factors influencing intentions to stay and retention of nurse managers: a systematic review

Factors influencing intentions to stay and retention of nursemanagers: a systematic review

PAMELA BROWN R N , M N1, KIMBERLY FRASER R N , P h D

2, CAROL A. WONG R N , P h D3, MELANIE MUISE

M A4 and GRETA CUMMINGS R N , P h D

4,5

1Supervisor, Alberta Health Services, 2Assistant Professor, Faculty of Nursing, University of Alberta, Edmonton, AB,3Associate Professor, Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of WesternOntario, London, ON,4Research Assistant, CLEAR (Connecting Leadership, Education & Research) OutcomesResearch Program, Faculty of Nursing, University of Alberta and 5Professor, Faculty of Nursing, University ofAlberta, Edmonton, Alberta, Canada

Correspondence

Greta G. Cummings

Faculty of Nursing

University of Alberta

5–112 Edmonton Clinic Health

Academy

Edmonton

Alberta T6G 1C9

Canada

E-mail: [email protected]

B R O W N P . , F R A S E R K . , W O N G C . A . , M U I S E M . & C U M M I N G S G . (2012) Journal of Nursing

Management

Factors influencing intentions to stay and retention of nurse managers:a systematic review

Aims This systematic review aimed to explore factors known to influence intentionsto stay and retention of nurse managers in their current position.

Background Retaining staff nurses and recruiting nurses to management positions

are well documented; however, there is sparse research examining factors that

influence retention of nurse managers.

Evaluations Thirteen studies were identified through a systematic search of the

literature. Eligibility criteria included both qualitative and quantitative studies that

examined factors related to nurse manager intentions to stay and retention. Quality

assessments, data extraction and analysis were completed on all studies included.

Twenty-one factors were categorized into three major categories: organizational,

role and personal.

Key issues Job satisfaction, organizational commitment, organizational culture and

values, feelings of being valued and lack of time to complete tasks leading to work/

life imbalance, were prominent across all categories.

Conclusion These findings suggest that intentions to stay and retention of nurse

managers are multifactoral. However, lack of robust literature highlights the need

for further research to develop strategies to retain nurse managers.

Implications for nurse management Health-care organizations and senior decision-

makers should feel a responsibility to support front-line managers in relation to

workload and span of control, and in understanding work/life balance issues faced

by managers.

Keywords: intention to stay, nurse managers, retention, systematic review,

work/life balance

Accepted for publication: 3 November 2011

Journal of Nursing Management, 2012

DOI: 10.1111/j.1365-2834.2012.01352.xª 2012 Blackwell Publishing Ltd 1

Background

A national study published by the Canadian Nurses

Association (CNA) predicts Canada will be short

almost 60 000 full-time equivalent registered nurses by

2022 (Canadian Nurses Association 2009). The CNA

advises that recruiting and retaining nurses is a multi-

faceted challenge that must be supported across the

Canadian health-care system (Tomblin-Murphy et al.

2009). Although the shortage concerns centre on

compromises to health-care delivery, an understanding

of nurse managers in health-care organizations is also

important. Nurse managers can assist in minimizing the

nursing shortfall, as research suggests that effective

nurse managers play an instrumental role in staff nurse

retention and ultimately the quality of patient care

(Volk & Lucas 1991, Kleinman 2004a, Laschinger

et al. 2004, Anthony et al. 2005, Wong & Cummings

2007, Mackoff & Triolo 2008a). Nurse managers are

directly involved in implementing organizational strat-

egies and are an essential component in meeting current

and future ideals, goals and objectives. However,

recruitment and retention of nurse managers is not

without its unique challenges. Hospital restructuring

over the last decade has resulted in a loss of manage-

ment positions. Between 1994 and 2002, managerial

positions across Canada dropped by 29% (Laschinger

et al. 2004). The Canadian Institute for Health Infor-

mation (2006) statistics reported an additional decrease

of 2.2% in managerial positions between 2003 and

2006.

It is also becoming increasingly difficult to attract

experienced nurses into the declining number of middle-

management positions. A recent Canadian study

examining the profile of nursing leadership revealed

that few senior nurse leaders were <45 years of age

(Laschinger et al. 2008). In addition, only 2.2% of first-

line managers and 6.3% of middle managers were 25–

35 years of age. When managers past management

experience was examined, 40% had <5 years of expe-

rience (Laschinger et al. 2008). A major shift toward

more clinical opportunities for advanced practice nurses

is a feature that has an impact on the recruitment of

nurses to middle-management positions (Ruden 2002).

Furthermore, those who do become managers often

have a short tenure in the position (Mackoff & Triolo

2008a,b).

Recruitment and retention of nurse managers is not

just a problem unique to Canada. In an Australian study

of first-line managers over a 10-year period from 1989

to 1999, fewer managers intended to stay in nursing

management in 1999, 72.7% compared with 84.2% in

1989 (Duffield et al. 2001). Of the managers who in-

tended to leave their positions in 1999, 39.3% reported

plans to move into a clinical position compared to

29.1% in 1989. Similarly, the National Health Service

(NHS) in the UK also reports having a high turnover of

managers particularly since the introduction of Trusts

(Trusts are a self-governing administrative body within

the NHS, usually a group of hospitals; http://en.

wikipedia.org/wiki/NHS_trust) as providers of health

services, leading to managerial instability (Scott 2002).

The existing and looming nurse shortage combined with

a decrease in managerial positions has resulted in

increased concerns for the delivery and management of

health care in several countries. Although factors re-

lated to retention of staff nurses have been well docu-

mented in the literature, little has been published about

the factors that affect the intentions to stay or retention

of nurse managers. The purpose of this paper is to de-

scribe the findings of a systematic review of studies that

examined factors related to the intentions to stay or

retention of nurse managers in health-care organiza-

tions and to make recommendations for further study.

Methods

Search strategy, data sources and screening

In this systematic review, 11 databases were searched to

identify studies on nurse manager intent to stay and

retention. These include: ABI Inform, Academic Re-

search, Nursing & Allied Health Source, Dissertations

& Thesis, CINAHL, ERIC, Health Source, Medline,

Health Star, Psych Info and Embase. A Health Services

librarian was consulted to determine the most appro-

priate search strategy for this area of research. To find

studies published between 1985 and November 2009

that examined factors related to the retention of nurse

managers, the key search terms used included manager*

or patient care manager* or middle manager* or

administrator* and retention or intent to stay or intent

to leave or commitment or turnover and nurse*.

