International Journal of Nursing Studies 39 (2002) 867878

The inuence of nurses working motivation and

job satisfaction on intention to quit: an empirical
investigation in Taiwan
Huey-Ming Tzeng*
Department of Nursing, I-Shou University, No. 1, Section 1, Hsueh-Chang Road, Ta-Hsu Hsiang, Kaohsiung County 840, Taiwan
Received 21 August 2001; received in revised form 21 January 2002; accepted 22 April 2002

Abstract
The present era of cost-containment pressures indicates that nursing executives have to ensure that, their nurses have
a work environment with the work characteristics known to be linked to job satisfaction and good outcomes. The
research hypothesis investigated here was: the higher nurses levels on general job satisfaction, overall satisfaction with
their professional role, and general job happiness, the lower their intention to quit would be. The controlling variables
included demographic characteristics, working motivation, and nine job satisfaction subscales. This study was
conducted in 3 hospitals located in southern Taiwan. All nurses working for these 3 hospitals were the target subjects.
The overall response rate (648 completed questionnaires) was 82%. The nurses Job Satisfaction and the perceptual
degree of its importance questionnaire was used. Ordinal logistics regression analyses were utilized. General job
satisfaction, general job happiness, satisfaction with salary and promotion, institution, educational background, and
age of nurses youngest child were proved to be signicant predictors of nurses intention to quit. Suggestions for future
studies and administrative strategies in decreasing nurses intention to quit were discussed. r 2002 Elsevier Science Ltd.
All rights reserved.
Keywords: Working motivation; Job satisfaction; Intention to quit; Nurse

1. Introduction
A competitive healthcare market is indeed qualityoriented, and improving the quality of healthcare
services is a continuing challenge to managers in the
healthcare industry. Similar to the western societies,
Taiwans healthcare industry became a cost-containing
environment after the government implemented the
National Health Insurance System in 1995. The present
era of cost-containment pressures indicates that nursing
executives have to ensure that, their nurses have a work
environment with the work characteristics known to be
*Tel.: +886-9261-50912, 886-7-6577711x5752; fax: +886-76577056.
E-mail address: tzeng hueyming@yahoo.com
(H.-M. Tzeng).

linked to job satisfaction and good outcomes. Research

of Leiter et al. (1998) concluded that patients, who
stayed on wards where nursing staff felt more exhausted
or more frequently expressed their intention to quit,
were less satised with their medical care. This study
conrmed the importance of understanding nurses job
satisfaction and intention to quit as both concepts,
which would contribute to patient outcomes. Several
recent studies further conrmed that nurses job
satisfaction contributed to the perceptual levels of
patient satisfaction with nursing care, which is one of
the most important clinical outcome indicators (Tzeng
and Ketean, 2002; Tzeng et al., 2002; Tzeng et al.,
2001). Moreover, both nurses job satisfaction and
patient satisfaction have been identied in the Nursing
Report Card for Acute Care (American Nurses Association, 1995) as two of the important nursing quality

0020-7489/02/$ - see front matter r 2002 Elsevier Science Ltd. All rights reserved.
PII: S 0 0 2 0 - 7 4 8 9 ( 0 2 ) 0 0 0 2 7 - 5

868

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

outcome indicators. Nurses intention to quit has a

strong effect on their actual action of turnover, which
might lead to certain amount of decrease in the quality
and increase in the cost for patient care (Alexander et al.,
1998).
In a local conference for enhancing the communication among hospital nursing executives, nurse educators
and government ofcers in Taiwan, it was concluded
that nurses turnover rates among hospitals have been
decreased from up to 50% down to below 10%. In some
public healthcare institutions, the turnover rates were
even lower than 5% per year. In other words, Taiwans
turnover rates were no longer a severe issue for the nurse
market. This trend might be caused by the changes in the
macro-economical environment (e.g., cost containment,
more supply than demand for nurses, difculties for
nurses to change their career path). As for nurses
intention to quit was related to their loyalty and work
performance (Dolan et al., 1992), nurses intention to
quit, instead of turnover, was determined as the target
variable of this study. As a result, this exploratory
project aimed to investigate the effects of working
motivation, job satisfaction, and general perceptual
factors as related to jobs, on nurses intention to quit.
The purpose of this study was to develop and test a
conceptual model of nurses intention to quit, and to
contribute to the developing domain of nursing outcome
studies.

2. Literature review
Previous studies (e.g., McNeese-Smith, 1996; Lee
et al., 1999; Tzeng, 1997) report that managerial factors
affected employees attitudes, job satisfaction, organizational commitment, and motivation to perform well, and
these factors, in turn, inuenced organizational outcomes. Organizational outcomes included, for example,
patient satisfaction and employees intention to quit.
Study of Bjorvell and Brodins (1992) found that half
of the nursing staff wanted to quit their jobs. Those
nurses, who had intention to quit, perceived themselves
as less satised with several aspects (job dimensions of
cooperation, job complexity, help received from superiors, and sufcient time for nursing care delivery), than
did those who did not have any intention to quit. Results
also showed that the head nurses seemed to have an
important supportive function, and suggested that a
supportive institution might reduce personnel turnover
in hospitals.
Dolan et al. (1992) concluded that occupational
stressors, lack of professional latitude, and role of
problems, predicted nurses intention to quit their
working healthcare organizations. For the aims of
beneting the quality of patient care and the respective
hospitals, possible remedies to address these job

