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WORKPLACE ISSUES IN NURSING
Factors influencing Macao nurses’ intention to leave current
employment
Moon Fai Chan, Andrew Leung Luk, Sok Man Leong, Siu Ming Yeung and Iat Kio Van
Aims. To investigate factors associated with nurses’ intention to leave current employment in Macao.
Background. The shortage of nursing staff and nurses voluntarily leaving their jobs has continued to be a problem affecting the
delivery of health care all over the world. One way to alleviate this shortfall is via recruitment, but this is not always successful.
Another way is to reduce the rate at which nurses voluntarily leave their work places.
Design. A descriptive survey was conducted and data were collected using a self-reported structured questionnaire. Nurses were
recruited in the Health Bureau and one private hospital in Macao. The status of nurses’ intention to leave current employment
(yes vs. no) was the dependent variable and nurses’ predisposing characteristics, organisational environments and five
components on job satisfaction outcomes were independent variables.
Results. Of 426 nurses, 166 (39Æ0%) indicated an intention to leave current employment. The results showed that age
(p < 0Æ001), work experience (p < 0Æ001), workplace (p = 0Æ015) and job satisfaction: pay and benefits (p < 0Æ001) were
significant risk factors to predict nurses’ intention to leave current employment.
Conclusions. More than one-third of the nurses in Macao indicated an intention to leave current employment. This figure may
be a cause of concern for the hospital management and highlights the need to implement strategies to improve the commu-
nication between nurses and the organisation, to enhance nurse job satisfaction and commitment to the organisation.
Relevance to clinical practice. Our findings outline some issues contributing to this problem and provide the nurse manager with
information regarding specific influences on nurses’ turnover in Macao. Given the complexity of issues outlined in this analysis,
nurse managers should assist their nursing staff to deal with those influences, make efforts to address the nursing shortage that
will require additional communications and recognise the needs and values of their staff and empower them to create a better
work environment. As a consequence, their commitment to the organisation can be fostered.
Key words: intention to leave, job satisfaction, Macao, nurses, nursing
Accepted for publication: 2 January 2008
Introduction
Over the past 10 years, the shortage of nursing staff and
nurses voluntarily leaving their jobs has continued to be a
problem affecting the delivery of health care all over the
world. One way to alleviate this shortfall is via recruitment,
but this is not always successful (Kunaviktikul et al. 2000,
Shields & Ward 2001). Another way is to reduce the rate at
which nurses voluntarily leave their workplaces (Sourdif
2004, Tourangeau & Cranley 2006). Tourangeau and
Cranley (2006) developed a ‘Determinants of Nurse Intention
to Remain Employed’ model that identifies a set of four
predictor variables of nurses’ intention to remain employed:
(1) job satisfaction, (2) nurses’ personal characteristics, (3)
