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An Empirical Analysis of Nurse Retention: What Keeps RNs in Nursing?

Dotson, Michael J. PhD; Dave, Dinesh S. PhD; Cazier, Joseph A. PhD; Spaulding, Trent J. PhD

JONA: The Journal of Nursing Administration: February 2014 - Volume 44 - Issue 2 - p 111–116
doi: 10.1097/NNA.0000000000000034

OBJECTIVE: This study investigates the effects of stress, economic factors, altruism, and value congruence on intentions to leave jobs and the nursing profession.

BACKGROUND: Retaining nurses will be critical for healthcare organizations as the demand for nurses increases. Regulation and cost pressures are changing the nursing work environment.

METHODS: We surveyed 861 RNs in the southeastern United States. Structural equation modeling was used to analyze the survey.

RESULTS: Results confirm the importance of stress and salaries and underscore the impact of both value congruence and altruism. Evidence shows a correlation between altruistic desires and intentions to leave the profession.

CONCLUSIONS: Efforts to retain nurses should include matching nurse and organizational values. Initiatives need to be undertaken to increase professional autonomy and provide opportunities for the expression of altruism. Further research is indicated to investigate the unexpected result that highly altruistic nurses are leaving the profession.

Author Affiliations: Professor of Marketing (Dr Dotson); Professor of Computer Information Systems (Dr Dave); Associate Professor, Computer Information Systems (Dr Cazier); Assistant Professor of Health Care Management (Dr Spaulding); Appalachian State University, Boone, North Carolina.

This work was funded in part by a grant from the Northwest Area Education Center in North Carolina.

The authors declare no conflicts of interest.

Correspondence: Dr Spaulding, Department of Nutrition and Healthcare Management, Appalachian State University, L. S. Doughtery, Room 101, 261 Locust St, Boone, NC 28608 (

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