For the purpose of the study, managers were defined

as nurses with responsibility for nursing and acute-care

patient areas in any health-care facility. Middle man-

agers were defined as having at least one level of man-

agement above their level and supervising at least one

level of management. Front-line managers were defined

as having no level of management below them but may

have charge nurses, supervisors or team leaders who

report directly to them (Laschinger et al. 2008). We

defined retention as the ability to retain valued

employees or the extent to which employees remain in

P. Brown et al.

ª 2012 Blackwell Publishing Ltd2 Journal of Nursing Management

their job (Kovner et al. 2009). Studies that examined

manager intentions to stay or leave were also included,

as intent to stay or leave has been reported to be directly

related to retention and turnover, with intent to stay

having the strongest relationship to actual retention

(Kovner et al. 2009, Reitz et al. 2010). Reference lists

from all articles retrieved were manually searched to

ensure completeness.

In addition to databases, Canadian Journal of Nursing

Leadership (http://www.longwoods.com/publications/

nursing-leadership), the American Organization of Nurse

Executives (http://www.aone.org) and the Canadian

Institute for Health Information (http://secure.cihi.ca/

cihiweb/splash.html) websites were accessed for relevant

research reports (see Table 1 for detailed search strategy).

Inclusion criteria

Studies were included if they met the following cri-

teria: (1) peer reviewed research, (2) measured factors

influencing nurse manager retention, (3) quantitative

or qualitative research designs or doctoral disserta-

tions to ensure a wide range of evidence was available

for analysis, and (4) the study sample included

front-line nurse or patient-care managers. Owing to

the large volume of abstracts and English-only

proficiency, this review was also restricted to English

language articles.

Screening

Each abstract was examined twice by the first reviewer

using the inclusion criteria. Studies were excluded if they

did not clearly measure retention, intentions to stay, or

predictors of retention in the quantitative studies or did

not describe the relationship between factors and man-

ager�s decisions to stay or leave in the qualitative studies.

Although definitions of a nurse manager were not

always explicit, studies were included if they referred to

a manager as a middle or front-line manager responsible

for more than one unit on a 24-hour basis. A second

reviewer evaluated a sample of 10 articles using the

inclusion criteria, and both reviewers agreed on whether

or not these studies met the inclusion criteria.

Data extraction

Data extracted from quantitative studies included: au-

thor, journal, country, date of publication, research

purpose and questions, theoretical framework, design,

setting, subjects, sampling method, measurement

instruments, reliability and validity, analysis, retention

measures, predictors and significant and non-significant

findings. Data extracted from the qualitative studies

included: author, journal, country, date of publication,

theoretical framework/justification for the research,

subjects, sampling method, method, rigor, analysis and

results.

Quality review assessment

Each quantitative study was reviewed at least twice

using a quality-rating tool adapted from an instrument

used in previous studies (Cummings & Estabrooks

2003, Estabrooks et al. 2003). The adapted assessment

tool measures overall quality based on research design,

sampling method, measurement and statistical analysis

of each study included. All studies included were of

correlational design, therefore only one quality assess-

ment tool was required. The tool comprised 13 items,

with a possible total score of 13 points and all items

given a weight of 1 point each. Scoring categories were

high quality (10–13), moderate (5–9) and low (0–4).

The qualitative studies were screened and assessed for

suitability using the electronically retrieved Critical

Appraisal Skills Programme (CASP) screening tool for

qualitative studies (Public Health Resource Unit 2006).

Qualitative studies were assessed for appropriateness of

research design, sampling, data collection, ethical issues

and data analysis. The CASP tool does not provide for

an overall score.

Table 1Literature search strategy

Databases Search terms

ABI InformAcademicResearch

Administrator* AND Retention AND Nurse*

CINAHL Patient caremanager*

Intent to stay

Nursing & AlliedHealth Source

Manager* Intent to leave

EMBASE Middlemanager*

Commitment

ERIC TurnoverHealth SourceNursingHealth StarProquestDissertationsand ThesisPsych INFOMedline

Websites: Canadian Journal of Nursing Leadership (CJNL) http://www.longwoods.com/publications/nursing-leadership; *Electronicdatabase search. American Organization of Nurse Executives(AONE) http://www.aone.org; Canadian Institute of Health Informa-tion (CIHI) http://secure.cihi.ca/cihiweb/splash.html.

Factors influencing retention of nurse managers

ª 2012 Blackwell Publishing LtdJournal of Nursing Management 3

Synthesis of results

Content analysis was used to synthesize the results from

both the quantitative and qualitative studies. Content

analysis refers to a systematic means of categorizing the

content or in this case factors or variables into themes

(Burns & Grove 2009). A meta-analysis was not pos-

sible because of the heterogeneity of study designs, and

predictor and outcome variables. Thus, each factor was

examined for number of times cited, in what context

and how important they were determined to be in

influencing nurse managers� intention to stay in their

current position.

Results

Search results

The search strategy identified 2449 citations. Titles and

abstracts were screened, of which 159 were selected for

second screening. Of these, 18 articles were selected for

full review. These were screened in greater depth using

inclusion criteria, of which 14 articles reporting on 13

studies were retained (see Figure 1 for summary of

search results).

Eight of the 13 studies were quantitative, using

correlational designs (Cavanagh 1990, Littell 1995,

Scott 2002, Johnstone 2003, Mitchell 2007, Skytt et al.

2007, Way et al. 2007, Laschinger et al. 2008) and five

were qualitative, using interview methods such as focus

groups and interviews (American Organization of

Nurse Executives 1994, Parsons & Stonestreet 2003,

Provost 2006, Strelioff 2007, Mackoff & Triolo

2008a,b). Six were conducted in the USA, four in

Canada, one in Sweden, one in England and one in New

South Wales, Australia. Most of the study practice

settings were described as acute care with only one

giving a breakdown of academic versus community

hospitals. All studies were published between 1990 and

2008 (see Table 2 for characteristics of quantitative

studies included and Table 3 for characteristics of

qualitative studies).

Quality assessment

In the quality assessment of the eight quantitative

(correlational) studies, seven were rated moderate or

higher (scores ‡5) and were retained. The eighth study

was a combined quantitative/qualitative study. It was

rated as a low-quality quantitative study with a score of

3 but was retained because of the moderate assessed

value of the qualitative material. Six of the eight

quantitative studies were rated as moderate quality.

