Impact of Unit-level Nurse Practice Environment on Nurse Turnover Intention in the Small and Medium Sized Hospitals

중소병원 간호단위의 간호근무환경이 간호사의 이직의도에 미치는 영향

  • Received : 2012.09.27
  • Accepted : 2012.12.12
  • Published : 2012.12.31


Purpose: The purpose of this study was to investigate the impact of the unit-level nurse practice environment on nurse turnover intention in the small and medium sized hospitals. Methods: A cross-sectional study was conducted using a questionnaire survey with 308 nurses in 38 nursing units of 6 small and medium sized hospitals, having over 200 beds and under 300 beds and located in B metropolitan city. Data were collected from July 20 to August 10, 2011. Data were analyzed using hierarchical multiple regression. Results: The mean turnover intention in nurses of small and medium sized hospitals was $3.52{\pm}0.53$. Factors affecting turnover intention in the nurses included age, work unit, monthly income, number of night-duties, work hours per day and unit-level nurse practice environment. The unit-level nurse practice environment accounted for 15% of turnover intention when other variables were controlled. Conclusion: The results of the study indicate that nurse turnover intention is associated with the nurse practice environment at the unit level. Small and medium sized hospitals can improve nurse retention and lower turnover intention by changing the nurse practice environment of unit, such as creating better support services and nurse participation in hospital affairs.



  1. Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcome. Journal of Nursing Administration, 38, 223-229.
  2. Aiken, L. H., Havens, D. M., & Sloane, D. M. (2000). The magnet nursing services recognition program: A comparison of two groups of magnet hospital. American Journal of Nursing, 100(3), 26-35.
  3. Baernholdt. M., & Mark, B. (2009). The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Journal of Nursing Management, 17, 994-1001.
  4. Cho, E. H., Choi, M. N., Kim, E. Y., Yoo, I. Y., & Lee, N. J. (2011). Construct validity and reliability of the Korean version of the Practice Environment Scale of Nursing Work Index for Korean nurses. Journal of Korean Academy of Nursing, 41, 325-332.
  5. Choi, E. H., Kim, J. H., Lee, H. S., Jang, E. H., & Kim, B. S. (2009). The effect of the intramural marketing activities on nurses' job satisfaction and turnover intention. Journal of Korean Clinical Nursing Research, 15, 29-41.
  6. Cimiotti, J. P., Quinlan, P. M., Larson, E. L., Pastor, D. K,. Lin, S. X., & Stone, P. W. (2005). The magnet process and the perceived work environment of nurses. Nursing Research, 54, 384-390.
  7. Er, K. S., Hur, H. K., Kim, K. K., Cho, Y. J., Kim, E. H., & Kim, S. J. (2004). The relationship between job characteristics, job satisfaction, and intents to leave among hospital nurses. Journal of Korean Clinical Nursing Research, 9(2), 81-92.
  8. Hardy, S., & Leiba-O'Sulivan, S. (1998). The power behind empowerment: Implication for research and practice. Human Relation, 51, 451-483.
  9. Hospital Nurses Association. (2010). Survey on hospital nurse staffing. Seoul: Author.
  10. Jeong, B. J., Kim, H. S., Hwang, S. K., Park, J. H., Song, S. K., Jeong, M. Y., et al. (2011). A study on the according to the nursing shortage of job satisfaction and turnover intention of nurses. The Korean Journal of Health Service Management, 5(1), 15-29.
  11. Jeong, J. H., Kim, J. S., & Kim, K. H. (2008). The risk factors influencing turnover intention of nurses. Journal of Korean Academy of Nursing Administration, 14(1), 35-44.
  12. Kang, G. N. (2010). Nurses' practice environment, nursing professionalism, career commitment, and turnover intention in the small-medium sized hospital. Unpublished master's thesis, Ewha Womans University Seoul, Korea.
  13. Kang, S. Y., Um, Y. R., & Han, S. S. (2005). A professional nursing practice environment and its impact on nurses' task motivation. Journal of Korean Academy of Nursing, 35, 353-361.
  14. Kim, J. K. (2007). Job satisfaction and patient satisfaction related to nurse staffing. Journal of Korean Academy of Nursing Administration, 13, 98-108.
  15. Kim, J. K., & Park, S. A. (2003). A study of the job satisfaction of clinical nurses related to nurse staffing. Journal of Korean Academy of Nursing Administration, 9, 529-539.
  16. Kim, M. A., Park, K. O., You, S. J., Kim, M. J., & Kim, E. S. (2009). A survey of nursing activities in small and medium-size hospitals: Reasons for turnover. Journal of Korean Clinical Nursing Research, 15, 149-165.
  17. Kim, M. R. (2007). Influential factors on turnover intention of nurses: The affect of nurse's organizational commitment and career commitment to turnover intention. Journal of Korean Academy of Nursing Administration, 13, 335-344.
  18. Ko, H. J. (2010). Nurse work environments, job satisfaction and intention to leave among nurses. Unpublished master's thesis, Hanyang University, Seoul, Korea.
  19. Lake, E. T. (2002). Development of the practice environment scale of the nursing work index. Research in Nursing & Health, 25, 176-188.
  20. Lake, E. T., & Friese, C. R. (2006). Variations in nursing practice environments relation to staffing and hospital characteristics. Nursing Research, 55, 1-9.
  21. Lee, H. Y. (2011). Effects of professional work environments on hospital. Unpublished master's thesis, Hanyang University, Seoul, Korea.
  22. Lee, Y. J., & Kim, K. B. (2008). Experiences of nurse turnover. Journal of Korean Academy of Nursing, 38, 248-257.
  23. Lee, Y. T., Kim, J. D., Lee, Y. H., Kang, D. U., & Park, J. E. (2008). Nursing staff supply and survey by differential nursing medical fee. Seoul: Association of Small and Medium Hospitals.
  24. McCusker, J., Dendukuri, N., Cardinal, L., Laplante, J., & Bambonye, L. (2004). Nursing work environment and quality of care: Differences between units at the same hospital. International Journal of Health Care Quality Assurance, 17, 313-322.
  25. Mobley, W. H. (1982). Employee Turnover: Cause, Consequences and Control. Massachusetts: Addision-Wesley.
  26. Park, Y. O., Lee, K. J., Cho, E. H., & Park, H. J. (2009). Factors affecting turnover intention of nurses in long-term care facilities for elderly people. Journal of Korean Gerontological Nursing, 11, 81-89.
  27. Yoo, S, J., & Choi, Y, H. (2009). Predictive factors influencing turnover intention of nurses in small and medium-sized hospitals in Daegu city. Journal of Korean Academy of Nursing Administration, 15(1), 16-25.
  28. Van Bogaert, P., Clarke, S., Roelant, E., Meulemans, H., & Heyning, P. V. (2010). Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: A multilevel modelling approach. Journal of Clinical Nursing, 19, 1664-1674.