Authors: MF Chan, PhD, CStat, Former Associate Professor of Kiang
Wu Nursing College of Macau, Macau SAR, China; AL Luk, PhD,
RN, Associate Professor, Kiang Wu Nursing College of Macau,
Macau SAR, China; SM Leong, MSc, Assistant Professor, Kiang Wu
Nursing College of Macau, Macau SAR, China; SM Yeung, MSN,
CNS, RN, Senior Lecturer, Kiang Wu Nursing College of Macau,
Macau SAR, China; IK Van, RN, Head, Kiang Wu Nursing College
of Macau, Macau SAR, China
Correspondence: MF Chan, Assistant Professor, Alice Lee Centre for
Nursing Studies, National University of Singapore, Singapore,
117574. Telephone: 65 6516 8684.
E-mail: [email protected]
� 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 893–901 893
doi: 10.1111/j.1365-2702.2008.02463.x
work group cohesion and collaboration and (4) nurses’
organisational commitment. They reported that control over
these four main factors had direct effects on nurse intention
to remain employed. A limited number of Macao studies have
been conducted (in Chinese) to identify factors influencing
nurses’ intention to leave or remain employed (Leong 2003,
2004, Wong et al. 2003, Van 2005, Luk et al. 2006). These
studies suggested that the current settings and conditions of
the health-care system are not optimised to retain nurses. It is
therefore essential to focus on the development and imple-
mentation of effective retention strategies. However, Morrell
(2005) look at this issue in a different way by analysing the
decision processes of nurses who have actually left, rather
than drawing inferences based on current employees; by
constructing a typology for nurse leavers, to devise retention
programmes for current employees to enhance the effective-
ness of workforce planning. Nevertheless, before any effec-
tive retention programmes can be developed, the factors
which influence nursing staff decisions to change their career
must first be identified.
Factors related to nurses’ intention to leavecurrent employment
Throughout the literature, job satisfaction was the most
consistent predictor of nurse intention to leave and has been
reported as explaining most of the variance on intention to
leave (Hsiao & Lu 1996, Borda & Norman 1997, Aiken et al.
2002, Ingersoll et al. 2002, Sourdif 2004, Morrell 2005).
Shields and Ward (2001) found that nurses who reported
overall dissatisfaction with their jobs had a 65% higher
probability of intending to leave than satisfied nurses.
Consistently, positive relationships have been found between
job satisfaction and intention to leave (Chan & Morrison
2000). Most studies have also reported positive relationships
between nurse intention to leave and specific components of
job satisfaction, including satisfaction with pay and benefits
(Santos & Cox 2000, Lacey 2003, Morrell 2005), scheduling
(Roberts et al. 2004), autonomy and responsibility (Larrabee
et al. 2003), professional opportunities (Anderson & Choi
1980, Joshua-Amadi 2002), support (Sourdif 2004) and good
work relationships (Adams & Bond 2000, Chan & Morrison
2000). Other associated factors, including individual predis-
posing characteristics such as age (Blegan 1993, Borda &
Norman 1997), years of experience (Shader et al. 2001) and
education (Roberts et al. 2004), are found to have an impact
on nurses’ intention to leave. Studies suggested that nurses
were more likely to stay in their jobs when they were older,
worked in specialised clinical areas and had more years of
experience (Chan & Morrison 2000, Shader et al. 2001, Hu
et al. 2004). By contrast, younger and more educated nurses
were more likely to be dissatisfied with their jobs and leave
(Shields & Ward 2001). However, some researchers suggest
that it is age cohort or generational affiliation issues rather
than age alone that affects nurses’ intention to leave
(Duchscher & Cowin 2004, Hu et al. 2004). To summarise,
there are mixed findings on the association of nurses’
predisposing characteristics (age, education, work experi-
ences), organisational environment factors (types of wards,
levels of grade) and nurses’ perceived job satisfaction with
nurses’ intention to leave. There is limited knowledge about
which factors contribute to Macao nurses’ intention to stay
or leave.
Aims
The aim of this quantitative study was to investigate factors
associated with nurses’ intention to leave current employment
in Macao. This is an important issue because turnover and
retention are not synonymous and understanding nurses’
intention to remain employed or to leave is important for
Macao’s health-care educators and health policy makers as
they plan the future management of health care in Macao
(Leong 2003, 2004, Van 2005). Identifying which factors
cause the retention of nurses as a distinct construct from those
causing turnover is crucial. This study considers intent rather
than actually remaining employed as the dependent variable,
because this has been supported by other studies (Cavanagh &
Coffin 1992, Chan & Morrison 2000, Sochalski 2002).
The study
Design and participants
There are only two hospitals in Macao, one is public and the
other is private and a descriptive study was conducted and
recruitment was performed via these two hospitals. This
survey was one component of a study investigating the status
of health-care services in Macao (Luk et al. 2006). Hence, we
use elements of the nurse survey to explore factors affecting
nurses’ intention to remain employed in Macao. All full-time
nurses who worked in the two organisations were included in
this study. They also had to be able to read or write Chinese
and give informed consent. The recruitment period was
between April–June in 2006.
