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Related Factors of Turnover Intention among Korean Hospital Nurses: A Systematic Review and Meta-Analysis

Youngock Lee1, Jiyeon Kang2
Korean Journal of Adult Nursing 2018;30(1):1-17.
Published online: February 18, 2018

1Kosin University Gaspel Hospital, Busan, Korea

2Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Kang, Jiyeon https://orcid.org/0000-0002-8938-7656 Department of Nursing, Dong-A University, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea. Tel: +82-51-240-2871, Fax: +82-51-240-2920, E-mail: jykang@dau.ac.kr
- This manuscript is a revision of first author's doctoral dissertation.
• Received: November 9, 2017   • Accepted: February 18, 2018

© 2018 Korean Society of Adult Nursing

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to conduct a systematically review of factors related to the reported intention of hospital nurses in Korea to leave their positions.
  • Methods
    Appropriate studies in the recent ten years were selected from databases. A total of 263 studies were selected for the systematic review on the basis of the PRISMA flow. The correlational effect size of 35 studies was analyzed through meta-analysis using CMA 3.0.
  • Results
    Through systematic review, 52 related factors were classified by ecological system: 18 individual, 12 microsystem, 11 mesosystem, 8 exosystem, and 3 macrosystem. The overall effect size of turnover intention was 3.26. The total correlational effect size of related factors was 0.28: 0.14 for individual, 0.50 for microsystem, 0.25 for mesosystem and 0.40 for exosystem. Among single factors with larger effect size, emotional labor, role conflict, and work-home conflict were classified into contributors whereas organizational commitment, job satisfaction, and internal marketing were classified as inhibitors.
  • Conclusion
    Previous studies focused on the individual and the microsystem in the quantitative respect. In addition, the effect size was relatively greater for the microsystem and the exosystem. It is therefore necessary to conduct further research on the systems with larger effects.
  • Key Words: Nurses; Employee turnover; Systematic review; Meta-analysis; Ecological system
Figure 1.
PRISMA flow for the study.
kjan-30-1f1.jpg
Table 1.
Characteristics of Selected Studies for Systematic Review (K=263/N=79,236)
Characteristics Categories Number of studies (%) Number of participants
Publication year 2006~2010 58 (22.0) 17,761
2011~2013 107 (40.7) 45,290
2014~2016 98 (37.3) 16,185
Gender All included 127 (48.3) 43,017
Female only 33 (12.6) 7,718
Male only 3 (1.1) 424
Not reported 100 (38.0) 28,077
Career New nurse only 17 (6.5) 4,360
All included 246 (93.5) 74,876
Marital status Married only 9 (3.4) 1,923
All included 254 (96.6) 77,313
Hospital size General 166 (63.1) 46,338
Advanced general 54 (20.5) 13,056
General + Advanced general 43 (16.4) 19,842
Nursing units Special units only† 28 (10.6) 5,554
All units included 188 (71.5) 62,244
Not reported 47 (17.9) 11,438
Location Metropolitan area 85 (32.3) 22,145
Non-metropolitan area 89 (33.9) 22,835
Nationwide 19 (7.2) 16,437
Not reported 70 (26.6) 17,819
Publication type Dissertation 129 (49.0) 36,585
Journal article 134 (51.0) 42,651
Measurements for turnover intention Lawler (1983) 70 (26.6) 19,555
Mobley (1982) 45 (17.1) 11,933
Kim (2007) 21 (8.0) 4,899
Becker (1992) 11 (4.2) 2,562
Lee (1994) 6 (2.3) 1,378
Cook, Hepworth & Warr (1981) 5 (1.9) 1,349
Price & Mueller (1986) 5 (1.9) 1,454
Micheals & Specter (1982) 5 (1.9) 939
Yun & Kim (2013) 4 (1.5) 905
Others 91 (34.6) 34,262
Research design Cross-sectional survey 252 (95.8) 78,910
Interventional study 4 (1.5) 244
Qualitative study 7 (2.7) 82

†Emergency rooms, intensive care units, operating rooms.

