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The effect of career compromise on nurses’ turnover intention: the mediating role of job satisfaction

BMC Nursing volume 23, Article number: 700 (2024) Cite this article

Abstract

Aim

We aimed to examine the relationships among nurses’ career compromise, job satisfaction, and turnover intention and the mediating role of job satisfaction in the relationship between career compromise and turnover intention.

Background

Nurses are prone to career compromise when there is a discrepancy between the reality of their job and their personal career expectations due to personal or family factors. High levels of career compromise may have a significant impact on turnover intentions through low job satisfaction, thereby affecting the stability of the nursing workforce. There is a paucity of research on the impact of nurses’ career compromise on turnover intentions.

Method

This was a cross-sectional research design of nurses in hospitals in Guangdong Province using a convenience sampling method. The Career Compromise Scale (CCS), Job Satisfaction Scale (JSS), and Turnover Intention Scale (TIS) were used. The obtained data were analyzed through descriptive statistics, Spearman’s correlation coefficient, and the mediating effect of perceived organizational support was tested through the PROCESS macro mediation model in SPSS.

Results

Data from 821 nurses who met the inclusion criteria were analyzed. The total score of nurses’ turnover intention was 14.68 ± 4.32. Spearman’s correlation analysis showed that career compromise was negatively correlated with job satisfaction (r = -0.594, p < 0.01), job satisfaction was negatively correlated with turnover intention (r = -0.471, p < 0.01), and career compromise was positively correlated with turnover intention (r = 0.544, p < 0.01). The mediating effect of job satisfaction on the relationship between career compromise and turnover intention has been demonstrated. The mediating effect is significant, with a value of 0.056, representing 25.71% of the total effect.

Conclusions

The turnover intention of nurses in Guangdong Province is high. Job satisfaction mediated the relationship between career compromise and turnover intention. This study further enriches JD-R theory and COR theory and provides new perspectives for nurse managers to develop intervention strategies to stabilize the nursing workforce and reduce turnover.

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Introduction

The current global shortage of health workers is becoming increasingly apparent. According to the World Health Organization (WHO) 2020 report, the global shortage of health workers is 15 million people [1]. By the end of 2022, there will be 5.2 million registered nurses in China, with only 3.7 registered nurses per 1,000 people [2], which is still a large gap compared to the overall goal of China’s “14th Five-Year Plan” for health personnel development [3]. In areas where there is a shortage of nurses, the infection rate of infectious diseases and the mortality rate of patients are increasing. The shortage of nurses has seriously affected the quality and safety of medical care and the stability of the nursing workforce and has posed serious challenges to China’s health care system [4].

Turnover intention is an important predictor of turnover behavior. Turnover intention is an employee’s behavioral intention or attitude toward leaving his organization or unit, and it is a psychological state or tendency before generating turnover behavior [5]. Cao’s survey of nurses in 23 hospitals in China revealed that the average total score for nurses’ turnover intention was 13.97 ± 3.63 [6]. According to the results of a 2022 survey of nurses in Guangdong Province, China, the turnover intention of nurses was 64.1% [7]. The “Healthy China 2030” plan proposes that to achieve a higher level of health for all, it is necessary to provide equitably accessible, systematic and continuous health services, and the stability of the nursing workforce is the basis for the provision of continuous medical and health services [8]. With the continuous growth of the domestic population and the aging of the population, the workload and work intensity of nurses have increased, resulting in a high nurse turnover rate. Therefore, how to reduce nurses’ turnover intention and alleviate the shortage of nurses’ human resources is an urgent problem in China and globally.

Background

Career compromise refers to the concession made by an individual’s self-concept as it develops over time, as it gradually combines with virtual perceptions such as career impressions and career preferences to form career aspirations and in the realization stage due to the discrepancy between the ideal and reality [9]. Research has shown that there are many factors that influence nurses’ turnover intention, with individual psychological factors playing a large role [10]. Tsaousides noted that when individuals adjust or even abandon their career goals because their actual work does not match expectations, they often feel frustrated and dissatisfied, which leads to negative emotions that reduce their job performance and career satisfaction [11]. It has been found that career compromise creates a strong motivation for individuals to change careers, and that overall levels of job burnout increase when individuals perceive that their ability to grow or advance increases, leading to an increase in turnover intention [12]. Nurses are forced to make compromises with jobs that do not meet their expectations due to personal or family factors, but long-term compromises can lead to low job satisfaction, poor professional identity, burnout, and other negative effects, which in turn lead to the idea of leaving the job [13]. Therefore, clarifying the relationship between career compromise and nurse turnover will help managers develop effective interventions to reduce nurses’ turnover intention.