Power calculation
The power of this study was estimated based on the logistic
model and the odds ratios (OR) between nurses’ intention to
MF Chan et al.
894 � 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 893–901
leave current employment and job satisfaction from previous
studies (Chan & Morrison 2000, Ingersoll et al. 2002,
Larrabee et al. 2003). An average OR was found (=1Æ34) and
the required sample was around 420, which could achieve
83% power at a 5% level of significance (nQuery Advisor
2001).
Data collection
Data were collected via a self-completed structured question-
naire in two hospitals and the average time for completing it
was around 30 minutes; 968 were sent out and 792 received
at the end (an 81Æ8% response rate), but due to (1) missing
responses to the question on intention to remain employed or
not and (2) the fact that 268 nurses replied ‘Not sure’ to this
question, only 426 records (53Æ8%) were ultimately used in
this study for further data analysis.
Instrument
Several tools have been developed in the West to assess
nurses’ job satisfaction, for example, the Nursing Work Index
(NWI) or NWI-R (Aiken & Patrician 2000, Aiken et al.
2002), the Index of Work Satisfaction (IWS) (Stamps &
Piedmonte 1986, Lee 1998) and the Job Satisfaction Scale
(Murrells et al. 2005) but none of them included Chinese
culture. However, Wong et al. (2003) had developed a Job
Satisfaction Questionnaire in the Macao setting (Appendix
1). The self-reported questionnaire consisted of two parts:
Part I comprised the demographic data and Part II comprised
questions on the Job Satisfaction Questionnaire developed by
Wong et al. (2003). Part I consisted of questions regarding
age, education level, ranking, employment status, years of
work experience, workplace and type of hospital. This
information provided a background about the nurses and
was used to determine factors related to the intention to
remain employed. In addition, a question was asked to each
nurse, ‘Do you intend to change your job?’, to which they
replied using one of three choices, ‘Yes’, ‘No’ and ‘Not sure’.
Those who replied ‘Not sure’ were not used for this study due
to their unconfirmed status. Part II consisted of 37 items
comprising five-point scale questions that queried nurses’ job
satisfaction levels on five components: (1) pay and benefits
(10 items), (2) support (seven items), (3) autonomy and
professional opportunities (10 items), (4) scheduling (six
items) and (5) relationships and interaction (four items). Each
item was ranked on a five-point scale, from 5 ‘very satisfied’
to 1 ‘very dissatisfied’. The average mean scores of each
component were used for comparison, with higher scores
indicating positive job satisfaction levels.
Validity and reliability of the instrument
Validity
Confirmatory factor analyses (CFA) were conducted to
establish the construct validity for this questionnaire. Unlike
traditional factor analysis, CFA enables the researcher to
construct and statistically test hypotheses about the rela-
tionship between observed variables and the constructs they
are assumed to measure (Joreskog & Sorbom 1993). CFA
were conducted using AMOS (Arbuckle 1999). A five-factor
model was assessed. A covariance matrix was used as the
starting point for the estimation process and the maximum
likelihood function was used to estimate the parameters. The
assessment of fit for the present study was based on (1) the v2
likelihood ratio; (2) the ratio of the v2 to its expected value
(v2/df), a ratio of four or less being judged as an acceptable fit
(Bentler 1990); (3) the goodness-of-fit index (GFI); (d) the
adjusted goodness-of-fit index (AGFI); (4) the comparative fit
index (CFI), a revised norm fit index corrected for sample size
dependency and (5) the root mean square residual (RMR), an
index of the average discrepancy between the observed and
hypothesised covariance matrices (Marsh & Hocevar 1985,
Bentler 1990). Table 1 presents the goodness-of-fit indices of
the factor model assessed for job satisfaction, with significant
v2 values (p < 0Æ001). The v2/df ratio was under the critical
value (3Æ16) and the CFI (0Æ79) indicated an acceptable fit to
the data. The other indices, GFI (0Æ80), AGFI (0Æ77) and
RMR (0Æ06) also indicated an acceptable fit in the model.