stressors were improving nurses quality of life, mental

health, and decreasing the rate of turnover.
Keel (1993) indicated that burnout affects mainly
nurses, physicians, social workers and teachers. Burnout
seems to be caused by stressful working conditions,
disproportional-high efforts (time, emotional involvement, and empathy) and dissatisfaction with jobs. For
the goals of lowering professional stress and improved
satisfaction, social support and improved team cooperation could protect nurses against burnout.
Study of Abbott et al. (1994) noted the relationship
between the form of practice models (e.g., case management, managed care) and the levels of nurses job
satisfaction. They concluded that managed care had a
positive impact on nurses job satisfaction. Thus,
according to Kovner et al. (1994) research (on the
relative impact of various nursing care delivery models
and administration interventions on nurses job satisfaction), pay, autonomy, and professional status were
important predictors of job satisfaction. Different
administration initiatives had impact on the satisfaction
levels of interactions and task requirements. Initial
dissatisfaction with these administration initiatives was
noted. Moreover, study of Kennerly (1996) concluded
that initiating shared governance did not inuence the
levels of nurses job satisfaction, anticipated turnover,
and perceived work effectiveness. Increases in autonomy
were not continued over time.
Armstrong-Stassen et al. (1994) examined the relationship between nurses job satisfaction dimensions,
burnout, and intention to quit. Results demonstrated
that career future and burnout (emotional exhaustion)
predicted the levels of nurses intention to quit. Kind of
work, amount of work, and career future were
associated with burnout. Parker and Kulik (1995)
demonstrated that work support and job stress were
predictors of nurses burnout. Higher turnover rates
were associated with poorer self-rated and supervisorrated job performance, more sick leaves, more reported
absences for mental health reasons, and higher intention
to quit. Lim and Yuens (1998) concluded that demands
from patients/relatives, doctors, and perceived job image
were correlated with nurses job satisfaction. Demands
from patients/relatives and perceived job image were
found to be associated with nurses intention to quit.
Kivimaki et al. (1995) found that job satisfaction and
motivation to perform well were related to the levels of
job enrichment. The nurses occupying highly enriched
jobs reported signicantly higher job satisfaction and
motivation.
Professional growth opportunities, workload, dissatisfaction with work hazards, and relationship with
coworkers, were found to predict nurses turnover. In
nursing care delivery systems, the following aspects
(support for autonomy, executives leadership styles,
communication, adequate time for patient care, the

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

degree of environmental uncertainty, and reported

nursing stress) contributed to job satisfaction, motivation to perform well at work, and a work groups
effectiveness (Edgar, 1999; Healy and McKay, 1999;
Dunham-Taylor, 2000). Kangas and associates (1999)
further emphasized that a support environment was
most important to nurses job satisfaction. Thus, there
were no found differences in nurses job satisfaction or
patient satisfaction with nursing care in different
organizational structures or nursing care delivery
models (Kangas et al., 1999).
Adams and Bond (2000) found that in hospitals,
nurses interpersonal relationships (cohesive working
relationships, relationships with medical staff), their
perceptions of workload, and their evaluation of the
appropriateness of the system where nursing care are
practiced, were inuential factors of nurses job satisfaction. Analyses found that individual nurse characteristics were not related to job satisfaction. Agho (1993)
indicated that the major determinants of nurses job
satisfaction were routinization, participation, integration, distributive justice, instrumental communication,
promotional opportunity, and positive affectivity. Muller-Smith (1999) reported that the potential for growth
rather than fear of loss invented energy and excitement,
which led to a joyful workplace and a strong sense of
accomplishment. Liou et al. (1997) identied similar
aspects for nurses job satisfaction, including indirect
working environment, direct working environment,

869

salary and promotion, self-growth, challenging work,

interaction and feedback with patients and family
members, leadership style, working atmosphere, and
family support and religion.

3. The conceptual and tested framework

According to the previously reviewed literature, the
conceptual framework (see Fig. 1) was developed.
Whereas, Adams and Bond (2000) found that individual
nurse characteristics were not related to job satisfaction
or intention to quit. Nurses demographic characteristics
were controlled in the model for exploratory purposes.
The explanatory variables of nurses intention to quit
were demographic characteristics, nine job satisfaction
subscales (indirect working environment, direct working
environment, salary and promotion, self-growth, challenge in work, interaction and feedback with patients
and family members, leadership style, working atmosphere, and family support and religion), general job
satisfaction in the levels of satisfaction (general job
satisfaction); overall satisfaction levels with nurses
professional role, general feeling when doing the job in
the levels of happiness (general job happiness). The
demographic characteristics included hospital, nurses
age, marital status (single, married, or divorce/separated), years of professional experience, tenure, highest
educational degree, going to school for a higher

Demographic Characteristics
Hospital
Age
Marital status (single, married,
divorce or separated)
Years of professional experience
Tenure
Motivation (dream job, interest, for
money, no other choice, family
expectation)

Job Satisfaction Subscales

Indirect working environment
Direct working environment
Salary and promotion
Self-growth
Challenge in work
Interaction with and feedback from
patients and family members
Leadership style
Working atmosphere
Family support and religion

Dependent Variable:
Intention to quit

General Perceptual Factors

General job satisfaction
Overall satisfaction levels with the
professional roles
General job happiness

Fig. 1. The conceptual framework of nurses intention to quit. The ordinal dependent variable, having intention to quit, was rated into
ve categories: [(1) least agreeable, (2) disagreeable, (3) neutral, (4) agreeable, and (5) most agreeable]. The explanatory variables
included demographic characteristics, job satisfaction subscale, and three general perceptual factors.