Table 2.
Classification of Related Factors according to Ecological System
Eco-Systems Categories Related factors Number of studies† (%)
Individual Demographics characteristics Age 116 (44.1)
Gender 7 (2.7)
Religion 22 (8.4)
Education 62 (23.6)
Military service 1 (0.4)
Sex role identity 2 (0.8)
Marital staus 75 (28.5)
Subtotal 285 (48.9)
Job-related personal characteristics Position 62 (23.6)
Work experience 106 (40.3)
Estimated duration of work 9 (3.4)
Reason to work 4 (1.5)
Working at requested unit 3 (1.1)
Turnover experience 14 (5.3)
Rotation experience 6 (2.3)
Subtotal 204 (35.0)
Personal characteristics Emotional intelligence 11 (4.2)
Personality 24 (9.1)
Physical・ mental health 27 (10.3)
Positive psychological capital 32 (12.2)
Subtotal 94 (16.1)
Micro Family characteristics Number of children 10 (3.8)
Parenting-related stress 9 (3.4)
Work-home conflict 7 (2.7)
Support from family 2 (0.8)
Subtotal 28 (6.9)
Occupational characteristics Nursing professionalism 24 (9.1)
Organizational commitment 59 (22.4)
Job commitment 34 (12.9)
Burn out 44 (16.7)
Job stress 64 (24.3)
Job satisfaction 117 (44.5)
Emotional labor 29 (11.0)
Role conflict 6 (2.3)
Subtotal 377 (93.1)
Meso Unit characteristics Number of patients assigned 1 (0.4)
Working unit 41 (15.6)
Shift type 70 (26.6)
Subtotal 112 (43.2)
Work characteristics Heavy workload 4 (1.5)
Unit work environment 33 (12.5)
Subtotal 37 (14.3)
Manager characteristics Leadership 27 (10.3)
Supervisor's emotional experience 1 (0.4)
Subtotal 28 (10.8)
Unit culture Organizational culture of working unit 46 (17.5)
Workplace violence 19 (7.2)
Supervisor-subordinate relationship 5 (1.9)
Communication 12 (4.6)
Subtotal 82 (31.7)
Exo Hospital characteristics Type of hospital 8 (3.0)
Nursing manpower grade 2 (0.8)
Subtotal 10 (7.6)
Marketing Career development system 13 (4.9)
Internal marketing 80 (30.4)
Hospital work environment 7 (2.7)
Subtotal 100 (75.7)
Hospital culture Ethical climate 1 (0.4)
Leadership of chief executive officer 5 (1.9)
Inter-department communication 16 (6.1)
Subtotal 22 (16.7)
Macro Health policy Integrated nursing care service 1 (0.4)
Hospital accreditation 3 (1.1)
Subtotal 4 (80.0)
Social welfare Parenting support system 1 (0.4)
Subtotal 1 (20.0)

†Effect size for subtotals.

Table 3.
Comparison of Turnover Intention by Study Characteristics (K=35, N=11,885)
Characteristics Category k (n) Turnover intention 95%CI I2 (%) Q df (Q) p Analyzed model
Lower Upper
Publication year 2006~2010 5 (2,899) 3.26 3.03 3.49 97.7 0.30 2 .859 R
2011~2013 13 (4,140) 3.25 3.11 3.39          
2014~2016 15 (4,093) 3.31 3.17 3.43          
Number of participants ＜300 21 (4,554) 3.31 3.19 3.42 97.7 0.66 2 .718 R
300~＜500 6 (2,196) 3.21 3.00 3.42          
≥500 6 (4,382) 3.25 3.04 3.46          
Specialized unit ratio (%) ＞30 18 (7,558) 3.33 3.16 3.50 97.8 0.05 1 .814 R
≤30 9 (2,000) 3.31 3.19 3.43          
Hospital type Advanced 6 (1,842) 3.47 3.29 3.65 97.7 7.59 2 .023 R
General 24 (7,109) 3.26 3.17 3.35          
Advanced+General 3 (2,181) 3.05 2.80 3.30          
Location Metropolitan 11 (3,506) 3.31 3.17 3.45 97.8 2.14 2 .343 R
Non-metropolitan 12 (3,112) 3.32 3.19 3.46          
Nationwide 2 (1,644) 3.06 2.73 3.39          
Quality evaluation 4 4 (1,159) 3.19 2.89 3.48 98.4 1.12 2 .573 R
5 3 (765) 3.12 2.77 3.46          
6 26 (9,208) 3.30 3.17 3.40          

k=number of studies; n=number of participants; CI=confidence interval; R=random effect model.