Reliability
Internal consistency was evaluated for the job satisfaction
scale with Cronbach’s alpha coefficients. It showed an
acceptable internal consistency. For the five components on
Table 1 Goodness-of-fit indices of the
factor model for the nurses’ satisfaction
questionnaire
Model v2 df p-value v2/df GFI AGFI CFI RMR RMSEA
Five factor 1958Æ70 619 <0Æ001 3Æ16 0Æ80 0Æ77 0Æ79 0Æ06 0Æ07
v2/df, a ratio of four or less being judged as an acceptable fit. GFI, Goodness-of-fit index, scaled
to range from zero to one, one mean 100% fit. AGFI, Adjusted goodness-of-fit index, scaled to
ranged from zero to one, one mean 100% fit. CFI, Comparative fit index, a revised norm fit
index corrected for sample size dependency. RMR, Root mean square residual, an index of the
average discrepancy between the observed and hypothesised covariance matrices.
Workplace issues in nursing Nurses’ intention to leave
� 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 893–901 895
job satisfaction, the Cronbach’s alpha on pay and benefits,
support, autonomy and professional opportunities, schedul-
ing, relationships and interaction and overall was 0Æ87, 0Æ87,
0Æ83, 0Æ77, 0Æ67 and 0Æ93, respectively.
Ethical considerations
The study was approved by the ethics committees of the
college and the study organisations. Informed consent was
obtained from participants prior to the conduct of the study.
Confidentiality was assured and participants were told that
they could withdraw from the study at any point without
adverse effects on their subsequent care.
Data analysis
A descriptive statistical analysis of the quantitative data was
conducted using SPSSSPSS 120Æ0 (SPSS 2004). Several statistical
techniques were employed to analyse the data. The data
analysis strategy was as follows. A confirmatory factor
analysis was performed initially on the items to confirm the
factorial reliability of the subscales of these measures in the
study sample. In addition, Cronbach’s alpha coefficients were
used to examine the internal reliability of each sub-scale in
each component, because a cluster analysis can be dramat-
ically affected by the inclusion of only one or two undiffer-
entiated variables. Thus, it is important to examine the factor
structure of the variables to be included in the cluster
analysis. Next, univariate analysis was used to examine any
factors (e.g. demographic and job satisfaction scores) asso-
ciated with the intention to leave. Finally, a multiple logistic
regression model (forward stepwise Wards method) was used
to identify which factors can predict intention to leave, with
the level of significance set at p < 0Æ05.
Findings
Predisposing characteristics, work environment and
intention to leave current employment
The predisposing characteristics of nurses are shown in
Table 2. Among the nurses, 73Æ3% aged 34 or below
(n = 121) reported that they had intention to leave, but
28Æ4% (n = 73) of those aged 45 or above reported that they
would remain employed (p < 0Æ001). More than 68% of
nurses (n = 112) with less than 10 years’ work experience
reported that they had intention to leave, but 62Æ5% of nurses
(n = 157) with more than 10 years’ work experience reported
that they would stay. Fifty-six percent (n = 93) who worked
in private hospitals reported that they had intention to leave,
but 60Æ8% (n = 158) who worked in public hospitals said
they would remain employed. Forty-six percent (n = 76) of
nurses working in internal/medical wards reported that they
had intention to leave, but 35Æ4% (n = 91) who worked in
OPD said they would stay. However, no statistically signif-
icant associations were found between intention to leave/stay
and nurses’ educational level (p = 0Æ052).
