The mediating role of job satisfaction related to nurse-nurse collaboration and turnover intention

The increasing need for healthcare services due to sociodemographic and epidemiological reasons causes has caused an increase in the need for nurses in some countries [1]. The World Health Organization has estimated that the global nurse shortage will be 5.7 million by 2030 [2].

In many developing and resource-poor countries, qualified nurses migrate to developed countries for different reasons [3]. There is also evidence that nurses’ intentions to leave the profession are increasing in many countries [4]. Nurses leaving their jobs and leaving the profession causes an increase in the nurse staff turnover rate. Excessive nursing turnover has a disruptive effect on the organizational process [5] and presents a financial burden due to hiring and training new nursing staff [6]. For these reasons, it is very important to determine the factors affecting nurses’ intention to leave.

Some research results have shown that nurse-nurse collaboration reduces nurses’ intention to leave [7, 8]. Collaboration in nursing is defined as “a relational process between colleagues who share similar professional values, philosophy, socialization, and experience.” (pp.376–377) [9]. Collaboration among nurses reduces medical errors, thereby enhancing patient safety and the quality of care [10, 11]. Collaboration between healthcare professionals strengthens the healthcare system by supporting healthcare team members to optimize their skills [12]. Additionally, nurse-nurse collaboration increases nurses’ job satisfaction [13, 14].

“Job satisfaction is the pleasurable or positive emotional state resulting from the appraisal of one job or job experiences” (p.1300) [15]. The level of job satisfaction of nurses is one of the determinants of staff retention, which has consequences for the individual and for healthcare institutions [16, 17]. There is a need to determine what factors increase the job satisfaction of nurses.

Many studies have shown that as job satisfaction increases, intention to leave decreases [18‐20]. However, there is not enough evidence in the literature to reveal the mediating role of job satisfaction on the effect of nurse-nurse collaboration on turnover intention. This makes the research an important one that adds an innovative perspective to the existing literature. It is thought that providing evidence on the factors that reduce nurses’ intention to quit will support the development of policies that will reduce nurse turnover. In addition, the study’s results pave the way for new research that will reveal the effects of nurse-nurse collaboration.

Intention to leave is a multi-stage process that begins with psychological reactions and may lead to the decision to leave the job [21]. The turnover intention is a significant predictor of actual turnover behavior and is a key factor contributing to nursing staff shortages [22]. This study hypothesizes that nurse-nurse collaboration and job satisfaction can reduce turnover intentions.

The following questions are addressed:

Q1. Does nurse-nurse collaboration affect job satisfaction?

Q2. Does job satisfaction affect intention to leave?

Q3. Does job satisfaction have a mediating role on nurse-nurse collaboration and intention to leave?

The purpose of this study was to test the hypothesis that nurse-nurse collaboration and job satisfaction can reduce turnover intentions. In this study, it was determined that female nurses had more nurse-nurse collaboration behavior than male nurses. Şahin et al., (2023) found that nurse-nurse collaboration among Turkish nurses did not vary according to gender [12]. This difference may be due to factors such as the conditions in the work environment and the participant profile. These findings provide a new perspective to the existing literature by showing that nurse-nurse collaboration may differ according to gender. Lemetti et al. (2021) found that determined that nurses’ nurse-nurse collaboration scores did not vary by gender in Finland [31]. It appears that our results are different from those of other studies. This may be due to differences in cultural contexts, social perceptions of gender roles, or egalitarian practices in work environments. The majority of nurses in Turkey are female, and the related perceptual differences may have contributed to these findings. Also, the reason why the results differ in this way may be because of different mediator variables. More studies are needed to determine whether male nurses are less resilient than female nurses, as interventions specifically designed to help increase the resilience of male nurses may be required. These research results may help us better understand how gender impacts the nursing profession and identify which strategies may be most effective for increasing the resilience of male nurses.

Those who chose the nursing profession voluntarily showed higher levels of nurse-nurse cooperation behavior than those who did not choose the nursing profession voluntarily. Collaboration between nurses contributes to the professional development of nurses [32]. Nurses who choose their profession voluntarily may turn to nurse-nurse collaboration to improve themselves professionally.