The main weaknesses of the quantitative studies were

response rates <60% (6/8) and non-justified sample

sizes (5/8). Four of the eight studies did not report

measuring the dependent variable with a valid instru-

ment and four studies did not use scales with internal

consistency of >70%. The main strengths of the quan-

titative studies were that they were multicentre studies

(8/8), were guided by theory (6/8), were prospective (7/

8) and used a valid tool to measure independent vari-

ables (6/8). Table 4 provides a summary of the quality

assessment of the quantitative studies.

Of the five qualitative studies, one was a master�slevel thesis (Provost 2006) and one was a doctoral dis-

sertation (Strelioff 2007). The main weakness of the

qualitative studies was the lack of discussion regarding

Database titles and abstractsscreened and discarded 2290

141 Ar cles screened andexcluded

4 Ar cles excluded atmanuscript level

14 Ar cle srepor ng on 13studies

Manual and web search Database yield2449

Articles screened for inclusion/exclusion criteria 159

18 articles screened

Retained8 Quantitative studies5 Qualitative studies

Figure 1Search and retrieval process.

P. Brown et al.


Tab

le2

Cha

ract

eris

tics

ofqu

antit

ativ

est

udie

sin

clud

ed

Ref

eren

ceD

esig

n/an

alys

isS

ubje

cts/

sam

ple/

setti

ngF

ram

ewor

kM

easu

rem

ents

Sco

rings

Rel

iabi

lity

Val

idity

Cav

anag

h(1

990)

Cro

ss-s

ectio

nals

urve

yS

tepw

ise

regr

essi

onN

urse

man

ager

sn

=83

Pro

fitan

dno

n-pr

ofit

hosp

itals

ingr

eate

rLo

sA

ngel

esar

ea

Not

repo

rted

Pric

ean

dM

uelle

ras

sess

men

tof

varia

bles

Inte

rval

scor

eO

vera

lla

=0.

83F

acto

rlo

adin

g

John

ston

e(2

003)

Cro

ss-s

ectio

nals

urve

yS

tepw

ise

regr

essi

onN

urse

man

ager

sn

=80

3D

ata

retr

ieve

dfr

omN

ewS

outh

Wal

esH

ealth

Wor

kfor

ceP

lann

ing

Uni

t�sda

taba

se

Not

repo

rted

Pro

ject

spec

ific

surv

eyS

elec

tst

atem

ent

from

14R

ank

stat

emen

ts

Not

repo

rted

Not

repo

rted

Lasc

hing

eret

al.

(200

8)N

atio

nalc

ross

-sec

tiona

lco

rrel

atio

nal

Nur

sele

ader

sn

=11

64A

cade

mic

and

com

mun

ityho

spita

lsin

10C

anad

ian

hosp

itals

Con

cept

ual

mod

elS

elf

repo

rtst

anda

rdiz

edm

easu

res

Sep

arat

esc

ores

for

each

varia

ble

a=

0.74

–0.9

3C

onst

ruct

Litte

ll(1

995)

Cor

rela

tiona

lusi

ngfa

ctor

and

regr

essi

onan

alys

is

Nur

sem

anag

ers

n=

290

Acu

teca

reho

spita

lin

the

US

A

Rev

ised

orga

niza

tiona

lcl

imat

em

odel

Nur

seJo

bS

atis

fact

ion

Sca

leF

ive-

poin

tLi

kert

Sca

le26

item

sa

=0.

89F

ace

Mitc

hell

(200

7)E

lect

roni

csu

rvey

Fac

tor

anal

ysis

Nur

sele

ader

sn

=42

3A

mer

ican

Org

aniz

atio

nof

Nur

seE

xecu

tives

Cog

nitiv

eco

nsis

tenc

yre

sear

chm

odel

Alle

nO

rgan

izat

iona

lC

omm

itmen

tS

cale

McD

onal

d&

Gan

zV

alue

Tax

onom

y

Sev

en-p

oint

Like

rtS

cale

a=

0.59

–0.8

5C

onst

ruct

Sco

tt(2

002)

Cor

rela

tiona

lwith

qual

itativ

eco

mpo

nent

Ser

vice

man

ager

sn

=33

Not

repo

rted

Sel

fre

port

onde

cisi

onm

akin

gpa

rtic

ipat

ion,

rece

ivin

gfe

edba

ckan

dfe

elin

gva

lued

Dic

hoto

mou

s(y

es,

no)

Not

repo

rted

Not

repo

rted

Sky

ttet

al.

(200

7)D

escr

iptiv

eR

etro

spec

tive

usin

gqu

estio

nnai

res

and

exit

lette

rs

Nur

sele

ader

sn

=32

Tw

oho

spita

lsin

aco

unty

coun

cili

nS

wed

en

Not

repo

rted

Stu

dy-s

peci

ficqu

estio

nnai

reIn

terv

alsc

ores

Not

repo

rted

Not

repo

rted

Way

etal

.(2

007)

Des

crip

tive

corr

elat

iona

lusi

ngsu

rvey

san

dhi

erar

chic

alre

gres

sion

anal

ysis

Clin

ical

man

ager

s(n

=10

4an

dn

=99

)T

hree

inst

itutio

nalb

oard

sin

New

foun

dlan

dan

dLa

brad

orin

2000

and

2003

Pre

dict

ive

mod

elof

orga

niza

tiona

lco

mm

itmen

tan

dtu

rnov

erin

tent

ions

Em

ploy

eeA

ttitu

deS

urve

y,co

nsis

ting

offiv

ein

stru

men

ts(I

mpa

ctof

Hea

lthC

are

Ref

orm

Sca

le,

Psy

chol

ogic

alC

ontr

act

Vio

latio

nS

cale

,G

ener

alJo

bS

atis

fact

ion

Sca

le,

Org

aniz

atio

nal

Com

mitm

ent

Que

stio

nnai

rean

dth

eIn

tent

toS

tay

Sca

le)

mea

surin

gse

ven

varia

bles

Item

sra

ted

depe

ndin

gon

varia

ble

bein

gm

easu

red,

from

1–5,

1–6

or1–

7

Ran

ging

from

a=

0.70

toa

=0.

92

Con

stru

ctan

din

tern

alco

nsis

tenc

y



rigor (3/5): two had in-depth discussion of rigor and one

included a brief discussion on measures and strategies

used to ensure rigor.