Job satisfaction is an emotional experience that reflects an individual’s evaluation of his or her work situation and work experience [14]. The job satisfaction of clinical nurses has a direct impact on their physical and mental health, job performance, and organizational commitment [15]. Job satisfaction plays an integral role in a nurse’s affective experience and serves as a key predictor of whether or not a nurse will leave their current position [16]. Nurses with low job satisfaction are more likely to seek other alternative jobs to change their current work experience and ultimately engage in turnover behavior [17]. In addition, some studies have shown that there is a negative correlation between nurses’ job satisfaction and career compromise [18]. Nurses with high levels of career compromise tend to perceive a large gap between career expectations and workplace reality, and their increased dissatisfaction with the work environment and development opportunities leads to decreased motivation and enthusiasm, which in turn negatively affects quality of care and patient safety. The JD-R model suggests that any work environment can be categorized into two types of factors: job demands and job resources [19]. Job demands are the physiological and psychological costs associated with work. Career compromises represent an increase in job demands, i.e., nurses may have to deal with some undesirable working conditions or environments at work, which increases their workload and stress. In contrast, job resources are physical and psychological resources that help employees achieve their job goals and reduce job demands and their associated physiological and psychological costs. According to the gain path of the JD-R model, adequate job resources can stimulate employees’ intrinsic motivation and increase their work engagement and motivation. Job satisfaction contributes to increased work engagement [20]. It is a positive psychological resource. Increasing job satisfaction not only reduces the negative effects of increased job demands but also increases work engagement and leads to positive work outcomes (i.e., reduced turnover intention). Reducing career compromise may be one way to increase job satisfaction, which in turn reduces turnover intention.

Although previous studies have shown that there is a relationship between nurses’ career compromise, job satisfaction, and turnover intention, no mediation analysis has been found between career compromise, job satisfaction, and turnover intention. Therefore, we proposed a conceptual model diagram for this study based on the JD-R model, as shown in Fig. 1.

Fig. 1
figure 1

The theoretical model

Full size image

The purpose of this study was to examine the relationship between nurses’ career compromise, job satisfaction, and turnover intention.

We propose four hypotheses as follows:

H1

Career compromise is negatively related to job satisfaction (path a).

H2

Career compromise is positively related to turnover intention (path c).

H3

Job satisfaction is negatively related to turnover intention (path b).

H4

The effect of career compromise on turnover intention is partially mediated by job satisfaction (path c’).

Method

Study design and participants

To test the generalizability of the study model, a cross-sectional research design was conducted between March and April 2024 in Guangdong Province, China, using convenience sampling. The inclusion criteria were as follows: (1) possession of a professional nursing license; (2) more than 6 months of continuous clinical work; (3) no mental or cognitive disorders; and (4) voluntary participation in this study. The exclusion criteria were as follows: (1) nonhospital nurses (e.g., interns, trainee nurses); and (2) off-duty nurses who were on vacation or studying abroad. According to the Kendall sample estimation method, the sample size was 5–10 times the number of variables [21]. A total of 18 variables (10 sociodemographic variables, 3 career compromise variables, 2 job satisfaction variables, and 3 turnover intention variables) were examined in this study. A follow-up loss rate of 20% and a sample size of 108–216 were assumed. Therefore, we aimed to collect at least 108 questionnaires.

Data collection form

All the data were collected online, and a questionnaire was published using the Questionnaire Star platform (professional questionnaire website, https://www.wjx.cn). The team leader took the initiative to contact the director of the nursing department of each hospital and explained the purpose of the survey, the participants, and the method of completing the questionnaire in detail. After receiving permission, the two-dimensional code and link of the questionnaire were sent through the WeChat platform, and the nursing department of the hospital transmitted it to the nurses of the hospital. A total of 857 electronic questionnaires were collected. Thirty-six questionnaires were excluded because the completion time was less than 3 min, and there were obviously inappropriate answers; ultimately, 821 valid questionnaires were collected (response rate: 95.8%).

Measures

We designed our own demographic questionnaire with a total of 10 items, including gender, age, education level, marital status, number of children, years of service, department, professional title, employment status, and monthly income.

The Career Compromise Scale (CCS) developed by Weng was used in this study [22]. The scale contains a total of 12 items in 3 dimensions: Compromise on Development Opportunities (4 items), Compromise on Career Matching (4 items), and Compromise on Social Expectations (4 items). The original scale is a universal scale that has been widely used with groups such as corporate employees, migrant workers, and student teachers. Each item was scored on a 5-point Likert scale ranging from 1 to 5, from “strongly disagree” to “strongly agree.” The total score ranged from 12 to 60, with higher scores indicating a greater degree of occupational compromise. The Cronbach’s alpha coefficient for this scale was 0.910, and in this study, it was 0.940.