Table 4.
Effect size of Related Factors for Turnover Intention
System Related factors k Effect size 95% CI z p Heterogeneity Analyzed model
Tau2 Q df (p) I2
Individual Age 2 -0.17 -0.23~-0.11 -5.16 ＜.001 0.00 0.00 1 (1.000) 0.0 Fixed
Gender 10 -0.01 -0.05~0.03 -0.59 .558 0.00 7.73 9 (.562) 0.0 Fixed
Religion 9 0.09 0.05~0.12 4.34 ＜.001 0.00 8.55 8 (.382) 6.4 Fixed
Marital status 26 0.14 0.10~0.18 6.08 ＜.001 0.01 114.87 25 (＜.001) 78.2 Random
Positive personality 3 -0.14 -0.20~-0.08 -4.36 ＜.001 0.00 0.85 2 (.653) 0.0 Fixed
Physical ․ mental health 3 -0.15 -0.21~-0.09 -4.81 ＜.001 0.00 1.87 2 (.393) 0.0 Fixed
Positive psychological capital 2 -0.38 -0.44~-0.32 -10.87 ＜.001 0.00 0.10 1 (.758) 0.0 Fixed
Work experience 2 -0.69 -0.99~0.62 -1.06 .289 1.29 388.56 1 (＜.001) 99.7 Random
Turnover experience 14 -0.02 -0.08~0.03 -0.77 .439 0.01 55.29 13 (＜.001) 76.5 Random
Rotation experience 3 0.03 -0.12~0.18 0.40 .693 0.01 10.05 2 (.007) 80.1 Random
Individual total 76 0.14 0.10~0.17 7.27 ＜.001 0.02 686.34 75 (＜.001) 89.1 Random
Micro Work-home conflict 2 0.40 0.35~0.44 14.61 ＜.001 0.00 0.40 1 (.525) 0.0 Fixed
Nursing professionalism 4 -0.38 -0.47~-0.28 -7.22 ＜.001 0.01 13.98 3 (.003) 78.5 Random
Organizational commitment 10 -0.63 -0.70~-0.56 -12.48 ＜.001 0.03 118.05 9 (＜.001) 92.4 Random
Burn out 4 0.37 -0.21~0.76 1.26 .206 0.38 297.13 3 (＜.001) 99.0 Random
Job stress 7 0.13 -0.19~0.42 0.77 .439 0.18 337.92 6 (＜.001) 98.2 Random
Job satisfaction 8 -0.49 -0.57~-0.40 -9.47 ＜.001 0.02 47.64 7 (＜.001) 85.3 Random
Emotional labor 6 0.44 0.36~0.52 9.10 ＜.001 0.01 26.60 5 (＜.001) 81.2 Random
Role conflict 2 0.41 0.34~0.47 10.98 ＜.001 0.00 0.50 1 (.480) 0.0 Fixed
Micro total 44 0.50 0.46~0.55 18.73 ＜.001 0.04 603.47 43 (＜.001) 92.9 Random
Meso Shift type 19 0.18 0.13~0.23 7.10 ＜.001 0.01 63.15 18 (＜.001) 71.5 Random
Heavy workload 2 0.33 0.15~0.49 3.51 ＜.001 0.02 9.43 1 (.002) 89.4 Random
Unit work environment 3 -0.36 -0.55~-0.14 -3.11 .002 0.04 21.01 2 (＜.001) 90.5 Random
Leadership of the manager 2 -0.30 -0.37~-0.23 -7.84 ＜.001 0.00 0.32 1 (.573) 0.0 Fixed
Unit organizational culture 4 -0.36 -0.43~-0.29 -9.31 ＜.001 0.00 6.82 3 (.078) 56.0 Random
Workplace violence 2 0.19 0.08~0.30 3.28 .001 0.00 2.13 1 (.144) 53.1 Random
Meso total 33 0.25 0.21~0.29 11.59 ＜.001 0.01 153.59 32 (＜.001) 79.2 Random
Exo Internal marketing 2 -0.40 -0.49~-0.30 -7.04 ＜.001 0.00 2.16 1 (.142) 53.7 Random
Exo total 2 0.40 0.30~0.49 7.04 ＜.001 0.00 2.16 1 (.142) 53.7 Random
Total   155 0.28 0.25~0.32 14.37 ＜.001 0.06 3,221.01 154 (＜.001) 95.2 Random

k=number of studies (or effect sizes for totals); CI=confidence interval.