Cited by

  1. The effects of workplace bullying on turnover intention in hospital nurses vol.14, pp.1, 2016,
  2. Impacts of Critical Thinking Disposition and Nursing Work Environment on Nurses' Clinical Decision Making Abilities vol.22, pp.3, 2016,
  3. Factors Influencing Nurse Turnover Intention of Senior Convalescence Hospitals in the Metropolitan Area vol.25, pp.3, 2016,
  4. The Relationship among Practice Environment, Organizational Justice, and Job Satisfaction of Male Nurses vol.25, pp.3, 2016,
  5. Effects of Nursing Practice Environment and Self-esteem on Critical Thinking Disposition among Clinical Nurses vol.23, pp.2, 2017,
  6. Patterns and Influential Factors of Inter-Regional Migration of New and Experienced Nurses in 2011~2015 vol.47, pp.5, 2017,
  7. Factors Influencing Nurse Turnover Intention in Small and Medium Sized Hospitals in the Metropolitan Area vol.20, pp.5, 2014,
  8. Effects of General Hospital Nurses' Work Environment on Job Embeddedness and Burnout vol.20, pp.1, 2014,
  9. Relationship between the Practice Environment of Nursing and Critical Thinking Disposition of Nurses in Local General Hospitals vol.20, pp.2, 2014,
  10. Roles of Empowerment and Emotional Intelligence in the Relationship between Job Embeddedness and Turnover Intension among General Hospital Nurses vol.20, pp.3, 2014,
  11. Effect of Job Embeddedness and Job Satisfaction on Turnover Intention in Nurses vol.27, pp.2, 2015,
  12. Effects of Nursing Practice Environment, Compassion Fatigue and Compassion Satisfaction on Burnout in Clinical Nurses vol.21, pp.2, 2015,
  13. Moderating Effects of Work-family Conflict between Job · Organizational · Career Characteristics and Turnover Intention among Nurses in Small and Medium-sized Hospitals vol.21, pp.3, 2015,
  14. Effects of Work Environment, Organizational Culture and Demands at Work on Emotional Labor in Nurses vol.22, pp.2, 2016,
  15. Effects of Advanced Beginner-Stage Nurses' Sense of Calling, Job Satisfaction and Organizational Commitment on Retention Intention vol.22, pp.2, 2016,
  16. Influence of Job Embeddedness Factors on Turnover Intention of Nurses in Small and Medium Sized General Hospitals vol.22, pp.2, 2016,
  17. A Structural Model of Hospital Nurses' Turnover Intention: Focusing on Organizational Characteristics, Job Satisfaction, and Job Embeddedness vol.22, pp.3, 2016,
  18. Relationships among Nursing Work Environment, Job Embeddedness, and Turnover Intention in Nurses vol.22, pp.3, 2016,
  19. Predictors of Turnover Intention among Nurses in Small and Medium-sized Hospitals vol.23, pp.5, 2017,
  20. Influence of Nurses' Work Environment, Organizational Commitment, and Nursing Professionalism on Turnover Intention of Nurses in Long Term Care Hospitals vol.24, pp.4, 2018,
  21. Effects of Group Rational Emotive Behavior Therapy on the Nurses' Job Stress, Burnout, Job Satisfaction, Organizational Commitment and Turnover Intention vol.48, pp.4, 2018,
  22. Mediating Effect of Self-efficacy in the Relationship between Informal Learning, Shared Leadership and Organizational Socialization of Beginner · Advanced Beginner Nurses vol.24, pp.1, 2018,
  23. Nursing Tasks and Practice Environment for Nursing Work Perceived by Nurses Working on Comprehensive Wards versus General Wards vol.24, pp.1, 2018,
  24. Factors Associated with the Choices of Local Hospitals among New Graduate Nurses vol.24, pp.3, 2018,
  25. Intention to leave among staff nurses in small- and medium-sized hospitals pp.09621067, 2019,
  26. Factors affecting Organizational Commitment of General Hospital Nurses in Small and Medium Sized Cities vol.25, pp.1, 2019,