Analytical findings

Twenty-one factors influencing nurse managers� intent

to stay or leave were identified and synthesized into

three overall categories of organizational (institu-

tional), role (position) and personal (individual) fac-

tors. For this study, organizational factors were

defined as variables within the organization�s power to

change or influence and that could potentially influ-

ence the nurse manager�s work-life. Role or position

factors were defined as variables inherent to nurse

manager roles. Personal or individual factors were

defined as important to the individual nurse managers

because of their own personal beliefs, personal life,

and life experience. Table 5 provides a summary of all

factors and significance of the findings reported to

Table 3Characteristics of qualitative studies included

Reference DesignSubjects/sample/

settingFramework/justification Data collection Rigor

AmericanOrganization ofNurse Executives(1994)

Interviews Nurse managersn = 340New York,Philadelphia, Illinois,Florida, USA

40% of previouslysurveyed nursemanagers who hadindicated theywould leave theirposition within6 months wouldnot return to amanagementposition

Focus groups Not reported

Mackoff and Triolo(2008a)

Interviews Nurse managersn = 30In six hospital settingsin the USA

Short tenure ofnurse managerssuggests a needfor a new model ofengagement thattranslates intolongevity

Individual interviewsguided by theNurseManagement

EngagementQuestionnaireGratton andGhoshol (2005),Cooperrider (1990)

Questionnairetested by pilotgroup of long-standingnurse managers

Mackoff and Triolo(2008b)

Parsons andStonestreet (2003)

Interviews Nurse managersn = 28Five hospitalsSouthwest USA.Mixture of largetertiary and outlyingfacilities

EcologicalFramework, usingthe Health-Promoting Organizations Model(Parsons, 1999).

Results indented toguide executivestrategies andinterventions.

Open-ended,data-generatingquestions

Data reviewedrepeatedly forthemes, ranked inorder of dominance(most frequently toleast frequentlyindentified theme),

which werevalidated withparticipants.

Provost (2006) Interviews, surveys Service managersand potentialmanagers

n = 27Four urban acute-caresites of VancouverCostal Health, BritishColumbia, Canada

Urgent need to planfor leadershipsuccession

Action research Survey questionspiloted

Two groups, foursites

Strelioff (2007) Focus groups,individual Interviews

Patient caremanagers andassistant patientcare managers

n = 6Operating nursesfrom acute-carefacilities in Calgary,Alberta, Canada

High nurse managervacancy rate inCalgary OperatingRooms

Individual interviewsFocus groups

Questions pilotedUse of graphic artistto corroborate data

Participantsvalidated data

Identification of bias

P. Brown et al.


influence the nurse managers� intention to leave or

stay.

Some factors were conceptualized as unique to one

category, while others were conceptualized to influence

nurse managers� intent to stay or leave in more than one

category. For example, an administrative system was

conceptualized as an organizational factor and

empowerment was categorized in both organizational

and role factors, while job satisfaction encompassed

organizational, role and personal factors (Figure 2).

Organizational factors

In most of the studies, organizational factors were

fundamental to the retention of nurse managers. A total

of 12 factors were identified in 11 different studies

(American Organization of Nurse Executives 1994,

Scott 2002, Parsons & Stonestreet 2003, Provost 2006,

Mitchell 2007, Skytt et al. 2007, Strelioff 2007, Way

et al. 2007, Laschinger et al. 2008, Mackoff & Triolo

2008a,b). The most common organizational factor

influencing retention was organizational culture and

values (Parsons & Stonestreet 2003, Mitchell 2007,

Strelioff 2007, Way et al. 2007, Mackoff & Triolo

2008a,b). Specific aspects of organizational cultures and

values related to lifelong learning, meaningful profes-

sional development, respect for employees, administra-

tive philosophy and the value that the organization

placed on striving for excellence.

Understandably, organizations have an indispensable

relationship with nurse managers. Mitchell (2007) re-

ported that organizational commitment, an attitudinal

state when an individual identifies with the organiza-

tion�s values, was negatively correlated with intent to

leave and was the greatest predictor of manager�s intent

to leave. Way et al. (2007) tested organizational com-

mitment and intent to stay and found the level of trust

in employer and job satisfaction of nurse managers

explained 47% of the variance in intent to stay in the

year 2000. The role of trust, however, was inconsistent

as a result of its strong relationship with emotional

climate over time, as it failed to be significant in 2002,

with 52% of the variance explained by emotional cli-

mate and job satisfaction. Other organizational factors

included adequacy of human and financial resources


Parsons & Stonestreet 2003, Strelioff 2007) and effec-

tive administrative systems (Parsons & Stonestreet

2003, Skytt et al. 2007, Strelioff 2007).

In general, leadership behaviours are essential in

health-care organizations. Laschinger et al. (2008)

found that when senior leaders were perceived by

middle and front-line managers to be transformational

leaders, they reported lower turnover intentions. This

supports Strelioff�s (2007) qualitative study finding of

leadership behaviour or style being important to nurse

managers, with transformational leadership being the

preferred style. Adequate and appropriate feedback,

support and communication between senior manage-

ment, nurse managers, and among teams in general

were identified as influential to both organizational and

role factors (American Organization of Nurse Execu-

tives 1994, Scott 2002, Parsons & Stonestreet 2003,

Skytt et al. 2007, Strelioff 2007). When nurse managers

felt valued and received what they generally perceived

to be adequate feedback, they had greater intentions to

stay; however, this was not always statistically signifi-

cant (Scott 2002). Lack of recognition was reported to

result in a sense of being devalued, and the manager role

in general was felt not to be valued (Parsons &

Stonestreet 2003).

Role factors

Several organizational factors mentioned above are

also connected to role factors: feedback, support,

communication and leadership are aspects that help

define the managerial role but are defined within orga-

nizations. Lack of support for the nurse manager was

related to nurse managers� intentions to leave their

positions (American Organization of Nurse Executives

Table 4Summary of quality assessment of the quantitative studies

Criteria

Studies(n = 8)

Yes No

DesignProspective studies 7 1Used probability sampling 0 8

SampleAppropriate/justified sample size 3 5Sample drawn from more than one site 8 0Anonymity protected 6 6Response rate >60% 2 6

MeasurementFactor measured reliably 5 3Factor measured using a valid instrument 6 2Dependent variable measured using a valid instrument 4 4Internal consistency of scale >70% 4 4Theoretical model/framework 6 2

Statistical analysisCorrelations analysed when multiple factors studied 5 3Management of outliners managed 1 7



Tab

le5

Fac

tors

influ

enci

ngnu

rse

man

ager

inte

ntio

nto

stay

Fac

tors

Fin

ding

sS

ourc

e

The

me

1:O

rgan

izat

iona

lFac

tors

Val

ues/

cultu

reO

pera

tiona

lized

asse

vera

lfac

tors

,in

clud

ing

emot

iona

lclim

ate

and

prac

tice

issu

es.

