positively related to job satisfaction and negatively related
to position turnover (Shader et al. 2001). Empowerment and
supportive work environments are linked to higher levels of
job satisfaction (Ning et al. 2009).
Leadership practices
Leadership practices influencing ITS are shared decision-
making, supervisor support, autonomy, staffing, and praise
and recognition (Cowden et al. 2011). Staff nurses identify
managers as effective leaders when work places are empow-
ering, shared decision-making is the norm, and staffing levels
are adequate (Laschinger 2008). Shared decision-making has
been identified as a significant predictor of intention
(Ellenbecker et al. 2007, Mrayyan 2008). A shared gover-
nance environment that actively engages staff nurses partic-
ipation in decision-making results in greater staff nurse
control over nursing practice and the work environment
(Hibberd & Smith 2006). Staff nurses behavioral intentions
to remain in the job are influenced by their relationships with
their supervisors (Allen et al. 2009, Cowden et al. 2011). A
significant positive relationship is generally reported between
perceived supervisor support and ITS (Chen et al. 2008).
Supervisor support is defined as the extent of support and
caring demonstrated by nurse managers/supervisors towards
their employees (Cohen & Stuenkel 2009). Supervisor
support is indirectly related to ITS through job satisfaction
(Lu et al. 2005, Tourangeau & Cranley 2006) and organi-
zational commitment (Kovner et al. 2009).
Autonomy refers to the degree to which employees can
make independent decisions and self-manage their delivery of
nursing care (Cohen & Stuenkel 2009). Autonomy consis-
tently predicts job satisfaction (Kovner et al. 2009) and is
directly related to ITS (Tai et al. 1998, Boyle et al. 1999).
Praise and recognition are specific leadership practices
associated with behavioral intention. Praise and recognition
refer to the extent to which nurses are acknowledged for their
efforts, contribution to patient care, and the achievement of
organizational goals (Ellenbecker et al. 2007). Supervisor
praise and recognition of staff nurses increases job satisfac-
tion (Lu et al. 2005) and is directly related to ITS (Touran-
geau & Cranley 2006, Wilson 2006). Conversely, its absence
is considered a contributing factor for intent to leave (Storey
et al. 2009). Recognition has been found to be a primary
source of joy in the workplace (Manion 2003).
Work environment
The work environment directly affects nurses job satisfaction
(Ellenbecker et al. 2007) and indirectly affects ITS (Buchan
1999). Favourable perceptions of the work environment
positively influence ITS (Shader et al. 2001, Ingersoll et al.
2002, Tourangeau et al. 2010). A supportive environment is
an important contributor to ITS (Taunton et al. 1997, Tai
et al. 1998, Boyle et al. 1999). It is related to ITS through job
satisfaction and organizational commitment. Two frequently
occurring environmental predictors of job satisfaction and
ITS are work group cohesion and empowerment.
Work group cohesion refers to the extent to which
employees are supportive of one another and work together
to achieve goals (Cohen & Stuenkel 2009). It includes the
collegiality and support received from peers, supervisors, and
other team members (Boyle et al. 1999, Tourangeau &
Cranley 2006). Work group cohesion has a positive relation-
ship with job satisfaction (Lynn & Redman 2005). When
work group cohesion is perceived as positive, it is reflected in
high levels of job satisfaction (Sourdif 2004, Hayes et al.
2006, Tourangeau & Cranley 2006). As group cohesion
increases, so does ITS (Boyle et al. 1999, AbuAlRub 2010)
JAN: DISCUSSION PAPER A conceptual model of nurses intent to stay
2012 Blackwell Publishing Ltd 1649
and retention (Strachota et al. 2003). A negative perception
of group cohesion results in higher turnover and lower job
satisfaction (Shader et al. 2001). Work group cohesion is also
related to organizational commitment (Ingersoll et al. 2002)
and joy at work (Manion 2003).
