Causal modeling of self-concept, job satisfaction, and retention of nurses.

BACKGROUND: The critical shortage of nurses experienced throughout the western world has prompted researchers to examine one major component of this complex problem - the impact of nurses' professional identity and job satisfaction on retention.

DESIGN: A descriptive correlational design with a longitudinal element was used to examine a causal model of nurses' self-concept, job satisfaction, and retention plans in 2002.

METHOD: A random sample of 2000 registered nurses was selected from the state registering authority listing. A postal survey assessing multiple dimensions of nurses' self-concept (measured by the nurse self-concept questionnaire), job satisfaction (measured by the index of work satisfaction) was undertaken at Time 1 (n=528) and 8 months later at Time 2 (n=332) (including retention plans (measured by the Nurse Retention Index). Using confirmatory factor analysis, correlation matrices and path analysis, measurement and structural models were examined on matching pairs of data from T1 and T2 (total sample N=332).

FINDINGS: Nurses' self-concept was found to have a stronger association with nurses' retention plans (B=.45) than job satisfaction (B=.28). Aspects of pay and task were not significantly related to retention plans, however, professional status (r=.51), and to a lesser extent, organizational policies (r=.27) were significant factors. Nurses' general self-concept was strongly related (r=.57) to retention plans.

CONCLUSIONS: Strategies or interventions requiring implementation and evaluation include: counseling to improve nurse general self-concept, education programs and competencies in health communication between health professionals, reporting of nurse-initiated programs with substantial patient benefit, nurse-friendly organizational policies, common health team learning opportunities, and autonomous practice models.