The Job Satisfaction Scale (JSS) was developed by Warr and translated into Chinese by our researcher Lu Hong [23]. The scale consists of 15 items and 2 dimensions, namely, job status (10 items) and interpersonal relationships at work (5 items). The scale is rated on a 5-point Likert scale ranging from 1 to 5, from “very dissatisfied” to “very satisfied”. The total score ranges from 15 to 75, and the scale score is the sum of the scores of each dimension. The dimension score is the total mean score of each item of the dimension, and the mean value ranges from 1 ≤ score < 2 for very dissatisfied, 2 ≤ score < 3 for dissatisfied, 3 ≤ score < 4 for fair, 4 ≤ score < 5 for satisfied, and 5 for very satisfied. The overall Cronbach’s alpha coefficient of the scale was 0.920, and this value was 0.973.

The Turnover Intention Scale (TIS), as revised by Jingyuan Li, is based on Michaels and Spector [24]. It comprises six items and three dimensions: TI I (items 1 and 6), TI II (items 2 and 3), and TI III (items 4 and 5). These dimensions indicate the likelihood of leaving, looking for, and getting a job, respectively. The scale was scored on a 4-point Likert scale ranging from 1 to 4, from “never” to “often,” with mean scores of less than 1, greater than 1 and ≤ 2, greater than 2 and ≤ 3, and greater than 3 corresponding to low, low, high, and very high willingness to leave, respectively. The Cronbach’s alpha coefficient for this scale is 0.773, and in this study, it is 0.868.

Data analysis

The analysis was conducted using IBM SPSS 27.0. First, categorical variables were expressed as frequencies and percentages. Second, Spearman’s correlation was used to analyze the relationship between career compromise, job satisfaction, and intention to leave. Finally, we used the PROCESS macro-mediation model (Model 4) in SPSS [25]. We set career compromise as the independent variable, job satisfaction as the mediator variable, and turnover intention as the dependent variable to estimate the magnitude and significance of the mediation effect. A bootstrap method was used with a sample size of 5,000 and a 95% confidence interval. If the confidence interval does not include zero, the mediation effect is considered significant [26].

Results

Sample characteristics

Table 1 presents a summary of the general characteristics of the study population. Of the 821 nurses, 96.5% were female, 43.4% were ≤ 30 years of age, 71.7% had a bachelor’s degree or higher, 66.6% were married, the majority of nurses had 11–20 years of service (32.9%), 26.4% were from internal medicine, 30.9% had intermediate titles, the majority of nurses had a temporary employment status (68.0%), and 55.4% of the nurses earned ¥5,001–10,000 per month.

Table 1 General characteristics of the nurses (N = 821)
Full size table

Scores of nurses’ career compromise, job satisfaction and turnover intention

The average total score of nurses’ career compromise was 31.3 ± 10.6, of which 9.9 ± 3.8 was for development opportunities, 9.8 ± 3.9 was for career matches, and 11.5 ± 4.2 was for social expectations. The average total score for job satisfaction was 53.9 ± 11.4, of which the score for the interpersonal relationship dimension was 18.6 ± 3.7, and the score for the job status dimension was 35.3 ± 7.9. The average total score for turnover intention is 14.7 ± 4.3, of which the score for the turnover intention I dimension is 4.7 ± 1.9, the score for the turnover intention II dimension is 4.4 ± 1.7, and the score for the turnover intention III dimension is 5.5 ± 1.5.

Correlation coefficients among nurses’ career compromise, job satisfaction and turnover intention

Table 2 shows the results of the correlation analysis between nurses’ career compromise, job satisfaction and turnover intention. There was a negative correlation between career compromise and job satisfaction (r = -0.594, p < 0.01). There was a positive correlation between career compromise and turnover intention (r = 0.544, p < 0.01). There was a negative correlation between job satisfaction and turnover intention (r = -0.471, p < 0.01). Hypotheses 1–3 were tested, and the results indicated that the three variables used in this study could be included in structural equation modeling for analysis.

Table 2 Correlations between nurses’ career compromise, job satisfaction and turnover intention (N = 821)
Full size table

3.4 Mediation analysis between nurses’ career compromise, job satisfaction and turnover intention

The results demonstrated that the 95% CI for both the direct and indirect effects of career compromise on nurses’ turnover intention did not include zero, indicating that job satisfaction partially mediated the relationship between career compromise and turnover intention. The direct effect of nurses’ career compromise on turnover intention was 0.159, the indirect effect was 0.056, the total effect was 0.214, and the percentage of mediation effect was 25.71% (see Table 3).