870

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

educational degree, having a religion, number of

children, the age of the youngest child, having administrative responsibilities, working motivation (dream
job, interest, for money, no other choice, or family
expectation). All nurse subjects in this study were
female, and as a result, gender was not included. The
dependent variable, intention to quit, was dened as an
ordinal variable, and rated in a 5-Likert scale [(1) least
agreeable, (2) disagreeable, (3) neutral, (4) agreeable,
and (5) most agreeable]. Denitions of included variables were listed in Appendix A: Denitions of the
variables. All the scales/items included in this study
were operationalized in the nurses job satisfaction and
the perceptual degree of its importance questionnaire.
The research hypothesis investigated here was: the
higher nurses levels on general job satisfaction, overall
satisfaction factor with their professional role, and
general job happiness, the lower their intention to quit
would be, after controlling for demographic characteristics, working motivation, and nine job satisfaction
subscales.

4. Methods
4.1. Subjects
This study was conducted in 3 hospitals located
in southern Taiwan. These hospitals nursing administrators acted as members of the Human Subject
Review committees. Committee members reviewed
this research proposal for approval, and assured having
appropriate human subject protection. The attached
cover sheet indicated that all collected data would
be used for research purposes only. Data would be
kept condential, and subjects identication will be
protected.
These 3 hospitals were located in the same demographic area. One of them is a Christian teaching
hospital (Hospital A), another one is a private-owned
local hospital (Hospital B), and the other one is a local,
veterans hospital (Hospital C). Data were collected
during the period from December 1999 to March 2000.
All the nurses working in these three institutions were
the target population (including the ones with managerial responsibilities, and excluding physician assistants),
for a total of 786 nurses. The questionnaire packages
were sent to the nurse subjects through the hospitals
nursing departments. This questionnaire packages (included a letter explaining the study purpose, a demographic information chart, a pre-stamped return
envelope, and a gift for appreciating subjects participation) were disseminated to all nurses through subjects
managers. The completed questionnaire (in a sealed
envelop) was returned to the principal investigator by
mail or through their nursing departments. Subjects

participated in this study voluntarily and anonymously. The overall response rate (648 completed
questionnaires) was 82%, and the correspondent rate
for each individual hospital ranged from 72% to
84%.
4.2. The nurses job satisfaction and the perceptual degree
of its importance questionnaire
This questionnaire set was written in Mandarin, and
only part of the items in this questionnaire was utilized.
There were a total of 48 items for measuring the levels of
the nine job satisfaction scales. Items were grouped into
9 scales: indirect working environment (6 items); direct
working environment (7 items); salary and promotion
(7 items); self-growth (3 items); challenge in work
(6 items); interaction with and feedback from patients
and family members (3 items); leadership style (7 items);
working atmosphere (7 items); and family support and
religion (2 items). Responses were given on a 5-point
Likert scale: ranging from 1 (least satised) to 5 (most
satised), and 9 (not applicable). Three general perceptual factors (general job satisfaction, overall satisfaction
with professional roles, general job happiness) were
rated from very satised or very happy to very
dissatised or very unhappy. The ordinal dependent
variable, having intention to quit, was rated into ve
categories: (1) Least agreeable, (2) disagreeable, (3)
neutral, (4) agreeable, and (5) most agreeable.
For the consistency of the tool, a test-retest method (2
weeks apart) was used. A total of 46 full-time nurses
participated in this test. The test-retest correlation
coefcients on items were ranged from 0.81 to 0.96. As
for the reliability analyses, alpha coefcients were
calculated using all the valid subjects. Except for the
satisfaction scale of family support and religion (alpha
coefcient=0.64), all the other alpha coefcients were
ranged from 0.74 to 0.92. For each scale, the mean value
was calculated by averaging the valid values of the
grouped items.
4.3. Data analyses
Data were entered and processed by using the
statistical package for the social sciences (SPSS) software, English version 10.0. Descriptive information for
all included variables was presented. Ordinal logistic
regression analyses were utilized to develop a model of
nurses intention to quit. The demographic characteristics were entered into the regression model rst,
followed by nine job satisfaction scales, and three
general job-related indicators at last. This procedure
allowed us to observe the changes on coefcients when
more explanatory variables were added into the
equation.

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

871

about 4.6% of participants had a baccalaureate, master

or higher degree. About 70.6% of nurses worked as a
nurse due to their own interest or just for money (35.3%
for each). In average, having an intention to quit was
rated as 3.02 (3, neutral) (SD=0.99). Except for the
aspects of indirect working environment and salary and

5. Results
Table 1 demonstrated the demographic information
of nurses. All participants were female, 26 years old with
more than 2.5 years of tenure in average. About 29.3%
of them were married, divorced or separated. Only

Table 1
Descriptive information (n 648)
Variables/values

Mean

SD

Minimum

Maximum

Age in years
Professional working experience in months
Tenure in months
Number of children
Age of the youngest child in years
Indirect working environment
Direct working environment
Salary and promotion
Self growth
Challenge in work
Interaction with patients and family members
Leadership style
Working atmosphere
Family support and religion
General job satisfaction
General satisfaction levels toward professional roles
General job happiness
Intention to quit

26.42
66.29
31.24
1.78
6.52
2.94
3.24
2.85
3.08
3.23
3.40
3.21
3.51
3.54
3.26
3.30
3.32
3.02

6.65
73.97
52.03
0.69
6.10
0.55
0.55
0.67
0.63
0.55
0.60
0.67
0.57
0.60
0.78
0.64
0.74
0.99

