Tied to the Job: Affective and Relational Components of Nurse Retention

Objective: To investigate whether affective and relational components of nurses' experience of work have a significant impact on their intentions to leave either the job or the nursing profession in models that control for other factors (sociodemographic, work conditions, perceptions of quality of care) that are known to affect career decisions. Method: An exploratory, cross-sectional postal survey of 2880 nurses in grades A–I in 20 National Health Service (NHS) Hospital Trusts, 11 in inner London and nine in outer London, was carried out between January and July 2002, looking at nurses' intention to leave their current job or the nursing profession. The data were analysed using logistic regression with robust standard errors. Results: In models that controlled for known sources of job dissatisfaction, relationships with supervisors and managers were found to have a significant effect on respondents' career intentions. Feeling valued by the Trust and by society was very important. Nurses seemed to distinguish between local problems that are the responsibility of the Trust and those, such as levels of pay, that could only be solved at the national level. Conclusion: Nurses' career intentions are complex and multifactorial. Feelings of being valued and listened to play a role, as well as the individual and job-related characteristics. The study highlights the role of supervisors and managers in retaining staff and suggests that investment in robust systems of communication, conflict resolution and security could slow nurse turnover. The NHS as an employer may be most interested in the role of pay in nurse retention, and the general public in how societal attitudes and verbal abuse shape nurses' career decisions.