Table 3 Results of the regression models testing the mediation hypothesis(N = 821)
Full size table

Discussion

This study examined the relationship between nurses’ career compromise and willingness to leave based on the JD-R model with job satisfaction as the mediating variable. We found that career compromise had a significant positive effect on turnover intention and a negative effect on job satisfaction. The study suggested that nurses’ job satisfaction may act as a protective factor against reduced turnover intention and may partially mediate the relationship between career compromise and turnover intention. The results of this study may inform nurse managers to reduce nurses’ turnover intention from the psychological domain and to develop nursing interventions.

Current status of nurses’ turnover intention

The results of this study showed that the nurses’ turnover intention score was 14.68 ± 4.32, indicating that the nurses’ turnover intention is currently at a high level in Guangdong hospitals, which is similar to the results of a survey conducted by Liu on nurses’ turnover intention in tertiary public hospitals in Heilongjiang Province, China [27]. This may be due to the large population and high demand for healthcare in Guangdong Province, resulting in high workloads and overtime work for nurses, coupled with a shortage of nursing human resources and an increase in psychological problems and burnout among nurses [28]. One study showed that stress and anxiety were significant predictors of high turnover intention among nurses [29]. Among the mean scores of the dimensions, Turnover Intention III (2.77 ± 0.75) scored the highest, and Turnover Intention II (2.21 ± 0.87) scored the lowest. This indicates that nurses are more likely to obtain an outside job and are less motivated to find another job. The reasons for this may be the shortage of talent in the healthcare sector, the increase in social demand, and the fact that nurses are more irreplaceable in terms of specialization and technology than people in other professions, which contributes to the increase in nurses’ employment advantages. At the same time, nurses believe that their current jobs are stable and that the sense of accomplishment and value associated with their work keeps them in their jobs and discourages them from taking other jobs.

Correlations among career compromise, job satisfaction and turnover intention among nurses

The results of the study showed that nurses’ career compromise had a negative effect on job satisfaction; i.e., the greater the degree of career compromise was, the lower the nurses’ satisfaction was. Nurses usually have certain expectations about their future jobs before entering the workforce, and when the actual situation does not match their career expectations and their current job does not fulfill their career goals or expectations, their motivation and initiative at work decrease, which leads to a decrease in job satisfaction. According to the results of this study, job satisfaction has a negative effect on turnover intention, i.e., the lower the satisfaction is, the greater the turnover intention. Job satisfaction is an important variable of work attitude [30]. It not only affects job performance but also influences individual career development and is an important factor in turnover in organizations. Related studies have also shown that nurses’ job satisfaction, as an attitudinal response to their work, plays a key role in their retention intention [31,32,33]. Haul et al. conducted a one-year prospective longitudinal study of nurses and found that the better nurses’ work environment is, the greater their job satisfaction and the lower their turnover rate [34]. The greater the nurses’ job satisfaction is, the lower their negative emotions such as depression and avoidance are, and the more stable their career perceptions and self-esteem are, the lower their turnover intentions are [17]. Therefore, it is recommended that nurse managers take steps to reduce nurses’ career compromise, such as providing better career development opportunities, improving the work environment, and increasing salaries and benefits, to increase nurses’ job satisfaction and thus reduce turnover. This will help stabilize the nursing team and reduce nurse turnover.

The mediating effect of job satisfaction on the relationship between career compromise and turnover intention among nurses

The results of this study revealed that nurses’ career compromise has a direct positive effect on turnover intention and an indirect negative effect on turnover intention through satisfaction. Nurses compromise when factors such as the work environment, salary and compensation, and career development opportunities do not meet their expectations, but long-term compromises create more stress and pressure on nurses. In addition, career compromise negatively affects nurses’ motivation and initiative, leading to lower job satisfaction, easier burnout, loss of confidence in one’s current work, and ultimately the idea of leaving the profession. Resource conservation theory [35] suggests that job satisfaction, as a positive psychological resource, is a core element in reducing turnover intentions and increasing work efficiency. Higher job satisfaction reduces nurses’ work stress and burnout and improves their sense of professional identity and self-efficacy, helping them maintain a more positive attitude toward their clinical work [33, 36]. Job satisfaction, as a mediating variable, plays a moderating role in nurses’ work performance.