19.00
1.00
1.00
1.00
1.00
1.00
1.43
1.00
1.00
1.00
1.00
1.00
1.57
1.50
1.00
1.00
1.00
1.00

52.00
360.00
357.00
4.00
26.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00

Frequency (valid percent)

Hospital
A
B
C
Marital status
Single
Married
Divorced or separated
Highest educational degree
Diploma
Associate degree
Baccalaureate degree
Master degree or higher
Part-time student status
No
Yes
Having a religion
No
Yes
Managerial responsibility
No
Yes
Working motivation (multiple choices)
Dream job
Interest
For money
No other choice
Family expectation

394
174
80

60.8
26.9
12.3

446
182
3

70.7
28.8
0.5

65
511
22
6

10.7
84.6
3.6
1.0

509
83

86.0
14.0

118
530

18.2
81.8

600
48

92.4
7.6

78
229
229
114
156

12.0
35.3
35.3
17.6
24.1

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

872

promotion, most of the nurses felt satised to neutral

about their jobs.
In assessing overall model t, the goodness of t
measure compared the predicted probabilities to the
observed probabilities. Smaller values of the 2 log
likelihood measure indicated better model t (Hair et al.,
1998). Table 2 indicated a good t on all three ordinal
regression models. The explanatory variables in the third
model were statistically and signicantly associated
(Pearson Chi-Square=2677.67, df=1864, p 0:01),
however (predictors should be independent to each
other.)
By observing Model 1 alone (Table 3) (when p was set
at 0.10), if a nurse was working at Hospital B
(estimate=0.751, Wald w2 5:48; p 0:02), having less

number of children (estimate=0.351, Wald w2 3:39;

p 0:07), and her motivation to work was not for
money (estimate=0.437, Wald w2 6:66; p 0:01),
no other choice (estimate=0.554, Wald w2 6:52;
p 0:01),
and
family
members
expectation
(estimate=0.346, Wald w2 3:19; p 0:07), this nurse
would have higher intention to quit (the Nagelkerke
Pseudo R2 0:109). For Model 2 (when p was set at
0.10), if a nurse was working at Hospital B (estimate=1.024, Wald w2 7:39; p 0:01) and having
lower satisfaction levels with direct working environment (estimate=0.417, Wald w2 2:81; p 0:09),
salary and promotion (estimate=0.469, Wald
w2 5:81; p 0:02), and challenge in work
(estimate=0.697, Wald w2 7:35; p 0:01), and her

Table 2
Model tting information for three ordinal logistic regression models: nurses intention to quit as the dependent variable (the link
function is logit)
The chi-square test for goodness-of-ta
Modelb

2 log likelihood intercept only

2 log likelihood nal model

Chi-square

Degree of freedom

Signicance

1
2
3

1501.89
1361.83
1327.51

1443.17
1211.11
1096.74

58.72
150.72
230.77

20
29
32

0.00**
0.00**
0.00**

Pearsons chi-square testc

Model

Chi-square

Degree of freedom

Signicance

Pearson
Deviance
Pearson
Deviance
Pearson
Deviance

2073.90
1434.85
1895.82
1211.11
2677.67
1096.74

2112
2112
1919
1919
1864
1864

2
3
Model

Pseudo R-squared

Cox and Snell R2

Nagelkerke
Cox and Snell R2
Nagelkerke
Cox and Snell R2
Nagelkerke

2
3

0.72
1.00
0.64
1.00
0.00**
1.00

0.103
0.109
0.266
0.283
0.385
0.410

Note:
**p 0:01; 2-tailed.
a
The chi-square test for goodness-of-t compares the results of a study of data to determine how likely the sample results actually
are, given the parameter estimates. A good model is one, which results in a high likelihood of the observed values or a small value for
2 Log Likelihood.
b
The rst model included only demographic variables; the second model was composed of demographic variables and the 8 job
satisfaction scales; and the third model included demographic variables, 8 job satisfaction scales, and three general job-related
indicators.
c
The Pearsons chi-square test (also called the chi-square test of independence) examined a set of variables to determine whether they
are associated.
d
The Cox and Snell R2 measure operates in the same manner as the R2 measure in multiple regression, with higher values indicating
greater model t (less than 1). Nagelkerke, which has a range of 01, is a modication of the Cox and Snell R2 measure (Hair et al.,
1998).

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

873

Table 3
Parameter estimates of the ordinal regression models: nurses intention to quit as the dependent variable (the link function is logit)
Model

Variable

Threshold (intercept)
Intention to quita=1
Intention to quit=2
Intention to quit=3
Intention to quit=4
Location (explanatory variables)
Nurse age
Professional experience
Tenure
Number of children
Age of the youngest child
Hospital=A
Hospital=B
Hospital=C
Marital status
Single
Married
Divorced or separated
Education
Diploma
Associate degree
Bachelor degree
Master degree or higher
Part-time student status=no
Part-time student status=yes
Has a religion=no
Has a religion=yes
Administrative position=no
Administrative position=yes
Motivation to work
Dream job=no
Dream job=yes
Interest=no
Interest=yes
For money=no
For money=yes
No other choice=no
No other choice=yes
Family expectation=no
Family expectation=yes

Estimate

Standard
error

Wald w2

P value

95%CI

2.630
0.315
1.375
3.331

1.893
1.887
1.887
1.893

1.93
0.03
0.53
3.10

0.17
0.88
0.47
0.08*

7.00
4.69
3.04
1.12

0.010
0.004
0.002
0.351
0.006
0.066
0.751
&

0.046
0.004
0.002
0.191
0.033
0.302
0.321

0.05
0.81
1.06
3.39
0.03
0.05
5.48

0.83
0.37
0.30
0.07*
0.86
0.83
0.02**

0.10 to 0.08
0.004 to 0.01
0.002 to 0.007
0.73 to 0.02
0.06 to 0.07
0.66 to 0.53
0.12 to 1.38