Appendix 1.
List of Meta-Analyzed Studies
1st Author Year Sample size Hospital type Location Turnover intention (M±SD) Publication Quality score Related factors
Ahn, MK 2015 150 G NR 3.58±0.83 Yes 6 4, 13, 16, 19
Cho, SH 2011 388 G Non-M 3.00±0.81 No 6 3, 4, 13, 16, 19, 22
Choi, MY 2014 215 A Non-M 3.50±0.90 No 6 2, 4, 6, 14, 15
Choi, JH 2012 188 G Non-M 3.31±1.04 No 5 3, 4, 10, 19
Choi, HJ 2015 286 G NR 3.33±0.81 Yes 6 4, 9, 19
Han, YH 2010 1,500 G+A Nation 2.86±0.68 Yes 6 4, 12, 13, 19
Ham, MS 2014 238 G Non-M 3.51±0.75 No 6 4, 9, 10, 19
Hwang, YS 2014 209 G M 2.96±0.73 Yes 6 4, 12, 13, 21
Kwak, YK 2014 524 G NR 3.25±0.66 No 6 4, 6, 9, 10, 17, 19
Kim, KS 2013 168 G NR 3.10±0.87 Yes 6 3, 18, 20
Kim, SY 2013 360 G NR NR　 Yes 6 13, 21
Kim, SH 2014 297 G Non-M 3.45±0.85 Yes 6 2, 3, 4, 5, 9, 17
Kim, JH 2013 275 G M 3.20±0.55 Yes 4 5, 15
Kim, CH 2009 716 G NR 3.44±0.80 Yes 6 1, 8, 11, 15, 23
Lee, SJ 2013 198 G Non-M 3.41±0.70 No 6 4, 14, 17, 18, 19
Lee, SY 2012 385 G Non-M 2.96±1.08 No 5 13, 16
Myung, MK 2013 193 G NR 3.18±0.80 No 6 1, 4, 8, 9, 12, 19, 21
Park, KO 2013 144 G+A Nation 3.26±0.45 Yes 6 24
Park, JM 2015 303 A M 3.17±0.57 No 6 2, 4, 19
Paek, YO 2012 353 G M 3.71±0.84 No 6 14, 9, 16, 19
Seok, HS 2013 393 G+A NR NR　 Yes 4 5, 12, 13, 23
Sung, MH 2013 537 G+A M 3.04±0.60 Yes 6 2, 4, 9, 14, 20
Seong, SS 2011 592 A M 3.48±0.66 No 6 4, 9, 19
Son, SY 2015 216 G M 3.08±0.63 Yes 6 3, 4, 9, 11, 17, 19, 25
Son, YJ 2012 513 G NR 3.43±0.85 Yes 6 1, 3, 8, 11, 17, 19, 25
Song, AR 2009 203 A Non-M 3.60±0.85 Yes 4 25
Shin OS 2013 159 G Non-M 3.19±0.58 No 6 2, 4, 9, 19
Yang, YJ 2015 241 A M 3.73±0.81 No 6 3, 4, 19, 22, 23
Yang, JH 2014 320 G NR 3.13±0.66 Yes 6 3, 4, 9, 13, 16, 17, 19
Yeun, YR 2014 198 G M 3.52±1.52 Yes 6 14, 15, 23
Yoo, SJ 2009 192 G Non-M 3.08±0.60 Yes 5 3, 4, 9, 13, 15, 16, 19
Yun, JN 2015 202 G Non-M 3.59±0.82 No 6 2, 4, 9, 15, 16, 17, 19
Yim, HY 2015 447 G Non-M 3.30±0.87 No 6 2, 4, 7, 15
Jung, EJ 2015 294 G M 3.19±0.71 No 6 2, 4, 13, 19, 24
Pyun, MS 2010 288 A M 3.35±0.62 No 4 2, 4, 6, 7

G=general hospital; AG=advanced general hospital; NR=not reported; M=metropolitan area; Non-M=non-metropolitan area; Nation=nationwide. Relates factors: 1=Age, 2=Sex, 3=Religion, 4=Marital status, 5=Positive personality, 6=Physical/mental health, 7=Positive psychological capital, 8=Work experience, 9=Turnover experience, 10=Rotation experience, 11=Work-home conflict, 12=Nursing professionalism, 13=Organizational commitment, 14=Burn out, 15=Job stress, 16=Job satisfaction, 17=Emotional labor, 18=Role conflict, 19=Shift type, 20=Heavy workload, 21=Unit work environment, 22=Leadership of the manager, 23=Unit organizational culture, 24=Workplace violence, 25=Internal marketing,

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    Related Factors of Turnover Intention among Korean Hospital Nurses: A Systematic Review and Meta-Analysis
    Korean J Adult Nurs. 2018;30(1):1-17.   Published online February 28, 2018
    DOI: https://doi.org/10.7475/kjan.2018.30.1.1
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    Related Factors of Turnover Intention among Korean Hospital Nurses: A Systematic Review and Meta-Analysis
    Korean J Adult Nurs. 2018;30(1):1-17.   Published online February 28, 2018
    DOI: https://doi.org/10.7475/kjan.2018.30.1.1
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    Related Factors of Turnover Intention among Korean Hospital Nurses: A Systematic Review and Meta-Analysis
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    Figure 1. PRISMA flow for the study.