Empowerment is a process that facilitates and supports a
persons involvement in the decision-making process and
actions taken to achieve organizational goals (Marquis &
Huston 2009). The concept of empowerment combines Spre-
itzers (1995) conceptualization of psychological empower-
ment and Laschingers work on the application of Kanters
(1977) theory of structural empowerment. A recent systematic
review of the literature identified a positive relationship
between psychological and structural empowerment with
psychological empowerment functioning as a mediator for
structural empowerment (Wagner et al. 2010). Spreitzers
(1995) theory of psychological empowerment suggests that the
attainment of a structurally empowered work environment is a
result of individuals intrinsic responses to characteristics in the
workplace. The level of an individuals psychological empow-
erment and degree of intrinsic motivation to achieve goals is
based on the individuals perception of the presence of the
cognitive dimensions of autonomy, competence, meaning, and
perceived impact of their work (Knol & van Linge 2009).
Structural empowerment refers to characteristics in the work-
place that facilitate the completion of goals. These include
access to adequate information, support, resources, and
opportunities for professional growth. Structural empower-
ment is dependent on the formal and informal power of the
individual within the organization (Laschinger et al. 2004,
2010, Laschinger 2008). It results in meaningfulness of work
(Greco et al. 2006, Laschinger 2008) and increased job
satisfaction (Larrabee et al. 2003, Laschinger et al. 2004,
Hayes et al. 2006). An empowering environment is present
when workplace conditions support optimal performance. The
level of empowerment present in the workplace determines the
degree of freedom nurses have to practice autonomously (Keys
2009). Empowerment is correlated with organizational
commitment (Storey et al. 2009) and ITS (Ellenbecker et al.
2007, Mrayyan 2008). We defined empowerment in our model
as the clinical nurses perception of the workplace, which arises
from both psychological (Spreitzer 1995) and structural
characteristics present in the workplace that support optimal
performance (Laschinger et al. 2010).
Job stress is a result of factors in the workplace that
interfere with a nurses ability to provide quality care
(Boswell 1992) and is reported to have a negative relationship
with ITS (Larrabee et al. 2010). Abuse and moral distress are
identified as job stressors (Sofield & Salmond 2003, Pauly
et al. 2009).
Abuse is defined as the presence of physical and/or verbal
harm in the work setting (Sofield & Salmond 2003). The
literature reports that 6595% of nurses have experienced
verbal abuse (Oztunc 2006, Roche et al. 2010). A recent
study in Australia found that physical violence was reported
by 144% of nurses, threat of violence by 208% of nurses
and emotional abuse by 382% of nurses (Roche et al. 2010).
A significant positive relationship exists between the amount
of verbal abuse nurses are subjected to and ITL (Sofield &
Salmond 2003).
Moral distress occurs when one knows the right course of
action, but is unable to take that course of action due to
institutional restraints, such as lack of time, lack of super-
visor support, physician orders and/or organizational policies
(Rice et al. 2008, Pauly et al. 2009). Hospital ethical climates
are reported to be a significant factor in the development of
nurses leaving intention, explaining 25% of the variance in
turnover intentions (Hart 2005).
Individual nurse characteristics
Individual nurse characteristics predictive of retention include
age, tenure, educational level (Tourangeau et al. 2010), and
personal joy (Manion 2003). Age is positively related to ITS
(Tai et al. 1998, Shader et al. 2001, Tourangeau & Cranley
2006). Younger nurses are less likely to remain in their
current position and older nurses are more likely to stay
(Hayes et al. 2006, Flinkman et al. 2008, Zurmehly et al.
2009). Tenure has a positive relationship with ITS. Generally,
the more years worked as a nurse, the higher the intent to
remain employed as a nurse (Taunton et al. 1997, Larrabee
et al. 2003). The educational level attained by nurses affects
ITS. Commonly the more educated the nurse, the lower the
likelihood of remaining in ones current position (Hayes et al.
