Date of Award

Spring 2019

Document Type

Open Access Dissertation


College of Nursing

First Advisor

Ronda G. Hughes


Background: The strength and quality of the nursing leader workforce is associated with staff nurse retention and patient outcomes. While leadership turnover is not always negative, there is still uncertainty, loss of program continuity, power shifts within an organization, and significant expense for the organization in recruiting and integrating a new leader.

Purpose: The purpose of this study is to explore intent to leave and turnover experiences of acute care nurse managers, directors, and executives.

Methods: For this nationwide survey, recruitment was done via snowball sampling through state hospital associations and professional organizations across the US with a resulting sample of 2131 participants. Data was collected in an online survey.

Results: Over half of respondents intend to leave their current positions within 5 years, and intention is not different across the three groups. Intent to leave and reasons for leaving differ by type of nurse leader with directors and executives citing retirement as one of the top three reasons for intent to leave (35.3% and 48.4%, respectively) which will result in a permanent loss of nurse leaders from the workforce. Burnout is listed as a reason for managers and directors, but not executives. Career progression is also cited as a top reason in all groups implying a desire to remain in administrative nursing.Differences in education exist with higher-ranking leaders being more likely to hold graduate degrees. Factors analysis for the Nurse Leader Environmental Support Survey revealed three factors associated with intent to leave: congruence with organizational culture, professional vulnerability, and workplace relationships. Nurse managers report the most vulnerability and least congruence with organizational culture both of which are correlated to job satisfaction. Nurse executives are more likely to have experienced involuntary job loss (18.2%) than managers (6.0%) and directors (12.0%). Reasons include termination, coerced resignation, facility closure, or elimination during a restructuring or merger.

Conclusion: These nurse leaders experience turnover and intent to leave differently. Impending retirement and desire for promotion highlight a need for career development and active succession planning. This study has implications for management development and graduate education programs in program development and student recruitment.


© 2019, Deborah Hughes Warden

Included in

Nursing Commons