Date of Award

Spring 5-28-2025

Document Type

Open Access Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Sun S. Kim, Professor

Second Advisor

Lingling Zhang, Associate Professor

Third Advisor

Anna E. Schierberl-Scherr, Assistant Professor

Abstract

ABSTRACT

THE MEDIATION EFFECT OF RESILIENCE AND THE MODERATION EFFECT OF HOSPITAL MAGNET STATUS ON THE RELATIONSHIP BETWEEN THE PRACTICE ENVIRONMENT AND TURNOVER INTENTIONS AMONG ACUTE CARE NURSES

May 2025

Elizabeth Helena Fraser, B.S.N., Elms College

M.S.N., Emmanuel College

Ph.D., University of Massachusetts Boston

Directed by Professor Sun S. Kim

The U.S. healthcare system has long suffered a critical nursing shortage, intensified since the coronavirus disease 2019 (COVID-19) outbreak. The shortage is a complex national crisis compounded by the high turnover of qualified nurses. Turnover is when a nurse leaves an organization for another nursing position or leaves the profession and needs to be replaced. Turnover rate for hospital bedside nurses in 2018 was 15.9%, which rose to 18.4% in 2023. The supply of registered nurses is influenced by retirement, the recruitment of new nurses, and the retention of existing nurses. The importance of retaining competent acute care nurses is the first step to alleviating the nursing shortage. It has been suggested that resilience may play a critical role in acute care nurses’ decision to leave or stay. However, not much is known about what personal and environmental factors are associated with resilience and how the relationships affect turnover intention. The purpose of this study was to examine the mediating effect of resilience on the relationship between the practice environment and turnover intentions and to assess the moderating role of hospital Magnet status on the relationship between practice environment and turnover intentions in acute care nurses post-COVID-19 pandemic. A cross-sectional survey was conducted between October 2023 and April 2024, using four instruments (Practice Environment Scale- Nursing Work Index, Workplace Resilience Scale, Maslach Burnout Inventory-Human Service Survey, and Anticipated Turnover Scale). A total of 240 acute care nurses, a combination of random and convenience samples, participated in this study. The mediation effect was analyzed using Hayes’ PROCESS macro in SPSS version 28.0. Results revealed that the hypothesized mediation and moderation effects were not supported. However, multiple regression analyses indicated that the greatest significant contributor to turnover intentions was emotional exhaustion (i.e., burnout, B =0.04, p B = -0.76, p B = -19.89, p B = 9.81, p =.015, 95% CI = 1.89, 17.73) between the practice environment and turnover intentions. The negative effects of the practice environment on emotional exhaustion and turnover intentions were stronger for nurses with lower levels of resilience. The model with three predictors (practice environment, emotional exhaustion, and resilience) explained 31% of the variance in turnover intentions

Comments

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Feb 7 2025 (withdrawn)

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