Conceptual Relationships and Assumptions In Weeks 3 and 4, you conducted a concept analysis. As Walker and Avant (2019) explain, concepts allow us to

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.

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Conceptual Relationships and Assumptions In Weeks 3 and 4, you conducted a concept analysis. As Walker and Avant (2019) explain, concepts allow us to
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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

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