The impact of social support upon intention to leave among female nurses in Europe: Secondary analysis of data from the NEXT survey

Abstract

Objectives

This study examined the importance of one's social work environment in the light of prevention of premature leave from the nursing profession. A research model with social support (from direct supervisor and close colleagues) as predictor and intention to leave as the dependent variable has been tested, while controlling for job satisfaction and age. Moreover, we have studied the impact of nurses’ age upon the prevalence of social support from both parties.

Participants

Data were obtained from 17,524 registered female nurses working in hospitals throughout Europe (Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, and Slovakia).

Results

Our findings indicated that a lack of job satisfaction is an important risk factor in the light of nurses’ turnover as for most countries the intention to leave cannot be buffered by social support from one's close colleagues. However, in general, social support from one's direct superior appeared to contribute negatively to the intention to leave the profession, over and above job satisfaction and age. As regards age effects, in line with our expectation, we have found a significant negative relationship between age and social support from close colleagues, while the hypothesis regarding the relationship between age and supervisory support could not be confirmed.

Conclusions

Given its importance in the light of preventing premature leave, we advocate not to neglect the possible positive effects of social support from important key figures like nurses’ direct supervisor and close colleagues. It is necessary for health care institutions to carefully pay attention to finding opportunities to obtain more social support for all staff members. In Section 5, limitations and practical implications of this study are dealt with.

Introduction

Most countries in the European Union experience a serious lack of nurses that participate at the labour market, to a large extent as a result of demographic changes. This shortage refers to both trained nurses that have prematurely left and future potential professionals. And even more distressing, this situation might worsen within the coming 20–30 years if no action is taken. Firstly, the proportion of younger people in the working population is decreasing, while at the same time the proportion of older people is increasing. Secondly, the number of people over 64 years old is increasing as well. Since it is the oldest members of the population who most require care, the pressure on the health care service will significantly increase as a result of these demographic changes. Therefore, it is of utmost importance to pay attention to factors that contribute to higher participation rates for nurses in the near future (Hasselhorn et al., 2003).

Several possible solutions have been defined to prevent a lack of active (employed) nurses (Hasselhorn et al., 2003). First, one may try to increase the input of nurses by providing more educational facilities at nursing schools. For many youngsters in western countries, however, nursing does not seem to be very attractive, owing to the high workload, the emotionally demanding work situation, and comparatively low pay (see Kirpal, 2004) that is associated with the profession. A second way to increase the number of nurses could be through immigration of nursing staff from other countries, although, in many cases (e.g. in case nurses from third world countries are recruited) this implies important ethical issues. Attempts have been made to recruit from new members states of the European Union to countries such as Germany, The Netherlands and Italy to meet the shortfall of nurses. Success of nurse migration appears limited, however, owing to language problems and high attachment to the own community in Eastern Europe, among other reasons (see Widerszal-Bazyl et al., 2003). Thirdly, one could try to raise the retirement age to solve the problem of nurses’ shortage. However, in many countries such as, for instance, Germany and Italy, only a small number of nurses remain in their profession until formal retirement age. In addition, the emotional and physical demands of the nursing profession might be too high for older nurses to cope with (see also Aiken et al., 2002, Bakker et al., 2000, Le Blanc et al., 2001), urging health care management to explore the possibility to divert them into less demanding roles. All in all, the most effective way of assuring nursing in the future seems to be promoting the retention of existing staff.

In the past, work attitudes, such as job satisfaction, were included in research models as the main determinants of withdrawal (Harrison and Martocchio, 1998, Sagie, 1998), while controlling for relevant demographic differences (Cohen and Golan, 2007). An important contribution of our approach lies in the incorporation of nurses’ social work environment (social support from one's direct supervisor and close colleagues), while controlling for job satisfaction, and age. As regards age, it is well-known that this demographic factor is correlated with turnover (intention) (see for instance, Griffeth et al., 2000), and should be controlled for.

By taking both social support from one's direct supervisor, and from one's close colleagues into account, our research model is in line with the so-called relational perspective on turnover models (Mossholder et al., 2005). Uhl-Bien et al. (2000) already noted that low-quality relationships, of which the lack of social support is obviously a core element, can have an impact upon turnover. Previously, two empirical studies investigating direct influences of social support have been conducted (Mossholder et al., 2005). Surprisingly, in both studies (Iverson, 1999, Iverson and Pullman, 2000) no significant relationship between co-worker support and turnover could be found. Given the fact that organizational support theory (Rhoades and Eisenberger, 2002) has widely indicated that perceived support is negatively related to withdrawal behaviour, accordingly, in our study we hypothesize a negative impact of social support upon intention to leave the nursing profession, while taking into account the possible effects of job satisfaction and nurses’ age.

The objectives of our study were twofold. A first objective was to investigate whether social work environment factors, i.e. social support from one's direct supervisor and from one's close colleagues, influence nurses’ intention to leave their profession, over and above job satisfaction and nurses’ age. Assessment of managerial practices (especially from one's direct supervisor) and work group attitudes (from one's close colleagues) appears to be of theoretical and practical relevance. Given the outcomes of previous empirical research pertaining to differences in the extent of social support that employees receive depending upon their age (Van der Heijden, 2002, Van der Heijden, 2003), we will start our analyses by investigating the association between nurses’ age and perceived social support. Only when we have a better understanding of how age influences nurses’ social work environment characteristics, an age-aware HRM policy can be implemented.

Second, this study aimed to examine some differences across European countries. There is a serious lack of cross-national comparative social science research to answer questions faced by working organizations, and to provide guidance for their career management practices (Arnold, 1997a, Arnold, 1997b, Brewster et al., 1996, McLean, 1991, Peterson, 1997, Wijers and Meijers, 1996). Furthermore, there is a strong North American bias in career research. Career dynamics are embedded in national cultures (Derr and Laurent, 1989, Derr and Oddou, 1991), shaping the individual definition of a career, and associating with different levels of career mobility, including occupational turnover. Across national cultures, there may be different determinants of career behaviours on the one hand, as well as different levels of these determinants, on the other hand (Sparrow and Hiltrop, 1997). For example, Ding and Lin (2006), in their comparison of the effects of determinants of turnover intentions of Taiwanese and US hospital nurses, found a direct negative effect of job satisfaction on turnover intention for Taiwanese nurses, but not for the US nurses.

In sum, it is important to investigate whether nurses in different European countries are affected by similar social work environment experiences when deciding about leaving their profession. In order to provide more information about cross-national differences, the present study collected data in eight European countries (Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, and Slovakia).