Job satisfaction and intention to leave current
employment
For job satisfaction, nurses scoring more than three in each
component were classified as the ‘satisfied’ group; otherwise,
they were ‘unsatisfied’. In Table 3, among nurses who had
intention to leave, 80Æ7% (n = 134), 33Æ1% (n = 55), 21Æ7%
(n = 36) and 68Æ1% (n = 113), scored as unsatisfied on pay
and benefits, support, autonomy and professional opportu-
nities and scheduling, respectively, but for those who said
they would not leave, only 50Æ0% (p < 0Æ001) on pay and
benefits, 17Æ7% (p < 0Æ001) on support, 7Æ7% (p < 0Æ001)
on autonomy and professional opportunities and 51Æ9%
(p = 0Æ001) on scheduling scored as unsatisfied. However, no
significant association was found between relationships and
interaction scores and intention to leave (p = 0Æ228).
Predictors of intention to leave current employment
Multiple logistic regression analyses were used to identify a
model to predict nurses’ intention to leave. The results
showed that age, work experience, workplace and job
satisfaction: Pay and benefits were significant risk factors
for intention to leave (Table 4). This model had a good fit
under the Hosmer–Lemeshow goodness-of-fit test (R2 = 0Æ35,
v2 = 1Æ38, p = 0Æ995), with 63Æ0% sensitivity, 77Æ2% speci-
ficity and 71Æ6% over power. Nurses with less than five years’
work experience were 4Æ62 times more likely to leave than
nurses with 10+ years’ (p < 0Æ001) work experience. Nurses
aged 24 or below were 0Æ21 times less likely to leave than
nurses aged 25–44 (p < 0Æ001). Nurses who worked in
internal/medical wards were 3Æ12 and 2Æ16 times more likely
to leave than nurses who worked in surgical wards
(p = 0Æ021) and OPD (p = 0Æ009), respectively. On job
satisfaction scores, nurses who scored as unsatisfied on pay
and benefits were 4Æ14 times more likely to leave than nurses
who scored as satisfied (p < 0Æ001).
Discussions
The findings in this study overall are consistent with those of
other studies conducted overseas. Evidence was found to
MF Chan et al.
896 � 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 893–901
support Tourangeau and Cranley’s (2006) model, with one of
the significant predictors being age: nurses aged 45 or above
were more likely to remain employed. This may be due to
their attitudinal priorities and the differences in values among
generations, as those nurses born in the 1960s or earlier are
generally called the ‘silent generation’ and are typified by
strong loyalty and seniority (Duchscher & Cowin 2004).
Today, those born in the 1980s are called ‘generation Xers’
and prefer more changes or challenges to achieve a better life
and prospects (Santos & Cox 2000). Another significant
predictor of intention to remain employed was nurses’ years
of work experience, which also reflect their commitment to
the organisation (Kunaviktikul et al. 2000, Sourdif 2004).
From our findings, nurses with less than five years’ work
experience are less likely to remain employed than those who
have worked for more than 10 years. It is therefore in the best
interest of management to develop and implement strategies
that support nurse organisational commitment (Hsiao & Lu
1996, Borda & Norman 1997, Ingersoll et al. 2002); for
example, promoting job security, abiding by humanitarian
values like fairness and courtesy, promoting more communi-
cation channels such as newsletters and encouraging staff