1.554
0.971
&

1.144
1.103

1.85
0.77

0.17
0.38

0.69 to 3.80
1.19 to 3.13

0.587
0.401
0.777
&
0.204
&
0.116
&
0.145
&

0.806
0.770
0.894

0.53
0.27
0.76

0.47
0.60
0.39

2.17 to 0.99
1.91 to 1.11
2.53 to 0.98

0.241

0.72

0.40

0.27 to 0.68

0.194

0.36

0.55

0.27 to 0.50

0.349

0.17

0.68

0.54 to 0.83

0.249

0.09

0.77

0.41 to 0.56

0.184

1.62

0.20

0.13 to 0.59

0.169

6.66

0.01***

0.77 to 0.11

0.217

6.52

0.01***

0.98 to 0.13

0.194

3.19

0.07*

0.73 to 0.03

0.074
&
0.234
&
0.437
&
0.554
&
0.346
&

to
to
to
to

0.06
2.33
3.98
5.92

Threshold (intercept)
Intention to quit=1

10.294

2.413

18.20

0.00***

Intention to quit=2

7.755

2.388

10.54

0.00***

Intention to quit=3

5.804

2.378

5.96

0.02**

Intention to quit=4
Location (explanatory variables)
Nurse age
Professional experience
Tenure
Number of children
Age of the youngest child

3.664

2.375

2.38

0.12

15.02 to
5.57
12.44 to
3.07
10.47 to
1.14
8.32 to 0.99

0.030
0.005
0.003
0.351
0.032

0.049
0.004
0.003
0.214
0.036

0.38
1.54
1.19
2.70
0.79

0.54
0.21
0.28
0.10
0.37

0.13
0.00
0.00
0.77
0.04

to
to
to
to
to

0.07
0.01
0.01
0.07
0.10

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

874
Table 3 (continued)
Model

Variable
Job satisfaction indicators
Indirect working environment
Direct working environment
Salary and promotion
Self-growth
Challenge in work
Interaction with patients and family
members
Leadership style
Working atmosphere
Family support and religion

Estimate

Standard
error

Wald w2

P value

95%CI

0.047
0.417
0.469
0.211
0.697
0.113

0.241
0.249
0.195
0.180
0.257
0.183

0.04
2.81
5.81
1.38
7.35
0.39

0.85
0.09*
0.02**
0.24
0.01***
0.54

0.52
0.90
0.85
0.14
1.20
0.47

0.315
0.213
0.048

0.193
0.207
0.173

2.67
1.06
0.08

0.10
0.30
0.78

0.69 to 0.06
0.62 to 0.19
0.29 to 0.39

0.325
1.024
&

0.362
0.377

0.81
7.39

0.37
0.01***

0.39 to 1.04
0.29 to 1.76

0.647
0.057
&

1.457
1.399

0.20
0.00

0.66
0.97

2.21 to 3.50
2.69 to 2.80

1.069
0.983
0.891
&
0.069
&
0.146
&
0.304
&

0.841
0.801
0.923

1.62
1.51
0.93

0.20
0.22
0.33

2.72 to 0.58
2.55 to 0.59
2.70 to 0.92

0.267

0.07

0.80

0.46 to 0.59

0.215

0.46

0.50

0.27 to 0.57

0.381

0.64

0.43

0.44 to 1.05

0.272

0.23

0.63

0.40 to 0.66

0.198

0.14

0.71

0.31 to 0.46

0.185

3.44

0.06*

0.71 to 0.02

0.238

0.37

0.55

0.61 to 0.32

0.211

0.41

0.52

0.55 to 0.28

12.063

2.498

23.32

0.00***

Intention to quit=2

9.298

2.469

14.49

0.00***

Intention to quit=3

7.179

2.454

8.56

0.00***

Intention to quit=4
Location (explanatory variables)
Nurse age
Professional experience
Tenure
Number of children
Age of the youngest child

4.783

2.448

3.82

0.05*

16.96 to
7.17
14.24 to
4.56
11.99 to
2.37
9.58 to 0.01

0.024
0.005
0.002
0.283
0.068

0.051
0.005
0.003
0.226
0.039

0.22
1.14
0.66
1.57
2.97

0.64
0.29
0.42
0.21
0.09*

0.12
0.00
0.00
0.73
0.01

Hospital=A
Hospital=B
Hospital=C
Marital status
Single
Married
Divorced or separated
Education
Diploma
Associate degree
Bachelor degree
Master degree or higher
Part-time student status=no
Part-time student status=yes
Has a religion=no
Has a religion=yes
Administrative position=no
Administrative position=yes
Motivation to work
Dream job=no
Dream job=yes
Interest=no
Interest=yes
For money=no
For money=yes
No other choice=no
No other choice=yes
Family expectation=no
Family expectation=yes
Threshold (intercept)
Intention to quit=1

0.131
&
0.074
&
0.344
&
0.144
&
0.135
&

to
to
to
to
to
to

to
to
to
to
to

0.43
0.07
0.09
0.56
0.19
0.24

0.08
0.01
0.01
0.16
0.15

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

875

Table 3 (continued)
Model

Variable
Job satisfaction indicators
Indirect working environment
Direct working environment
Salary and promotion
Self-growth
Challenge in work
Interaction with patients and family
members
Leadership style
Working atmosphere
Family support and religion
General items
General job satisfaction