This study examined the relationships among career compromise, job satisfaction, and turnover intention and the mediating role of job satisfaction in the interaction between career compromise and turnover intention. This study aimed to reduce nurses’ turnover intention by reducing their career compromise and increasing their job satisfaction. To achieve this goal, the health care system and nursing administrators must work together to understand the psychological needs of nurses, invest more in nursing, and improve nursing work environments and compensation to ensure a stable and healthy nursing workforce. In addition, the results of this study validate and validate COR theory and the JD-R model [19, 37]. This study is important for determining the relationship between career compromise and turnover intention. Career compromise, as a job requirement, and job satisfaction, as a psychological resource, emphasized how job satisfaction can act as a bridge between available resources and turnover intention, which can help to reduce nurses’ turnover intention. At the same time, hospitals should pay attention to providing adequate work resources for nurses, and by reducing career compromise, nurses can increase their motivation and initiative at work, improve their job satisfaction, and stimulate the creation of more work resources, which will lead nurses to invest more energy and effort in their work and increase their commitment to the organization. This study provides new perspectives for nurse managers to reduce nurses’ turnover intention and increase retention.

Conclusion

In summary, career compromise and turnover intention are negatively related to job satisfaction. Job satisfaction mediates the relationship between career compromise and turnover intention. The results of this study suggest that nurse managers should pay attention to the ideas of nurse groups, formulate relevant policies and strategies to effectively protect the interests of nurses, improve the work environment, and help nurses realize their self-worth to reduce the level of nurses’ career compromise, which will help improve job satisfaction, thereby reducing turnover intention, stabilizing the nursing workforce, and promoting the sustainable development of the nursing profession.

Limitations

First, this study is a cross-sectional survey that only examines the correlation between career compromise, job satisfaction, and turnover intention, and it is not possible to determine the causal relationship between them. Second, this study used a convenience sampling method to select nurses from different regions and hospitals of different grades in Guangdong Province, which may have led to sampling bias. Finally, the survey population of this study included nurses in Guangdong Province, which cannot comprehensively represent all nurses in China. Therefore, longitudinal studies can be used in future research to further confirm the causal relationship between career compromise, job satisfaction, and turnover intention. In addition, future studies should include larger samples and use probability sampling to reduce sampling bias and improve the generalizability of sample results.

Data availability

The original contributions presented in the study are included in the article/supplementary material, and further inquiries can be directed to the corresponding author.

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Acknowledgements

To all the healthcare professionals who participated in the study, the authors deeply appreciate you.

Funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Guangzhou Municipal Science and Technology Project (No. 2024B03J1258), and the Guangdong Health Economics Association Key Projects under Grant (No. 2022-WJZD-29).

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Authors and Affiliations

  1. Department of Nursing, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China

    Zhanghao Xie, Zhongqing Chen, Waner Wang, Jiangfeng Pu, Gege Li, Jiehao Zhuang, Xuanhao Fan, Ziyi Xiong, Hanxi Chen, Peng Xu & Huigen Huang

  2. Department of Nursing, Shantou University Medical College, Shantou, China

    Zhanghao Xie & Huigen Huang

  3. Department of Nursing, Southern Medical University, Guangzhou, China

    Zhongqing Chen, Ziyi Xiong & Huigen Huang

  4. Department of Nursing, Guangdong Pharmaceutical University, Guangzhou, China

    Waner Wang, Jiangfeng Pu, Jiehao Zhuang & Xuanhao Fan

  5. Department of Nursing, Jinan University, Guangzhou, China

    Gege Li

  6. Department of Nursing, Guangzhou Health Science College, Guangzhou, China

    Yuemei Liang

Authors
  1. Zhanghao Xie
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  2. Zhongqing Chen
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  8. Ziyi Xiong
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  9. Hanxi Chen
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  11. Peng Xu
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  12. Huigen Huang
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Contributions

ZX: Formal analysis, Writing – original draft, Writing review & editing. ZC & WW: Investigation, Writing – original draft. JP&GL: Investigation, Writing – original draft. JZ: Data curation, Writing – review & editing. XF: Data curation, Investigation, Writing, review & editing. HC & YL: Manuscript revision.PX & HH: Project administration, Writing – review & editing.

Corresponding authors

Correspondence to Peng Xu or Huigen Huang.

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Ethics approval and consent to participate

The studies involving humans were approved by the Guangdong Provincial People’s Hospital Ethics Committee from Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences) (No. KY2023-859).We confirm that informed consent was obtained from all subjects and all methods were carried out in accordance with academic standard.

Competing interests

The authors declare no competing interests.

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Xie, Z., Chen, Z., Wang, W. et al. The effect of career compromise on nurses’ turnover intention: the mediating role of job satisfaction. BMC Nurs 23, 700 (2024). https://doi.org/10.1186/s12912-024-02346-5

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Keywords

BMC Nursing

ISSN: 1472-6955

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