Sig

nific

ant

posi

tive

perc

eptio

nof

cultu

reco

rrel

ated

with

com

mitm

ent

and

inte

ntto

stay

.W

ayet

al.

(200

7)

Org

aniz

atio

nalc

ultu

rew

asth

em

ain

focu

sof

both

stud

ies.

Fiv

eke

yfa

ctor

sof

orga

niza

tiona

lcul

ture

wer

ede

fined

and

10si

gnat

ure

beha

viou

rsin

the

cultu

reof

enga

gem

ent

inre

latio

nto

nurs

em

anag

erre

tent

ion

wer

ein

dica

ted.

Mac

koff

and

Trio

lo(2

008a

,b)

Sig

nific

ant

rela

tions

hip

Mitc

hell

(200

7)T

hese

cond

mos

tpr

eval

ent

them

ew

asad

min

istr

ativ

eph

iloso

phy

Par

sons

and

Sto

nest

reet

(200

3)C

ultu

reof

lear

ning

impo

rtan

tS

trel

ioff

(200

7)R

esou

rces

(hum

anan

d/or

fisca

l)P

rinci

palr

easo

nfo

rjo

bdi

ssat

isfa

ctio

nA

mer

ican

Org

aniz

atio

nof

Nur

seE

xecu

tives

(199

4)M

anag

ers

expr

esse

dbu

rden

ofde

alin

gw

ithin

adeq

uate

reso

urce

sP

arso

nsan

dS

tone

stre

et(2

003)

Lack

ofre

sour

ces

adde

dto

wor

kloa

dan

dro

leov

erlo

adS

trel

ioff

(200

7)C

omm

unic

atio

n*O

verr

each

ing

them

eP

arso

nsan

dS

tone

stre

et(2

003)

Tea

mco

mm

unic

atio

nst

rate

gies

pivo

tal

Str

elio

ff(2

007)

Adm

inis

trat

ion

syst

ems

Nee

dfo

ref

fect

ive

reso

urce

man

agem

ent,

orie

ntat

ion,

prof

essi

onal

deve

lopm

ent

and

adeq

uate

com

pens

atio

nP

arso

nsan

dS

tone

stre

et(2

003)

Inad

equa

teco

mpe

nsat

ion

and

unju

stfo

rth

eam

ount

ofre

spon

sibi

lity

and

acco

unta

bilit

yS

trel

ioff

(200

7)Le

ader

ship

beha

viou

r*Le

ader

ship

styl

eof

seni

orm

anag

emen

tne

gativ

ely

corr

elat

edLa

schi

nger

etal

.(2

008)

Lead

ersh

ipst

yle/

beha

viou

rpi

vota

l.T

rans

form

atio

nall

eade

rshi

ppr

efer

red

Str

elio

ff(2

007)

Ver

tical

/hor

izon

talv

iole

nce

Rem

ains

anis

sue,

felt

supp

ort

inad

equa

teby

allp

rofe

ssio

nala

ndad

min

istr

ativ

ele

vels

Str

elio

ff(2

007)

Suc

cess

ion

plan

ning

*H

ascr

eate

da

gap

betw

een

need

for

qual

ified

cand

idat

esan

dla

ckof

prep

ared

cand

idat

esS

trel

ioff

(200

7)F

eedb

ack*

/sup

port

*/fe

elva

lued

*O

ften

lack

ing

Am

eric

anO

rgan

izat

ion

ofN

urse

Exe

cutiv

es(1

994)

Get

ting

feed

back

very

impo

rtan

tP

arso

nsan

dS

tone

stre

et(2

003)

Lack

ofre

cogn

ition

resu

lted

ina

sens

eof

bein

gde

valu

ed,

impo

rtan

tto

build

netw

ork

ofsu

ppor

t,an

dm

ento

ring

was

impo

rtan

tS

trel

ioff

(200

7)

Com

pens

atio

nre

late

dto

perc

eive

dor

gani

zatio

nals

uppo

rt.

Do

not

feel

the

man

ager

role

isva

lued

Pro

vost

(200

6)P

ositi

vely

sign

ifica

ntre

latio

nshi

pw

ithin

tent

tost

ayS

cott

(200

2)S

uppo

rtw

asde

fined

aspe

rson

al,

emot

iona

land

stra

tegi

c.A

lthou

ghsu

ppor

tfr

omm

anag

emen

tw

asim

port

ant,

itw

asdi

fficu

ltto

get;

expl

icit

feed

back

onor

gani

zatio

nalg

oals

was

not

clea

rS

kytt

etal

.(2

007)

Org

aniz

atio

nal

com

mitm

ent

Sig

nific

ant

posi

tive

corr

elat

ion.

Gre

ates

tpr

edic

tor

ofin

tent

tole

ave.

Mitc

hell

(200

7)A

ligni

ngin

divi

dual

goal

san

dor

gani

zatio

nalg

oals

and

valu

esis

stro

ngly

linke

dto

enga

gem

ent.

As

wel

las

com

mitm

ent

toca

ring

for

and

cont

ribut

ing

toth

ene

xtge

nera

tion

asle

ader

sis

rela

ted

tom

anag

erre

tent

ion

Mac

koff

and

Trio

lo(2

008b

)

Em

pow

erm

ent*

Impo

rtan

tto

beal

low

edto

use

own

judg

men

t,no

tbe

mic

rom

anag

ed,

begi

ven

oppo

rtun

ities

toha

ndle

thin

gson

thei

row

nP

arso

nsan

dS

tone

stre

et(2

003)

Was

also

oper

atio

naliz

edas

part

ofor

gani

zatio

nalc

ultu

re.

Em

pow

erm

ent

asa

fact

orw

assi

gnifi

cant

posi

tive

corr

elat

ion

with

inte

ntto

stay

Way

etal

.(2

007)

Tru

stin

empl

oyer

sT

este

dtr

ust

ason

e-tw

opr

edic

tive

elem

ents

ofin

tent

tost

ayin

rela

tion

toor

gani

zatio

nalc

ultu

re.

Tru

stis

ansi

gnifi

cant

posi

tive

corr

elat

ion

with

inte

ntto

stay

,bu

tm

aybe

due

with

emot

iona

lclim

ate

over

time.