    Figure 1.

    Related Factors of Turnover Intention among Korean Hospital Nurses: A Systematic Review and Meta-Analysis

    Characteristics of Selected Studies for Systematic Review (K=263/N=79,236)

    Characteristics Categories Number of studies (%) Number of participants
    Publication year 2006~2010 58 (22.0) 17,761
    2011~2013 107 (40.7) 45,290
    2014~2016 98 (37.3) 16,185
    Gender All included 127 (48.3) 43,017
    Female only 33 (12.6) 7,718
    Male only 3 (1.1) 424
    Not reported 100 (38.0) 28,077
    Career New nurse only 17 (6.5) 4,360
    All included 246 (93.5) 74,876
    Marital status Married only 9 (3.4) 1,923
    All included 254 (96.6) 77,313
    Hospital size General 166 (63.1) 46,338
    Advanced general 54 (20.5) 13,056
    General + Advanced general 43 (16.4) 19,842
    Nursing units Special units only† 28 (10.6) 5,554
    All units included 188 (71.5) 62,244
    Not reported 47 (17.9) 11,438
    Location Metropolitan area 85 (32.3) 22,145
    Non-metropolitan area 89 (33.9) 22,835
    Nationwide 19 (7.2) 16,437
    Not reported 70 (26.6) 17,819
    Publication type Dissertation 129 (49.0) 36,585
    Journal article 134 (51.0) 42,651
    Measurements for turnover intention Lawler (1983) 70 (26.6) 19,555
    Mobley (1982) 45 (17.1) 11,933
    Kim (2007) 21 (8.0) 4,899
    Becker (1992) 11 (4.2) 2,562
    Lee (1994) 6 (2.3) 1,378
    Cook, Hepworth & Warr (1981) 5 (1.9) 1,349
    Price & Mueller (1986) 5 (1.9) 1,454
    Micheals & Specter (1982) 5 (1.9) 939
    Yun & Kim (2013) 4 (1.5) 905
    Others 91 (34.6) 34,262
    Research design Cross-sectional survey 252 (95.8) 78,910
    Interventional study 4 (1.5) 244
    Qualitative study 7 (2.7) 82

    †Emergency rooms, intensive care units, operating rooms.

    Classification of Related Factors according to Ecological System

    Eco-Systems Categories Related factors Number of studies† (%)
    Individual Demographics characteristics Age 116 (44.1)
    Gender 7 (2.7)
    Religion 22 (8.4)
    Education 62 (23.6)
    Military service 1 (0.4)
    Sex role identity 2 (0.8)
    Marital staus 75 (28.5)
    Subtotal 285 (48.9)
    Job-related personal characteristics Position 62 (23.6)
    Work experience 106 (40.3)
    Estimated duration of work 9 (3.4)
    Reason to work 4 (1.5)
    Working at requested unit 3 (1.1)
    Turnover experience 14 (5.3)
    Rotation experience 6 (2.3)
    Subtotal 204 (35.0)
    Personal characteristics Emotional intelligence 11 (4.2)
    Personality 24 (9.1)
    Physical・ mental health 27 (10.3)
    Positive psychological capital 32 (12.2)
    Subtotal 94 (16.1)
    Micro Family characteristics Number of children 10 (3.8)
    Parenting-related stress 9 (3.4)
    Work-home conflict 7 (2.7)
    Support from family 2 (0.8)
    Subtotal 28 (6.9)
    Occupational characteristics Nursing professionalism 24 (9.1)
    Organizational commitment 59 (22.4)
    Job commitment 34 (12.9)
    Burn out 44 (16.7)
    Job stress 64 (24.3)
    Job satisfaction 117 (44.5)
    Emotional labor 29 (11.0)
    Role conflict 6 (2.3)
    Subtotal 377 (93.1)
    Meso Unit characteristics Number of patients assigned 1 (0.4)
    Working unit 41 (15.6)
    Shift type 70 (26.6)
    Subtotal 112 (43.2)
    Work characteristics Heavy workload 4 (1.5)
    Unit work environment 33 (12.5)
    Subtotal 37 (14.3)
    Manager characteristics Leadership 27 (10.3)
    Supervisor's emotional experience 1 (0.4)
    Subtotal 28 (10.8)
    Unit culture Organizational culture of working unit 46 (17.5)
    Workplace violence 19 (7.2)
    Supervisor-subordinate relationship 5 (1.9)
    Communication 12 (4.6)
    Subtotal 82 (31.7)
    Exo Hospital characteristics Type of hospital 8 (3.0)
    Nursing manpower grade 2 (0.8)
    Subtotal 10 (7.6)
    Marketing Career development system 13 (4.9)
    Internal marketing 80 (30.4)
    Hospital work environment 7 (2.7)
    Subtotal 100 (75.7)
    Hospital culture Ethical climate 1 (0.4)
    Leadership of chief executive officer 5 (1.9)
    Inter-department communication 16 (6.1)
    Subtotal 22 (16.7)
    Macro Health policy Integrated nursing care service 1 (0.4)
    Hospital accreditation 3 (1.1)
    Subtotal 4 (80.0)
    Social welfare Parenting support system 1 (0.4)
    Subtotal 1 (20.0)