Estimate

Standard
error

Wald w2

P value

95%CI

0.128
0.078
0.430
0.093
0.246
0.085

0.252
0.260
0.204
0.186
0.272
0.194

0.26
0.09
4.41
0.25
0.82
0.19

0.61
0.76
0.04**
0.62
0.37
0.66

0.62
0.59
0.83
0.27
0.78
0.47

0.187
0.160
0.177

0.200
0.216
0.180

0.87
0.55
0.96

0.35
0.46
0.33

0.58 to 0.20
0.58 to.26
0.18 to 0.53

0.788

0.188

17.55

0.00***

0.862

0.180

22.89

0.00***

Overall satisfaction levels with the

professional role

0.150

0.173

0.75

01.16 to
0.42
01.22 to
0.51
0.19 to 0.49

Hospital=A
Hospital=B
Hospital=C
Marital status
Single
Married
Divorced or separated
Education
Diploma
Associate degree
Bachelor degree
Master degree or higher
Part-time student status=no
Part-time student status=yes
Has a religion=no
Has a religion=yes
Administrative position=no
Administrative position=yes
Motivation to work
Dream job=no
Dream job=yes
Interest=no
Interest=yes
For money=no
For money=yes
No other choice=no
No other choice=yes
Family expectation=no
Family expectation=yes

0.564
1.035
&

0.375
0.387

2.26
7.15

0.13
0.01***

0.17 to 1.30
0.28 to 1.79

1.199
0.532
&

1.495
1.434

0.64
0.14

0.42
0.71

01.73 to 4.13
02.28 to 3.34

1.790
1.639
1.436
&
0.167
&
0.138
&
0.425
&

0.866
0.820
0.944

4.28
4.00
2.31

0.04**
0.05**
0.13

3.49 to 0.09
3.25 to 0.03
3.29 to 0.42

0.280

0.36

0.55

0.38 to 0.72

0.224

0.38

0.54

0.30 to 0.58

0.407

1.09

0.30

0.37 to 1.22

0.279

0.39

0.54

0.72 to 0.37

0.208

1.20

0.27

0.64 to 0.18

0.191

0.68

0.41

0.53 to 0.22

0.249

0.11

0.74

0.57 to 0.41

0.218

0.01

0.91

0.40 to 0.45

General job happiness

0.173
&
0.227
&
0.157
&
0.082
&
0.026
&

385

to
to
to
to
to
to

0.37
0.43
0.03
0.46
0.29
0.30

Notes:
*p 0:10; 2-tailed.
**p 0:05; 2-tailed.
***p 0:01; 2-tailed.
&: This parameter was set to zero because it was redundant.
Standard error=estimated precision of the coefcients.
95%CI=95% condence intervals for the coefcients.
Wald w2 =the Wald test statistic calculated from the data to be compared with the chi-square distribution with 1 degree of freedom.
a
The ordinal dependent variable, having intention to quit, was rated into ve categories: (1) least agreeable, (2) disagreeable, (3)
neutral, (4) agreeable, and (5) most agreeable.

876

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

motivation to work was NOT for money

(estimate=0.344, Wald w2 3:44; p 0:06), this nurse
would have higher intention to quit (the Nagelkerke
Pseudo R2 0:283).
Model 3 was the nal ordinal regression model for
testing the research hypothesis. Institution (Hospital B)
(estimate=1.035, Wald w2 7:15; p 0:01), age of the
youngest child (estimate=0.068, Wald w2 2:97;
p 0:09), holding a diploma (estimate=1.790, Wald
w2 4:28; p 0:04), holding an associate degree
(estimate=1.639, Wald w2 4:00; p 0:05), salary
and promotion (estimate=0.430, Wald w2 4:41;
p 0:04), general job satisfaction (estimate=0.862,
Wald w2 22:89; p 0:00), and general job happiness
(estimate=0.788, Wald w2 17:55; p 0:00) were
proved to be signicant predictors of nurses intention
to quit (when p was set at 0.10). The Nagelkerke Pseudo
R2 for Model 3 was 41%.

6. Discussion and conclusion

The research hypothesis (the higher nurses levels on
general job satisfaction, overall satisfaction with professional roles, and general job happiness, the lower
their intention to quit would be, after controlling
for demographic characteristics and working motivation
rst, and following by nine job satisfaction subscales)
was tested in this project. This hypothesis was not
fully supported (when p was set at 0.10), however. In
these three ordinal regression models, different demographic characteristics (such as working hospital,
number of children, age of the youngest child, and
motivation to work as a nurse) demonstrated statistically signicantly predicting power toward nurses
intention to stay. In Model 2, as compared to direct
working environment and salary and promotion,
challenge in work was the strongest job satisfaction
predictor of intention to quit. However, in Model 3,
general job happiness and general job satisfaction had
higher values in estimates than the one of salary and
promotion. These results showed the sophisticated
association and predicting power among included
variables and nurses intention to quit.
In the nal (third) ordinal regression model, only two
primary explanatory variables (general job satisfaction
and general job happiness) were statistically signicant
predictors of nurses intention to quit. Compared to
general job satisfaction, general job happiness was
seldom used in predicting outcome variables. Here,
job happiness was quantied as a general item to
measure nurses overall perceptions towards their jobs
when they are doing their jobs in the levels of happiness.
Tzeng and Ketean (2002) and Tzeng et al. (2001)
studies suggested a signicant relationship between
nurses general job happiness and patient satisfaction