Way

etal

.(2

007)

The

me

2:R

ole

Fac

tors

Rol

eex

pect

atio

nsE

xpec

tatio

nsun

clea

r,m

ore

impl

ied

than

clea

rlyde

fined

Pro

vost

(200

6)A

utho

rity

and

man

date

not

clea

rS

kytt

etal

.(2

007)

No

cong

ruen

ceam

ong

man

ager

sre

gard

ing

com

pete

ncie

sS

trel

ioff

(200

7)S

uppo

rt*

Ofte

nla

ckin

gA

mer

ican

Org

aniz

atio

nof

Nur

seE

xecu

tives

(199

4)

P. Brown et al.


Tab

le5

Con

tinue

d

Fac

tors

Fin

ding

sS

ourc

e

Sup

port

for

recu

rren

ted

ucat

ion

and

in-s

ervi

cetr

aini

ngw

asne

eded

Sky

ttet

al.

(200

7)N

otal

lpar

ticip

ants

belie

ved

effe

ctiv

em

ento

ring/

supp

ort

exis

tsS

trel

ioff

(200

7)A

bilit

yof

man

ager

tolis

ten

and

prov

ide

guid

ance

Par

sons

and

Sto

nest

reet

(200

3)

Em

pow

erm

ent*

Hav

ing

the

pow

erto

effe

ctch

ange

aro

lesa

tisfie

rA

mer

ican

Org

aniz

atio

nof

Nur

seE

xecu

tives

(199

4)A

son

eof

the

five

key

elem

ents

ofor

gani

zatio

nalc

ultu

re,

the

cultu

reof

rega

rdem

pow

ers

nurs

ing

prac

tice,

whi

chis

linke

dto

rete

ntio

nM

acko

ffan

dT

riolo

(200

8b)

Impo

rtan

tto

beal

low

edto

use

own

judg

men

t,no

tbe

mic

rom

anag

ed,

begi

ven

oppo

rtun

ities

toha

ndle

thin

gson

thei

row

nP

arso

nsan

dS

tone

stre

et(2

003)

Nee

dto

feel

they

mak

ea

diffe

renc

ean

dha

veau

tono

my

for

deci

sion

mak

ing

Pro

vost

(200

6)W

ork/

life

bala

nce

Suc

cess

fulp

erso

nalp

ract

ices

toat

tain

bala

nce

(i.e.

limit

hour

sw

orke

d),

exer

cise

,ac

cept

cann

otdo

anym

ore

Par

sons

and

Sto

nest

reet

(200

3)F

ound

tobe

the

mos

tsi

gnifi

cant

fact

orE

xpre

ssed

desi

reto

impr

ove

wor

k-lif

eba

lanc

eS

trel

ioff

(200

7)

Spa

nof

cont

rol

Incr

ease

dsp

anof

cont

rolp

ositi

vely

corr

elat

edw

ithin

tent

tole

ave

Lasc

hing

eret

al.

(200

8)T

oola

rge.

Cru

cial

elem

ent

inm

anag

erw

orkl

oad

Pro

vost

(200

6)Le

ader

ship

beha

vior

*Le

ader

ship

styl

eof

seni

orm

anag

emen

tne

gativ

ely

corr

elat

edLa

schi

nger

etal

.(2

008)

Lead

ersh

ipst

yle/

beha

vior

impo

rtan

t.T

rans

form

atio

nall

eade

rshi

ppr

efer

red

Str

elio

ff(2

007)

Fee

dbac

k*G

ettin

gfe

edba

ckve

ryim

port

ant

Par

sons

and

Sto

nest

reet

(200

3)N

otst

atis

tical

lysi

gnifi

cant

beca

use

ofsm

alln

umbe

rs;

the

type

offe

edba

ckw

asre

late

dto

feel

ing

valu

edS

cott

(200

2)S

taff

deve

lopm

ent

impo

rtan

tS

trel

ioff

(200

7)C

omm

unic

atio

n*O

ver-

reac

hing

them

eP

arso

nsan

dS

tone

stre

et(2

003)

Mul

tiple

team

com

mun

icat

ion

stra

tegi

espi

vota

lS

trel

ioff

(200

7)Q

ualit

yof

patie

ntca

reM

anag

ers

repo

rted

havi

ngbo

ttom

line

for

leav

ing

–w

hen

coul

dno

long

eren

sure

qual

ityof

care

Par

sons

and

Sto

nest

reet

(200

3)C

ultu

reof

exce

llenc

e,se

enas

clea

rco

mm

unic

atio

nof

high

stan

dard

s,w

asdi

rect

lyco

nnec

ted

tonu

rse

man

ager

enga

gem

ent.

Mac

koff

and

Trio

lo(2

008b

)

Suc

cess

ion

plan

ning

*C

ritic

alin

succ

essf

ully

reta

inin

gnu

rse

man

ager

sS

trel

ioff

(200

7)C

ritic

alin

succ

essf

ully

reta

inin

gnu

rse

man

ager

sP

rovo

st(2

006)

The

me

3:P

erso

nalF

acto

rsF

eelv

alue

d*R

ecog

nitio

nfr

ompa

tient

s,st

aff,

phys

icia

nsan

dup

per

man

agem

ent

Am

eric

anO

rgan

izat

ion

ofN

urse

Exe

cutiv

es(1

994)

Em

ploy

ees

belie

fsab

out

how

muc

hor

gani

zatio

nsva

lue

thei

rco

ntrib

utio

nan

dw

ellb

eing

are

linke

dto

posi

tive

emot

iona

lcom

mitm

ent

and

high

leve

lsof

perf

orm

ance

Mac

koff

and

Trio

lo(2

008a

,b)

Do

not

feel

the

man

ager

role

isva

lued

Pro

vost

(200

6)P

ositi

vely

sign

ifica

ntre

latio

nshi

pw

ithin

tent

tost

ayS

cott

(200

2)K

insh

ip/fa

mily

Mos

tim

port

ant

fact

orpr

edic

tor

for

turn

over

Cav

anag

h(1

990)

Job

qual

ifica

tions

Sec

ond

mos

tim

port

ant

fact

orfo

rst

ayin

gJo

hnst

one

(200

3)Id

entif

ied

10si

gnat

ure

beha

viou

rsth

atre

veal

edth

eex

perie

nces

,ca

pabi

litie

san

dat

trib

utes

oflo

ng-t

erm

indi

vidu

alnu

rse

man

ager

sM

acko

ffan

dT

riolo

(200

8a)

Ava

riety

ofin

divi

dual

attr

ibut

esin

clud

ing

pers

onal

ity,

tem

pera

men

t,ne

eds,

mot

ives

and

valu

es,

mor

alpu

rpos

ere

quire

dS

trel

ioff

(200

7)

Per

sona

lval

ues

No

sign

ifica

ntre

latio

nshi

pM

itche

ll(2

007)



1994, Parsons & Stonestreet 2003, Provost 2006, Skytt

et al. 2007, Strelioff 2007). Several studies also identi-

fied empowerment or lack of empowerment to be re-

lated to job longevity, intent to leave or retention


Parsons & Stonestreet 2003, Provost 2006, Mackoff &

Triolo 2008a). Nurse managers felt they needed to have

the power to effect change, use their own judgment and

be given opportunities to handle difficult situations on

their own.