involvement in decision making to show the transparency of
the communication system (Ingersoll et al. 2002). The
workplace is another predictor of intention to remain
employed, as ward culture was found to have a pervasive
Table 2 Comparison of characteristics
of the study nurses by intention to leave
current employment
Characteristics n (%)
Total (n = 426)
n (%)
Intention to leave current
employment v2 test
Yes (n = 166)
n (%)
No (n = 260)
n (%) p-value
Age group (years)*
24 or below 49 (11Æ6) 18 (10Æ9) 31 (12Æ1) <0Æ001
25–34 186 (44Æ1) 103 (62Æ4) 83 (32Æ3)
35–44 101 (23Æ9) 31 (18Æ8) 70 (27Æ2)
45–54 74 (17Æ5) 10 (6Æ1) 64 (24Æ9)
55+ 12 (2Æ8) 3 (1Æ8) 9 (3Æ5)
Educational level�
Certificate or others 38 (8Æ9) 8 (4Æ8) 30 (11Æ5) 0Æ052
Higher diploma 160 (37Æ6) 62 (37Æ6) 98 (37Æ7)
Baccalaureate or equivalent 227 (53Æ4) 95 (57Æ6) 132 (50Æ8)
Work experience (years)�
Five or fewer 108 (26Æ2) 59 (36Æ4) 49 (19Æ5) <0Æ001
6–10 98 (23Æ7) 53 (32Æ7) 45 (17Æ9)
10+ 207 (50Æ1) 50 (30Æ9) 157 (62Æ5)
Ranking�
Senior staff 30 (7Æ1) 7 (4Æ2) 23 (8Æ8) <0Æ001
Nurses working in a
hospital setting
353 (83Æ1) 154 (93Æ3) 199 (76Æ5)
Nurses work outside a
hospital setting
42 (9Æ9) 4 (2Æ4) 38 (14Æ6)
Perceived current quality of care
Very satisfied/satisfied 325 (76Æ3) 108 (65Æ1) 217 (83Æ5) <0Æ001
Very dissatisfied/dissatisfied 101 (23Æ7) 58 (34Æ9) 43 (16Æ5)
Type of hospital
Public 231 (54Æ2) 73 (44) 158 (60Æ8) 0Æ001
Private 195 (45Æ8) 93 (56) 102 (39Æ2)
Workplace/ward§
Internal/medical 143 (34) 76 (46Æ3) 67 (26Æ1) <0Æ001
Obstetrics and gynaecology 75 (17Æ8) 28 (17Æ1) 47 (18Æ3)
Surgical 31 (7Æ4) 7 (4Æ3) 24 (9Æ3)
Acute and emergency 52 (12Æ4) 24 (14Æ6) 28 (10Æ9)
Outpatient department 120 (28Æ5) 29 (17Æ7) 91 (35Æ4)
*Four missing data.�One missing data.�Thirteen missing data.§Five missing data.
Workplace issues in nursing Nurses’ intention to leave
� 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 893–901 897
influence over nurses’ behaviour patterns and their views of
the work environment (Santos & Cox 2000). In addition,
wards within the same hospital have been shown to vary on
several organisational characteristics (Adams & Bond 2000).
These patterns are consistent between staff grades within
wards and are related to the way in which patient care is
provided (Anderson & Choi 1980, Ingersoll et al. 2002).
Other studies have also reported that quality of ward
facilities and of services provided to the ward can affect
nurses’ ability to do their work. This in turn affects their job
satisfaction level, which indirectly affects their intention to
leave or stay. Consistent with previous studies, our results
show that nurses who work in the internal/medical wards are
more likely to leave than nurses working in surgical and OPD
wards. In specific reference to the workplace, medical wards
are usually the busiest wards in an acute hospital. Therefore a
rotation programme should be designed for junior nurses so
that they can be rotated to other specialties after working in
such busy wards for a year or two. This would not only
release them from the heavy workload, but also enrich their
professional experience by giving them the opportunity to
work in a new specialty. Furthermore, in-services training
should also be enhanced so that they are more equipped to
meet patients’ needs even if they are young and lacking
experience in the profession.