with nursing care. In addition, Tzengs (2002) conrmed

that nurses job satisfaction and job happiness were two
distinct concepts. Muller-Smith (1999) reported that the
potential for growth rather than fear of loss invented
energy and excitement, which led to a joyful workplace
and a strong sense of accomplishment. In conclusion,
this study provided strong evidence that job satisfaction
and job happiness are two discrete concepts and
explained a signicant amount of variance of nurses
intention to quit. Future research might investigate
whether employees job happiness is a predictor of the
other outcome indicators (e.g., work performance,
service attitudes). At the mean time, it would be
imperative to further investigate the possible differences
on employees perceptual levels on job happiness
between female and male and employees personality
characteristics.
Ordinal regression results also demonstrated that
working motivation (for money, no other choice,
and family expectation) were signicant predicators of
intention to quit in Model 1. Three job satisfaction
aspects (challenge in work, salary and promotion,
and direct working environment) were signicant predicators of nurses intention to quit in Model 2, but the
effects of work motivation (only working for money left)
were washed out. The variance of nurses satisfaction
with challenge in work and direct working environment
was washed out after entering general job-related
indicators as seen in the nal (third) model, where
salary and promotion was still a signicant predictor.
Previously reviewed literature also emphasized the
importance of building a support environment
with appreciated reward systems (Edgar, 1999; Healy
and McKay, 1999; Kangas et al., 1999; Adams and
Bond, 2000; Dunham-Taylor, 2000). Kivimaki et al.
(1995) provided a different insight that the nurses,
who are occupying highly enriched jobs, reported
signicantly higher job satisfaction and work motivation. Observing the organizational cultures of current
working places, building an environment emphasizing
afliation and recognition is a norm. However,
creating challenging works is still a hard-to-approach
matter to nursing executives. Different administration
initiatives (such as, implementing case management,
shared governance, work redesign, total quality management) had been introduced to the healthcare organizations (Abbott et al., 1994; Kennerly, 1996). Thus,
the positive impact of these initiatives on nurses
job satisfaction, especially with challenge in work, does
not seem to be considerable. For the purpose of
decreasing nurses intention to quit, it is suggested
to further explore extensively which factors matter to
nurses job satisfaction with challenging work, such as
achievement, autonomy at work, new challenge, stress
levels, and suitable work (workload, context, time,
emotional involvement). We believed that for increasing

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

877

Table 4
Denitions of the variables: operationalized in the Nurses Job Satisfaction and the Perceptual Degree of its Importance Questionnaire
Nurses job satisfaction aspects
Indirect working environment
Direct working environment
Salary and promotion
Self growth and development
Challenging work

Interaction with and feedback from patients and

family members
Leadership style

Working atmosphere

Family support and religion

Intention to quit
General job satisfaction
Overall satisfaction levels with professional roles
General feeling when doing jobs (general job
happiness)
Working motivation

Denition
The following nine scales were described as nurses satisfaction levels with
predefined job characteristics, which are:
A hospitals policies and benets (including leisure activities, housing,
parking, and vacation)
Medical equipments, working environment, scheduling, rotation to other
wards, working hours, workow, and stability of their jobs
Clinical ladder, fairness of the performance appraisal systems, bonuses, and
paid time off
Opportunities and arrangement of on-job training, participating in the
research activities, and writing or publication
Recognition for their achievements, independent thinking and decisionmaking, independent work, being challenged, competency towards their
jobs, and workload
The feedback from patients and family members, improvement of patients
conditions, and communication with patients and family members
How the hospital handles staffs complaints, direct supervisors leadership
styles, abilities of coordination, relationship with direct supervisors,
collaborative relationship among supervisors, and respect, fair treatment,
support and caring from their supervisors
The work units atmosphere, communication and the collaborative
relationship with physicians and other colleagues working in the same unit,
caring and support from their colleagues, and interaction with the
colleagues working in the other units
Caring and support from relatives regarding their jobs, and the religion of
the work place
Whether nurses often have intention to leave their currently working
hospital (in the scale from most agreeable to least agreeable)
Nurses overall perceptions towards the job in the levels of satisfaction
Nurses overall perceptions towards the professional roles they played in
the levels of satisfaction
Nurses overall perceptions towards their jobs, when they are doing their
jobs, in the levels of happiness
Nurses incentives (including dream job, interest, for money, no other
choice, and family expectation) to do their current jobs

nurses commitment and loyalty to their working

hospital (decreasing their intention to quit), nurse
executives should consider various aspects of job
characteristics. Thus, some factors, like salary and
promotion, might not be as modiable as the other job
characteristics.
Overall, this project provided an insight on the
inuence of nurses working motivation, job satisfaction, and general factors on nurses intention to quit in
Taiwan. The healthcare market in Taiwan might not
have immediate problems of nursing shortage and high
turnover rates. Nursing executives still need to reduce
nurses intention to quit and increase their job satisfaction. The reasons are that high intention to quit and low
job satisfaction might lead to certain amount of decrease
in the quality and patients intention to return for future
use, and increase in the cost for patient care under this
cost-containment environment.

Appendix A
Denitions of the variables: operationalized in
the Nurses Job Satisfaction and the Perceptual
Degree of its Importance Questionnaire is given in
Table 4.