A common factor specific to manager positions was

role expectations (Provost 2006, Skytt et al. 2007,

Strelioff 2007). In exploring the reasons why nurse

managers left, Skytt et al. (2007) found that role con-

ditions and expectations were too difficult to combine

and noted that job satisfaction increased after resigna-

tion. In addition, difficulty in combining responsibili-

ties, and lack of enough time to complete tasks specific

to the nurse manager�s role resulted in work/life

imbalance, which was a recurrent theme in the studies

of Strelioff (2007) and Parsons and Stonestreet (2003).

Participants in both these studies identified the need to

limit hours worked, accept when they had done enough

and find outside interests as important strategies for

improving work/life balance. Laschinger et al. (2008)

and Provost (2006) also identified that span of control

was associated with intent to leave and was a crucial

element in manager workload.Tab

le5

Con

tinue

d

Fac

tors

Fin

ding

sS

ourc

e

Job

satis

fact

ion�

Ran

ked

mos

tim

port

ant

reas

onfo

rst

ayin

gJo

hnst

one

(200

3)P

ositi

vely

sign

ifica

ntre

latio

nshi

pw

ithin

tent

tost

ayLa

schi

nger

etal

.(2

008)

No

rela

tions

hip

betw

een

job

satis

fact

ion

and

long

evity

Litte

ll(1

995)

Rel

ated

tow

ork

load

,ad

min

istr

ativ

esu

ppor

t,co

mpe

nsat

ion,

perc

eive

dor

gani

zatio

nals

uppo

rt,

abili

tyto

affe

ctch

ange

and

auto

nom

yP

rovo

st(2

006)

Job

satis

fact

ion

incr

ease

dw

hen

nurs

em

anag

erle

ftth

ero

leof

man

ager

Sky

ttet

al.

(200

7)Jo

bsa

tisfa

ctio

nw

asa

varia

ble

test

edbu

tre

sults

wer

eno

tsu

ppor

ted.

Ass

umed

tono

tbe

sign

ifica

ntto

turn

over

rate

s.C

avan

agh

(199

0)

Was

ado

min

ant

pred

icto

rin

the

inte

nt-t

o-st

aym

odel

,bu

tw

aspa

rtia

llym

edia

ted

bytr

ust

and

emot

iona

lclim

ate.

Way

etal

.(2

007)

*The

fact

orap

pear

sin

mor

eth

anon

eca

tego

ry.

�T

hefa

ctor

appe

ars

inal

lthr

eeca

tego

ries.

Organizational factors

Values/cultureHuman & fiscal resources

AdministrationOrganizational commitment

EmpowermentLeadershipSupportFeedbackCommunicationSuccessionplanningViolence

Job satisfaction

Feel valuedtrust

Role factors

Span of controlExpectationsQuality of care

Worklife balance

Personal factors

Kinship & familyJob qualifications

Personal values

Manager’s intent to stay

Figure 2Factors influencing nurse managers� intention to stay.

P. Brown et al.


Parsons and Stonestreet (2003) and Mackoff and

Triolo (2008a,b) found the ability to ensure quality of

care was an important retention factor. Some respon-

dents reported the inability to ensure quality of care as

their bottom line for leaving. Succession planning was

also reported as critical in successfully retaining nurse

managers, in Strelioff�s (2007) and Provost�s (2006)

qualitative studies.

Personal factors

Eight studies identified four personal factors that related

to nurse manager retention. The most frequently cited

personal factor was the importance of feeling valued by

the organization, peers and staff. How much the orga-

nization valued their contributions was linked to emo-

tional commitment and high levels of performance


Scott 2002, Provost 2006, Mackoff & Triolo 2008a,b).

Cavanagh�s (1990) study found kinship/family com-

mitments such as childbirth and early-life caring needs,

spousal commitments, caring for parents or other rela-

tives and required changes in work were the most sig-

nificant predictors of turnover. In contrast, Mitchell

(2007) did not find a significant relationship between

personal values and intent to leave; however, the

interaction between personal and organizational values,

described as organizational commitment, was related to

managers� intentions to leave.

Strelioff (2007) identified traits or distinguishing

characteristics and skills that influence the behaviour of

an individual that make success in a managerial role

more likely. These included personality, temperament,

needs, motives and values, integrity, sense of moral

purpose and emotional maturity. Similarly, Mackoff

and Triolo (2008a,b) identified a set of signature

behaviours that, if held by nurse managers, increased

the likelihood of staying in a managerial position. One

such element was ardour, an emotional connection with

work and the organization that goes beyond job satis-

faction. Another dispositional element was reported in

Johnstone�s (2003) study where nurse managers indi-

cated they would stay because they felt the position

suited their qualifications and skills. Johnstone also

found that job satisfaction, in combination with quali-

fications and skill, accounted for 70% of nurse man-

agers� intentions to stay in their positions.

Job satisfaction, however, resulted from a combina-

tion of organizational, role and personal factors. Six of

the 14 studies identified the over-arching variable of job

satisfaction as a significant factor (Cavanagh 1990,

Littell 1995, Johnstone 2003, Provost 2006, Way et al.

2007, Laschinger et al. 2008). Job satisfaction was

identified by Laschinger et al. (2008) and Way et al.

(2007) to be positively correlated with nurse managers�intent to stay. Provost�s (2006) study reported that

nurse managers� job satisfaction was related to work-

load, administrative support, compensation, perceived

organizational support, ability to affect change, auton-

omy, organizational structure and support. However,

Littell�s (1995) study found no significant relationship

between longevity and job satisfaction but found that

nurse managers in their positions for a shorter length of

time experienced greater satisfaction. Cavanagh (1990)

tested job satisfaction as one of 11 predictors of turn-

over but this was not reported in their results.