The final significant predictor is job satisfaction: pay and
benefits, as job satisfaction has frequently been reported as
the most common predictor for someone who decided to stay
or leave. Therefore, it is not surprising that this study found
that nurses who were unsatisfied with pay and benefits were
more likely to leave and those who felt otherwise were more
likely to remain employed. Regarding the job satisfaction of
nurses in Macao, a local study conducted by Luk et al. (2006)
showed that nurses in both public and private hospitals were
Table 3 Comparison of nurses’ Job
Satisfaction Questionnaire by intention to
leave current employment
Component
Total (n = 426)
n (%)
Intention to leave current
employment v2 test
Yes (n = 166)
n (%)
No (n = 260)
n (%) p-value
Component 1 – Pay and benefits (10 items)
Unsatisfied 264 (62) 134 (80Æ7) 130 (50) <0Æ001
Satisfied 162 (38) 32 (19Æ3) 130 (50)
Component 2 – Support (seven items)
Unsatisfied 101 (23Æ7) 55 (33Æ1) 46 (17Æ7) <0Æ001
Satisfied 325 (76Æ3) 111 (66Æ9) 214 (82Æ3)
Component 3 – Autonomy and professional opportunities (10 items)
Unsatisfied 56 (13Æ1) 36 (21Æ7) 20 (7Æ7) <0Æ001
Satisfied 370 (86Æ9) 130 (78Æ3) 240 (92Æ3)
Component 4 – Scheduling (six items)
Unsatisfied 248 (58Æ2) 113 (68Æ1) 135 (51Æ9) 0Æ001
Satisfied 178 (41Æ8) 53 (31Æ9) 125 (48Æ1)
Component 5 – Relationships and interaction (four items)
Unsatisfied 17 (4) 9 (5Æ4) 8 (3Æ1) 0Æ228
Satisfied 409 (96) 157 (94Æ6) 252 (96Æ9)
In each component, scores range from (1) very dissatisfied to (5) very satisfied; nurses scoring
more than three were classified as the satisfied group, with the remainder in the unsatisfied
group.
Table 4 Logistic regression model on nurses’ intention to leave
current employment
Predictor OR 95% CI p-value
Satisfaction: pay and benefits
Unsatisfied* 1 <0Æ001
Satisfied 4Æ14 2Æ52–6Æ82 <0Æ001
Age group (years)
24 or below* 1 <0Æ001
25–44 0Æ21 0Æ11–0Æ41 <0Æ001
45+ 0Æ57 0Æ22–1Æ51 0Æ257
Work experience (years)
Five or fewer* 1 <0Æ001
6–10 1Æ96 0Æ95–4Æ02 0Æ068
10+ 4Æ62 2Æ26–9Æ47 <0Æ001
Workplace or ward
Internal/medical* 1 0Æ015
Obstetrics and gynaecology 0Æ93 0Æ49–1Æ79 0Æ828
Surgical 3Æ12 1Æ19–8Æ18 0Æ021
Acute and emergency 1Æ05 0Æ52–2Æ10 0Æ895
Outpatient department 2Æ16 1Æ21–3Æ85 0Æ009
*Reference point; sensitivity is 63%, specificity is 77Æ2% and overall
is 71Æ6%; OR, odd ratios; Hosemer and Lemeshow test, v2 = 1Æ38,
p = 0Æ995; R2 is 0Æ35.
MF Chan et al.
898 � 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 893–901
unsatisfied, especially in the areas of pay and benefits. With
the economic boom in Macao, the shortages in the nursing
workforce are getting worse (Luk et al. 2006). This reaffirms
the importance of job satisfaction on nurses’ employment
decisions and is consistent with other studies (Santos & Cox
2000, Larrabee et al. 2003, Tourangeau & Cranley 2006).
Limitations
In line with most studies, there were several limitations in this
study that may have affected its outcomes. One potential
limitation is that our model explained 35% of variance in
nurse intention to remain employed. Our findings were
similar to those of models tested by Shader et al. (2001) and
Tourangeau and Cranley (2006), which explained 31 and
34%, respectively, and it is important to note that 65% of
variance remained unexplained, indicating that there are
other important predictors of nurse intention to remain
employed. It is suggested that these factors be explored in a
further study. Second, a self-reported questionnaire was used
to collect data for this study, leading to possible response bias
from each responder (Polit & Beck 2004). Third, although
we received a high response rate, only 53% of the data were
used for this article, which may have biased our results.
Fourth, this study may not represent the current work force in
Macao. For example we did not include gender in the
questionnaire, although it was a factor in intention to leave.
