A multilevel investigation on nursing turnover intention: the cross-level role of leader-member exchange.

AIM: To analyse nursing turnover intention from the unit by using multilevel approach, examining at the individual level, the relationships between job characteristics, job satisfaction and turnover intention, and at the group level the role of leader-member exchange.

BACKGROUND: Research on nursing turnover has given little attention to the effects of multilevel factors.

METHOD: Aggregated data of 935 nurses nested within 74 teams of four Italian hospitals were collected in 2009 via a self-administered questionnaire.

RESULTS: Hierarchical linear modelling showed that job satisfaction mediated the relationship between job characteristics and intention to leave at the individual level. At the unit level, leader-member exchange was directly linked to intention to leave. Furthermore, cross-level interaction revealed that leader-member exchange moderated the relationship between job characteristics and job satisfaction.

CONCLUSION: This study supported previous research in single-level turnover studies concerning the key role of job satisfaction, providing evidence that job characteristics are important in creating motivating and satisfying jobs. At the unit-level, leader-member exchange offers an approach to understand the role of unit-specific conditions created by leaders on nurses' workplace wellbeing.

IMPLICATIONS FOR NURSING MANAGEMENT: This study showed that it is important for nursing managers to recognise the relevance of implementing management practices that foster healthy workplaces centred on high-quality nurse-supervisor relationships.