Discussion

From the small number of studies retrieved, it is evident

that compared with the published literature on staff

nurse retention, little research has focused on nurse

manager retention. Clearly, nurse managers� intentions

to leave or stay are formed through a complex inter-

action of several factors at organizational, managerial

role and personal levels. Although the nurse manager

shortages that exist in various countries are a significant

concern, there is no clear evidence of factors that

influence managers� retention. This is important to

advancing knowledge of possible interventions that

could minimize nurse manager shortages in the future.

Several qualitative studies offered an exploration of

factors that were important to nurse managers, and

some of these factors were validated in correlational

studies. Taken as a whole, the factors identified from

the literature do not yet readily identify development of

retention interventions at this time. To understand the

complexity of issues related to nurse manager retention

it is important to consider how factors are interrelated

with one other from all three categories.

Many of the personal and role factors identified in the

literature are actually related to the organization�s cul-

ture and values, leadership styles and support for the

nurse manager role. Satisfaction with the manager role

leading to intention to stay or leave may also be related

to individual factors such as suitability of the individ-

ual�s qualifications and skills, the individual�s personal

values and their congruence with the role. Organiza-

tional values/culture and beliefs around the value of

leadership roles may determine how much support is

provided by the organization. The organization�s ability

to convey to the individual nurse manager a sense that

he/she is a valued employee with congruence between

its actions and its words is largely dependent on the



organization�s culture, values and the leadership style of

senior administration, a recommendation consistent

with Lee and Cummings (2008) findings for factors

influencing job satisfaction of nurse managers. The

organization�s ability to do this may be related to fac-

tors such as inadequate financial resources that result in

fewer managers, larger span of control and budgets that

do not allow for adequate resources to ensure quality of

patient care. Suitable candidate qualifications and skills

for the role were identified in this literature review as

being a significant retention factor. Organizations often

recruit nurse managers from the front-line clinical staff

who may be unprepared for many of the role demands

such as fiscal responsibilities and human resource issues.

Without adequate orientation and training for the

manager role, these candidates may feel abandoned

and inadequate when dealing with these issues. This

emphasizes the need for organizations to be committed

to dedicating sufficient human and fiscal resources to

ensure adequate training and support.

A good understanding of nurse managers� retention

issues and the development of retention strategies for

nurse managers will become increasingly important over

the next 10–15 years as the Baby Boomer generation

retires. This anticipated mass exit from the workforce

will contribute to the nursing shortage and leave a gap in

nursing clinical knowledge as well as in organizational

and managerial knowledge. This will become a critical

issue if we are not successful in attracting nurse managers

under the age of 40 years, as Laschinger et al.�s (2008)

profile of nursing management in Canadian hospitals

suggests. Effective, consistent nurse manager leadership

is required to retain front-line nurses and maintain

healthy workplace environments that ensure front-line

nurses are able to deliver quality patient care in an

increasingly complex health-care environment faced

with many challenges (Kleinman 2004b, Cummings

et al. 2010). Therefore, it is imperative that nursing

conduct quality studies focus specifically on the issue of

nurse manager retention, and that organizations develop

and implement evidence-based strategies to promote

retention and succession planning for nurse managers

(Carriere et al. 2009) that target nurses aged <40 years.

There is some evidence in the literature that organi-

zational interventions can influence the mental health

and work effectiveness of staff nurses (Laschinger &

Havens 1997). In times of transition, organizational

behaviours that support frequent opportunities for

communication, high visibility and verbalized commit-

ment to quality of patient care help nurse managers

accept and facilitate change (Knox & Irving 1997,

Cummings 2004). A systematic review of factors con-

tributing to nursing leadership suggests that leadership

qualities can be developed through specific and dedi-

cated educational activities (Cummings et al. 2008).

Strong leadership is essential for healthy health-care

work environments, for health-care providers and for

ensuring quality patient care. Future research should

examine the effectiveness of organizational interven-

tions in retaining nurse managers.

A more comprehensive understanding of the factors

related to the retention of nurse managers is of interest

to administrators responsible for the development of

strategies to improve retention. We need to better

understand the learning needs of new managers to aid in

the development of orientation and mentorship pro-

grammes, and to determine the supports and strategies

required over time to keep nurse managers in manage-

rial positions. This can be accomplished by conducting

longitudinal studies that include larger populations in a

wide range of practice settings. Additional quantitative

studies that examine the issues from comprehensive and

comparative perspectives are needed. Examining how

organizational, personal (individual) and position (role)

factors are related to each other and determining which

are more likely to lead to a decision to leave or stay

would add to the body of knowledge in nursing man-

agement. A more complete understanding of the issues

would enable organizations to determine what support

is needed to help qualified and experienced nurses

transitioning from the front lines to managerial posi-

tions.

Limitations

The intention of this systematic review was to examine

the available research-related factors affecting the

retention of nurse managers. Details of the reporting

structure for participants in the studies included were

not well described in the literature and were compli-

cated by the various titles used (patient service manager,

nurse manager, middle manager, nurse leader, senior

manager, clinical manager, front-line manager and pa-

tient care manager). The definition of a nurse manager

was not well defined in most studies, so it is possible

that some managers in some studies did not meet the

definition of middle or front-line managers used in this

study.

Conclusion

In this review, 13 studies (eight quantitative and five

qualitative) that examined nurse manager retention

were examined. These factors could be categorized into

P. Brown et al.


three themes: organizational, role (position) and indi-

vidual (personal). The results of this literature search

show that factors that influence the nurse manager�sintentions to leave or stay in a managerial position are

multifactoral, not well understood and have not been

studied across various practice settings. Furthermore,

the relationships among and between several factors

that are each known to influence nurse managers�decisions to stay or leave a managerial position are

complex. Further studies are needed to develop the in-

ter-relationship of factors and themes by concurrently

analysing factors identified by nurse managers to be

important considerations when determining their

intention to stay in or leave their current position.

Additional comprehensive, quantitative studies are re-

quired to confirm and expand on the findings of this

literature review, as has been done in the staff nurse

literature (Boyle et al. 1999, Tourangeau & Cranley

2006). The knowledge gained from future studies that

result in the development of theoretical concepts and

theories will add the nursing body of knowledge in the

area of nurse manager retention.

Source of funding

Social Sciences and Humanities Research Council of

Canada (SSHRC), Quality Work Environment

(QWEST) Study.

Ethical approval

Health Research Ethics Board, University of Alberta,

April 2008.

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