    †Effect size for subtotals.

    Comparison of Turnover Intention by Study Characteristics (K=35, N=11,885)

    Characteristics Category k (n) Turnover intention 95%CI I2 (%) Q df (Q) p Analyzed model
    Lower Upper
    Publication year 2006~2010 5 (2,899) 3.26 3.03 3.49 97.7 0.30 2 .859 R
    2011~2013 13 (4,140) 3.25 3.11 3.39          
    2014~2016 15 (4,093) 3.31 3.17 3.43          
    Number of participants ＜300 21 (4,554) 3.31 3.19 3.42 97.7 0.66 2 .718 R
    300~＜500 6 (2,196) 3.21 3.00 3.42          
    ≥500 6 (4,382) 3.25 3.04 3.46          
    Specialized unit ratio (%) ＞30 18 (7,558) 3.33 3.16 3.50 97.8 0.05 1 .814 R
    ≤30 9 (2,000) 3.31 3.19 3.43          
    Hospital type Advanced 6 (1,842) 3.47 3.29 3.65 97.7 7.59 2 .023 R
    General 24 (7,109) 3.26 3.17 3.35          
    Advanced+General 3 (2,181) 3.05 2.80 3.30          
    Location Metropolitan 11 (3,506) 3.31 3.17 3.45 97.8 2.14 2 .343 R
    Non-metropolitan 12 (3,112) 3.32 3.19 3.46          
    Nationwide 2 (1,644) 3.06 2.73 3.39          
    Quality evaluation 4 4 (1,159) 3.19 2.89 3.48 98.4 1.12 2 .573 R
    5 3 (765) 3.12 2.77 3.46          
    6 26 (9,208) 3.30 3.17 3.40          

    k=number of studies; n=number of participants; CI=confidence interval; R=random effect model.