This is because of the 1136 nurses who worked in Macao at
that time, fewer than 4Æ5% were male (Statistics and Census
Service 2006) and due to this small proportion and to avoid
privacy issues we decided not to identify participants’ gender.
Fifth, although results showed that pay and benefits was one
of the principle factors in intention to leave, other studies
suggested that reasons for leave may include work-related
(Sochalski 2002) or personal events (Morrell 2005) and a
qualitative approach which includes interviews with leavers
to explore the sources and reasons of intention to leave could
increase the knowledge about the nurses in Macao. Finally,
this study did not collect further information on whether
nurses are leaving for another nursing job within the
country’s health service or leaving nursing altogether. As
we know that the former situation means a healthy turnover
within nursing, the latter indicates loss of nurses to the health
service and we did not address this issue and further study is
suggested.
Conclusion
This article shows that more than one-third of the nurses in
Macao indicated an intention to leave. The findings may be a
cause of concern for hospital management, as a shortage of
nurses already exists at present and hospitals cannot afford to
lose any more nurses. On the other hand, this study has
highlighted the importance of the factors that may contribute
to predicting intention to leave for nurses in Macao. Our
findings may provide direction for nurse managers or health-
care management to implement strategies to improve the
communication between nurses and the organisation to
enhance their commitment to the organisation and thereby
their job satisfaction. This will help nurses to develop the
ability to recognise their own needs and values and empower
them to create a better work environment. As a result, their
commitment to the organisation will be elevated.
Acknowledgements
The authors would like to thank the Secretariat of the Social
Affairs and Culture, Macao SAR, China for funding the
research project.
Contributions
Study design: SML, ALL, SMY, IKV; data collection and
analysis: SML, ALL, SMY, IKV, MFC and manuscript
preparation: MFC, SML, ALL, SMY, IKV.
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Appendix 1
Job satisfaction questions with five-point response scales from 5 = very satisfied to 1 = very dissatisfied
Component
1 The feeling of worthwhile accomplishment I get from my work 3
2 The extent to which I can use my skills 3
3 The contribution I make to patient care 3
4 The amount of challenge in my job 3
5 The extent to which my job is varied 3
6 The extent to which my job is interesting 3
7 What I have accomplished when I go home at the end of the day 3
8 The amount of personal growth and development I get from my work 3
9 The extent of independent decision-making power I can exercise in my work 3
10 The amount of independent action I can exercise in my work 3
11 The time available to get through my work 4
MF Chan et al.
900 � 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 893–901
Component
12 The time available for patient care 4
13 Overall staffing levels 4
14 The way that I am able to care for patients 4
15 The amount of time spent on administration 4
16 The amount of support and guidance I receive from my supervisor 2
17 The opportunities I have to discuss my concerns with colleagues 2
18 The opportunities I have to discuss my concerns with my supervisor 2
19 The support available to me in my job 2
20 The overall quality of the supervision I receive in my work 2
21 The degree of respect and fair treatment I receive from my superior 2
22 The degree to which I feel part of a team 2
23 The relationship I have with other health-care workers 5
24 The contact I have with colleagues 5
25 The value placed on my work by my colleagues 5
26 The amount of pay I receive in comparison with people in other occupations 1
27 My rank 1
28 The degree to which I am fairly paid for what I contribute to this organization 1
29 My prospects for promotion 1
30 The opportunities I have to develop professionally 1
31 The match between my job description and what I do 1
32 The amount of job security I have 1
33 Time off to attend courses 1
34 Being sponsored to attend course 1
35 The extent to which I have adequate training for what I do 1
36 The value place on my work by my patients and/or their relatives 5
37 The amount of time spent talking with my patients 4
Component 1: pay and benefits; Component 2: support; Component 3: autonomy and professional opportunities; Component 4: scheduling;
Component 5: relationships and interaction.
Workplace issues in nursing Nurses’ intention to leave
� 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 893–901 901