Nurse Working Conditions, Organizational Climate, and Intent to Leave in ICUs: An Instrumental Variable Approach

Abstract

OBJECTIVE: To investigate causes of nurse intention to leave (ITL) while simultaneously considering organizational climate (OC) in intensive care units (ICUs) and identify policy implications. DATA SOURCES/STUDY SETTING: Data were obtained from multiple sources including nurse surveys, hospital administrative data, public use, and Medicare files. Survey responses were analyzed from 837 nurses employed in 39 adult ICUs from 23 hospitals located in 20 separate metropolitan statistical areas. STUDY DESIGN: We used an instrumental variable technique to assess simultaneously the relationship between OC and ITL. We estimated ordinary least squares and reduced form regressions to determine the extent of simultaneity bias as well as the sensitivity of our results to the instrumental variable model specification. PRINCIPAL FINDINGS: Fifteen percent of the nurses indicated their ITL in the coming year. Based on the structural model, we found that nurses' ITL contributed little if anything directly to OC, but that OC and the tightness of the labor market had significant roles in determining ITL (p values <.05). Furthermore, OC was affected by the average regionally adjusted ICU wages, hospital profitability, teaching, and Magnet status (p values <.05). CONCLUSIONS: OC is an important determinant of ITL among ICU nurses. Because higher wages do not reduce ITL, increased pay alone without attention to OC is likely insufficient to reduce nurse turnover. Implementing interventions aimed at creating a positive OC, as found in Magnet hospitals, may be a more effective strategy.