    Effect size of Related Factors for Turnover Intention

    System Related factors k Effect size 95% CI z p Heterogeneity Analyzed model
    Tau2 Q df (p) I2
    Individual Age 2 -0.17 -0.23~-0.11 -5.16 ＜.001 0.00 0.00 1 (1.000) 0.0 Fixed
    Gender 10 -0.01 -0.05~0.03 -0.59 .558 0.00 7.73 9 (.562) 0.0 Fixed
    Religion 9 0.09 0.05~0.12 4.34 ＜.001 0.00 8.55 8 (.382) 6.4 Fixed
    Marital status 26 0.14 0.10~0.18 6.08 ＜.001 0.01 114.87 25 (＜.001) 78.2 Random
    Positive personality 3 -0.14 -0.20~-0.08 -4.36 ＜.001 0.00 0.85 2 (.653) 0.0 Fixed
    Physical ․ mental health 3 -0.15 -0.21~-0.09 -4.81 ＜.001 0.00 1.87 2 (.393) 0.0 Fixed
    Positive psychological capital 2 -0.38 -0.44~-0.32 -10.87 ＜.001 0.00 0.10 1 (.758) 0.0 Fixed
    Work experience 2 -0.69 -0.99~0.62 -1.06 .289 1.29 388.56 1 (＜.001) 99.7 Random
    Turnover experience 14 -0.02 -0.08~0.03 -0.77 .439 0.01 55.29 13 (＜.001) 76.5 Random
    Rotation experience 3 0.03 -0.12~0.18 0.40 .693 0.01 10.05 2 (.007) 80.1 Random
    Individual total 76 0.14 0.10~0.17 7.27 ＜.001 0.02 686.34 75 (＜.001) 89.1 Random
    Micro Work-home conflict 2 0.40 0.35~0.44 14.61 ＜.001 0.00 0.40 1 (.525) 0.0 Fixed
    Nursing professionalism 4 -0.38 -0.47~-0.28 -7.22 ＜.001 0.01 13.98 3 (.003) 78.5 Random
    Organizational commitment 10 -0.63 -0.70~-0.56 -12.48 ＜.001 0.03 118.05 9 (＜.001) 92.4 Random
    Burn out 4 0.37 -0.21~0.76 1.26 .206 0.38 297.13 3 (＜.001) 99.0 Random
    Job stress 7 0.13 -0.19~0.42 0.77 .439 0.18 337.92 6 (＜.001) 98.2 Random
    Job satisfaction 8 -0.49 -0.57~-0.40 -9.47 ＜.001 0.02 47.64 7 (＜.001) 85.3 Random
    Emotional labor 6 0.44 0.36~0.52 9.10 ＜.001 0.01 26.60 5 (＜.001) 81.2 Random
    Role conflict 2 0.41 0.34~0.47 10.98 ＜.001 0.00 0.50 1 (.480) 0.0 Fixed
    Micro total 44 0.50 0.46~0.55 18.73 ＜.001 0.04 603.47 43 (＜.001) 92.9 Random
    Meso Shift type 19 0.18 0.13~0.23 7.10 ＜.001 0.01 63.15 18 (＜.001) 71.5 Random
    Heavy workload 2 0.33 0.15~0.49 3.51 ＜.001 0.02 9.43 1 (.002) 89.4 Random
    Unit work environment 3 -0.36 -0.55~-0.14 -3.11 .002 0.04 21.01 2 (＜.001) 90.5 Random
    Leadership of the manager 2 -0.30 -0.37~-0.23 -7.84 ＜.001 0.00 0.32 1 (.573) 0.0 Fixed
    Unit organizational culture 4 -0.36 -0.43~-0.29 -9.31 ＜.001 0.00 6.82 3 (.078) 56.0 Random
    Workplace violence 2 0.19 0.08~0.30 3.28 .001 0.00 2.13 1 (.144) 53.1 Random
    Meso total 33 0.25 0.21~0.29 11.59 ＜.001 0.01 153.59 32 (＜.001) 79.2 Random
    Exo Internal marketing 2 -0.40 -0.49~-0.30 -7.04 ＜.001 0.00 2.16 1 (.142) 53.7 Random
    Exo total 2 0.40 0.30~0.49 7.04 ＜.001 0.00 2.16 1 (.142) 53.7 Random
    Total   155 0.28 0.25~0.32 14.37 ＜.001 0.06 3,221.01 154 (＜.001) 95.2 Random

    k=number of studies (or effect sizes for totals); CI=confidence interval.

