Effects of organizational justice, work engagement, and nurses' perception of care quality on turnover intention among newly licensed registered nurses: A structural equation modelling approach.

AIMS AND OBJECTIVES: To investigate turnover intention among newly licensed registered nurses and to clarify the impact pathways of organizational justice, work engagement, and nurses' perception of care quality on turnover intention. BACKGROUND: Nurse shortage is an ongoing and urgent issue worldwide, in which nurse turnover could exacerbate the situation. Newly licensed registered nurses will become the main nursing workforce in the future; however, previous studies have not revealed the specific reasons underlying their turnover intentions. DESIGN: A descriptive, cross-sectional design. METHODS: A total of 569 newly licensed registered nurses undertaking direct care were recruited from thirteen hospitals from October to November 2018 across Beijing, China. Based on the job demands-resources model, we advanced a hypothetical model, linking the paths between organizational justice, work engagement, nurses' perception of care quality, and turnover intention. Structural equation modelling was used to examine the hypothetical model. The study adhered to the STROBE statement for observational studies. RESULTS: In total, 22.3% of newly licensed registered nurses had a high turnover intention. The final model had an acceptable fit and could explain 58% of the variance in turnover intention. The organizational justice was directly related to high work engagement, great nurses' perception of care quality, and low turnover intention. Additionally, organizational justice also had indirect effects on great nurses' perception of care quality and low turnover intention, which were partially mediated by work engagement. However, the effect of nurses' perception of care quality on turnover intention was not significant. CONCLUSION: The improvement of organizational justice could enhance work engagement, and nurses' perception of care quality, and reduce turnover intention, which is crucial to improving care quality and addressing the shortage of nurses. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence for policymakers and hospital administrators to take targeted measures to enhance work engagement, foster high-quality care and create better defenses against losing nurses.