References
Abbott, J., Young, A., Haxton, R., Van Dyke, P., 1994.
Collaborative care: a professional model that inuences job
satisfaction. Nursing Economics 12(3), 167-9, 174.
Adams, A., Bond, S., 2000. Hospital nurses job satisfaction,
individual and organizational characteristics. Journal of
Advanced Nursing 32 (3), 536543.
Agho, A.O., 1993. The moderating effects of dispositional
affectivity on relationships between job characteristics and

878

H.-M. Tzeng / International Journal of Nursing Studies 39 (2002) 867878

nurses job satisfaction. Research in Nursing and Health 16

(6), 451458.
Alexander, J.A., Lichtenstein, R., Oh, H.J., Ullman, E., 1998. A
causal model of voluntary turnover among nursing personnel in long-term psychiatric setting. Research in Nursing
and Health 21 (5), 415427.
American Nurses Association (ANA), 1995. Report to the
Board of Directors, 2728. American Nurses Association
Congress of Nursing Practice and Congress on Nursing
Economics, Agenda item #9.
Armstrong-Stassen, M., al-MaAitah, R., Cameron, S., Horsburgh, M., 1994. Determinants and consequences of
burnout: a cross-cultural comparison of Canadian and
Jordanian nurses. Health Care Women International 15 (5),
413421.
Bjorvell, H., Brodin, B., 1992. Hospital staff members are
satised with their jobs. Scandium Journal of Caring
Sciences 6 (1), 916.
Dolan, S.L., Van Ameringen, M.R., Corbin, S., Arsenault, A.,
1992. Lack of professional latitude and role problems as
correlated or propensity to quit amongst nursing staff.
Journal of Advanced Nursing 17 (12), 14551459.
Dunham-Taylor, J., 2000. Nurse executive transformational
leadership found in participative organizations. Journal of
Nursing Administration 30 (5), 241250.
Edgar, L., 1999. Nurses motivation and its relationship to the
characteristics of nursing care delivery systems: a test of the
job characteristics model. Canadian Journal of Nursing
Leadership 12 (1), 1422.
Hair, J.F., Anderson, R.E., Tatham, R.L., Black, W.C., 1998.
Multivariate data analysis, 5th Edition. Prentice-Hall,
Upper Saddle River, NJ.
Healy, C., McKay, M., 1999. Identifying sources of stress and
job satisfaction in the nursing environment. Australian
Journal of Advanced Nursing 17 (2), 3035.
Kangas, S., Kee, C.C., McKee-Waddle, R., 1999. Organizational factors, nurses job satisfaction, and patient satisfaction with nursing care. Journal of Nursing Administration
29 (1), 3242.
Keel, P., 1993. Psychological stress caused by work: burnout
syndrome. Sozial und Praeventivmedizin (Article in German) 38 (Suppl 2), S131132.
Kennerly, S.M., 1996. Effects of shared governance on
perceptions of work and work environment. Nursing
Economics 14 (2), 111116.
Kivimaki, M., Voutilainen, P., Koskinen, P., 1995. Job
enrichment, work motivation, and job satisfaction in

hospital wards: testing the job characteristics model.

Journal of Nursing Management 3 (2), 8791.
Kovner, C.T., Hendrickson, G., Knickman, J.R., Finkler, S.A.,
1994. Nursing care delivery models and nurse satisfaction.
Nursing Administration Quarterly 19 (1), 7485.
Lee, J.C., Chang, B.C., Pearson, M.C., Kahn, K.C., Rubenstein, C.V., 1999. Does what nurses do affect clinical
outcomes for hospitalized patients? A review of the
literature. Health Services Research 34 (5), 10111032.
Leiter, M.P., Harvie, P., Frizzell, C., 1998. The correspondence
of patient satisfaction and nurse burnout. Social Sciences in
Medicine 47 (10), 16111617.
Lim, V.K., Yuen, E.C., 1998. Doctors, patients, and perceived
job image: an empirical study of stress and nurses in
Singapore. Journal of Behavior in Medicine 21 (3),
269283.
Liou, C.N., Shi, W.H., Tseng, K.Y., 1997. Job satisfaction of a
medical centers nurses and related factors. VGH Nursing
14 (2), 143152.
McNeese-Smith, D., 1996. Increasing employee productivity,
job satisfaction, and organizational commitment. Hospital
& Health Services Administration 41 (2), 160174.
Muller-Smith, P., 1999. The energy business. Journal of
Perianesthetic Nursing 14 (5), 300302.
Parker, P.A., Kulik, J.A., 1995. Burnout, self- and supervisorrated job performance, and absenteeism among nurses.
Journal of Behaviors in Medicine 18 (6), 581599.
Tzeng, H.M., 1997. The inuence of staff nurses perceptions of
organizational culture on inpatient satisfaction with nursing
care. Unpublished Doctoral Dissertation, The University of
Michigan School of Nursing, Ann Arbor, MI, USA
Tzeng, H.M., 2002. Are we satisfying our nurses on the factors
they care for? An empirical study in Taiwan. Journal of
Nursing Administration 32 (6), forthcoming.
Tzeng, H.M., Ketean, S., 2002. The relationship between
nurses job satisfaction and inpatient satisfaction: an
exploratory study in a Taiwans teaching hospital. Journal
of Nursing Care Quality 16 (2), 5060.
Tzeng, H.M., Yang, C.S., Lee, S.Y., 2001. Brief report: the
relationship between patient satisfaction and health care
providers job satisfaction: an exploratory study on the 11
metropolitan public health care institutions in Taiwan.
Hospital (Taiwan) 34 (4), 1623.
Tzeng, H.M., Ketean, S., Redman, R.W., 2002. Relationship
of staff nurses strength of culture, job satisfaction, and
inpatient evaluation with nursing care. International Journal of Nursing Studies 39 (1), 7984.