2006, Tourangeau & Cranley 2006, Brewer et al. 2009). The
primary contributors to nurses personal joy at work are the
liking of nursing work, praise, and recognition received, level
of work group cohesion and the achievement of goals. Joy at
work is influenced by both intrinsic and extrinsic factors and
may have a direct link to ITS (Manion 2003).
Career development and opportunity elsewhere
Promotional growth and advancement opportunities are
predictive of turnover (Kovner et al. 2009). Career develop-
ment, training, and promotional opportunities within the
organization promote job satisfaction (Lu et al. 2005, Hayes
et al. 2006) and have a significant relationship with ITS
(Borda & Norman 1997, McCarthy et al. 2007). Dissatis-
faction with the lack of promotional or training opportunities
T.L. Cowden and G.G. Cummings
1650 2012 Blackwell Publishing Ltd
is a significant factor in turnover (Shields & Ward 2001). The
perception of a superior career opportunity elsewhere
decreases ITS and retention (Tai et al. 1998). Working
conditions, more so than the desire to increase income, drive
the search for opportunities elsewhere (Ellenbecker et al.
2007). Promotional opportunities are reported to be indi-
rectly related to ITS through job satisfaction and organiza-
tional commitment (Kovner et al. 2009) and are also reported
to have a direct relationship to ITS (Price 2001).
Theoretical model
Based on the literature, our experience and assessment of
previous models of ITS, we developed a new theoretical
model of the relationships among affective and cognitive
concepts that influence nurses ITS in their current position.
The new model is reflective of the literature-identified
relationships among select predictors of staff nurses inten-
tions to remain in their current positions (Cowden et al.
2011).The model is based on the supposition that ITS is the
direct antecedent to staff nurses retention in their current
position. The proposed theoretical model is built on the work
of both Boyle et al. (1999) and Tourangeau and Cranley
(2006).
Enhancements over other models
Our model differs from the models of Boyle et al. (1999) and
Tourangeau and Cranley (2006) in its complexity and detail.
Variables common to all three models are: age, autonomy,
career opportunities, education, job satisfaction, job stress,
leadership/management practices, opportunity elsewhere,
organizational commitment, work group cohesion, and work
status. The concepts of job stress and managerial practices
were replaced with multiple indicators in the new model to
enhance knowledge of the effects of specific affective and
leadership variables. The indicators used to illustrate job stress
were abuse and moral distress. Managerial practices were
expanded to include praise and recognition, shared decision-
making, and supervisor support. The work of Boyle et al. and
Tourangeau and Cranley did not address the emotional
response of individual staff nurses to their work environment.
Our new model proposes to capture the emotional response
through variables of desire to stay, job satisfaction, joy at
work, and moral distress. Concepts added to the model to
assess the perception of the work environment were adequate
staffing, empowerment, and position preference.
Boyle et al. (1999) used causal modeling to arrive at their
conclusions, enabling them to make statements about the
direct and indirect effects of variables; however, model fit was
not reported. Tourangeau and Cranley (2006) used multiple
regression techniques to analyze their data and were able to
make statements of prediction, but not confident assertions
about causal consequences. The causal statements arrived at
were not statistically tested within the study. Testing these
assertions would bring increased clarity to the relationships
and identify the directionality of relationships among con-
cepts. Building on the outcomes of Boyle et al.s and Touran-
geau and Cranleys models and testing the theoretical
assertions will confirm or clarify relationships previously
examined. Our enhanced model is testable and it will be tested
as a structural equation model (SEM) using data obtained
from a survey of nurses. SEM requires a sample size greater
than 200 (Tabachnick & Fidell 2007), with a ratio of cases to
indicator of 10:1 (Violato & Hecker 2007). The minimum
number of cases to sufficiently test this model is 240.
The literature is relatively silent on any distinction between
desire and intention to stay. We hypothesize that how a
nurse responds emotionally to his/her current position is
reflected in his/her desire to stay in that position. In our
model, the concept o