    List of Meta-Analyzed Studies

    1st Author Year Sample size Hospital type Location Turnover intention (M±SD) Publication Quality score Related factors
    Ahn, MK 2015 150 G NR 3.58±0.83 Yes 6 4, 13, 16, 19
    Cho, SH 2011 388 G Non-M 3.00±0.81 No 6 3, 4, 13, 16, 19, 22
    Choi, MY 2014 215 A Non-M 3.50±0.90 No 6 2, 4, 6, 14, 15
    Choi, JH 2012 188 G Non-M 3.31±1.04 No 5 3, 4, 10, 19
    Choi, HJ 2015 286 G NR 3.33±0.81 Yes 6 4, 9, 19
    Han, YH 2010 1,500 G+A Nation 2.86±0.68 Yes 6 4, 12, 13, 19
    Ham, MS 2014 238 G Non-M 3.51±0.75 No 6 4, 9, 10, 19
    Hwang, YS 2014 209 G M 2.96±0.73 Yes 6 4, 12, 13, 21
    Kwak, YK 2014 524 G NR 3.25±0.66 No 6 4, 6, 9, 10, 17, 19
    Kim, KS 2013 168 G NR 3.10±0.87 Yes 6 3, 18, 20
    Kim, SY 2013 360 G NR NR　 Yes 6 13, 21
    Kim, SH 2014 297 G Non-M 3.45±0.85 Yes 6 2, 3, 4, 5, 9, 17
    Kim, JH 2013 275 G M 3.20±0.55 Yes 4 5, 15
    Kim, CH 2009 716 G NR 3.44±0.80 Yes 6 1, 8, 11, 15, 23
    Lee, SJ 2013 198 G Non-M 3.41±0.70 No 6 4, 14, 17, 18, 19
    Lee, SY 2012 385 G Non-M 2.96±1.08 No 5 13, 16
    Myung, MK 2013 193 G NR 3.18±0.80 No 6 1, 4, 8, 9, 12, 19, 21
    Park, KO 2013 144 G+A Nation 3.26±0.45 Yes 6 24
    Park, JM 2015 303 A M 3.17±0.57 No 6 2, 4, 19
    Paek, YO 2012 353 G M 3.71±0.84 No 6 14, 9, 16, 19
    Seok, HS 2013 393 G+A NR NR　 Yes 4 5, 12, 13, 23
    Sung, MH 2013 537 G+A M 3.04±0.60 Yes 6 2, 4, 9, 14, 20
    Seong, SS 2011 592 A M 3.48±0.66 No 6 4, 9, 19
    Son, SY 2015 216 G M 3.08±0.63 Yes 6 3, 4, 9, 11, 17, 19, 25
    Son, YJ 2012 513 G NR 3.43±0.85 Yes 6 1, 3, 8, 11, 17, 19, 25
    Song, AR 2009 203 A Non-M 3.60±0.85 Yes 4 25
    Shin OS 2013 159 G Non-M 3.19±0.58 No 6 2, 4, 9, 19
    Yang, YJ 2015 241 A M 3.73±0.81 No 6 3, 4, 19, 22, 23
    Yang, JH 2014 320 G NR 3.13±0.66 Yes 6 3, 4, 9, 13, 16, 17, 19
    Yeun, YR 2014 198 G M 3.52±1.52 Yes 6 14, 15, 23
    Yoo, SJ 2009 192 G Non-M 3.08±0.60 Yes 5 3, 4, 9, 13, 15, 16, 19
    Yun, JN 2015 202 G Non-M 3.59±0.82 No 6 2, 4, 9, 15, 16, 17, 19
    Yim, HY 2015 447 G Non-M 3.30±0.87 No 6 2, 4, 7, 15
    Jung, EJ 2015 294 G M 3.19±0.71 No 6 2, 4, 13, 19, 24
    Pyun, MS 2010 288 A M 3.35±0.62 No 4 2, 4, 6, 7

    G=general hospital; AG=advanced general hospital; NR=not reported; M=metropolitan area; Non-M=non-metropolitan area; Nation=nationwide. Relates factors: 1=Age, 2=Sex, 3=Religion, 4=Marital status, 5=Positive personality, 6=Physical/mental health, 7=Positive psychological capital, 8=Work experience, 9=Turnover experience, 10=Rotation experience, 11=Work-home conflict, 12=Nursing professionalism, 13=Organizational commitment, 14=Burn out, 15=Job stress, 16=Job satisfaction, 17=Emotional labor, 18=Role conflict, 19=Shift type, 20=Heavy workload, 21=Unit work environment, 22=Leadership of the manager, 23=Unit organizational culture, 24=Workplace violence, 25=Internal marketing,
    Table 1. Characteristics of Selected Studies for Systematic Review (K=263/N=79,236)

    Emergency rooms, intensive care units, operating rooms.

    Table 2. Classification of Related Factors according to Ecological System

    Effect size for subtotals.

    Table 3. Comparison of Turnover Intention by Study Characteristics (K=35, N=11,885)

    k=number of studies; n=number of participants; CI=confidence interval; R=random effect model.

    Table 4. Effect size of Related Factors for Turnover Intention

    k=number of studies (or effect sizes for totals); CI=confidence interval.

    Appendix 1. List of Meta-Analyzed Studies

    G=general hospital; AG=advanced general hospital; NR=not reported; M=metropolitan area; Non-M=non-metropolitan area; Nation=nationwide. Relates factors: 1=Age, 2=Sex, 3=Religion, 4=Marital status, 5=Positive personality, 6=Physical/mental health, 7=Positive psychological capital, 8=Work experience, 9=Turnover experience, 10=Rotation experience, 11=Work-home conflict, 12=Nursing professionalism, 13=Organizational commitment, 14=Burn out, 15=Job stress, 16=Job satisfaction, 17=Emotional labor, 18=Role conflict, 19=Shift type, 20=Heavy workload, 21=Unit work environment, 22=Leadership of the manager, 23=Unit organizational culture, 24=Workplace violence, 25=Internal marketing,

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Appendix 1.

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