We found that married nurses had higher job satisfaction levels than single nurses. Haji Matarsat et al. (2021), determined that married nurses had higher job satisfaction than single nurses in Brunei [33]. In their study in Iran, Atefi et al. (2015) determined that married people have higher job satisfaction than unmarried people [34]. Our research support the results of other research in the literature.

Results showed that those who chose the nursing profession unwillingly had a higher level of intention to quit than those who chose the nursing profession voluntarily. Making a choice voluntarily is an indication of internal motivation. As a result of internal motivation, there is an increase in interest and pleasure in business activities. Internal motivation is the key to retention in the workplace because as internal motivation increases, interest and commitment to work-life increase [35]. In addition, in this research, it was determined that the job satisfaction level of those who chose the nursing profession voluntarily was higher than those who chose the nursing profession involuntarily. The reason for this situation may be due to high internal satisfaction.

The current study showed that nurse-nurse collaboration positively affects job satisfaction. Karadas et al. (2022) determined that nurse-nurse collaboration increased job satisfaction in their study on nurses in Turkey [14]. Ylitörmänen et al. (2019) determined in a study conducted with the participation of nurses in Finland and Norway that nurse-nurse collaboration positively affects job satisfaction [13]. A supportive work environment increases nurses’ job satisfaction while also strengthening team commitment. These results once again reveal the importance of policies that encourage collaboration among healthcare professionals.

The result of the current study showed that nurse-nurse collaboration negatively affects turnover intention. Ma & Stimpfel (2018) conducted a study on nurses and showed that effective collaboration reduced turnover intention, this result was consistent with the results of our study [8]. Nurse-nurse collaboration is defined as an interpersonal relationship that requires a high level of communication, coordination, problem-solving strategies, collaborative process, and professionalism [7]. In our regression analysis, a strong positive relationship was found between nurse-nurse collaboration and turnover intention. This strong relationship more clearly demonstrates the effect of nurses on reducing turnover intention. Nurses may not want to leave an environment where such positive processes take place.

The current study result showed that job satisfaction negatively affects turnover intention. Regression analysis revealed that there is a strong relationship between job satisfaction and turnover intention and that increasing job satisfaction significantly reduces turnover intention. Zahednezhad et al. (2021) determined in their study on Iranian nurses that there was a negative relationship between job satisfaction and turnover intention [36]. In their study on Jordanian nurses, Salahat & Al-Hamdan (2022) determined that job satisfaction was negatively related to turnover intention [37]. Our findings align with previous studies, possibly because nurses prefer to stay in studies they consider fulfilling.

This study showed that job satisfaction has a mediating role in the effect of nurse-nurse collaboration on turnover intention. Studies showed that nurse-nurse collaboration affects turnover intention [7, 38], and job satisfaction [13, 14, 38]. However, we did not encounter any study in the literature confirming the mediating role of job satisfaction in the relationship between nurse-nurse collaboration and intention to leave. Therefore, this result is the first evidence in the literature on this subject. Improving teamwork among nurses can positively impact patient care and patient safety [10]. Nurse collaboration can prevent errors and balance workload by increasing effective communication and teamwork among nurses [10, 11].

This study explored the mediating role of job satisfaction on the effect of nurse-nurse collaboration an on turnover intention. The results revealed a mediating role of job satisfaction in this relationship. Nurse-nurse collaboration increased job satisfaction. This result shows that improving nurse-nurse collaboration is beneficial for nurses. In addition, nurse-nurse collaboration significantly influences nurses’ intention to stay. This finding reveals that nurse-nurse collaboration benefits not only nurses, but also healthcare organizations.

Nurse-nurse collaboration has been a focus of research in recent years. Since this study is the first to reveal the mediating role of job satisfaction on the effect of nurse-nurse collaboration and on turnover intention, the results will contribute to a broader discussion about this topic. It is hoped that in future studies, investigating the relationship of nurse-nurse collaboration with different and mediator variables will be useful to reveal new relationships. The place of work may be an important variable to explore as it may affect factors such as nurses’ job satisfaction and cooperation.