Person-centred environments and nurses’ turnover intention: examining their relationship using structural equation modelling

BACKGROUND: A supportive practice environment is essential for nurse retention and to enable nurses to provide effective person-centred care. When nurses are prevented from acting according to their professional values, they may experience moral distress, potentially leading to disengagement and increased turnover intention. Although the impact of the practice environment on nurse outcomes is well documented, the pathways linking person-centred aspects of the practice environment to turnover intention remain underexplored. This study aimed to test a theoretical model linking these factors to inform targeted retention efforts.

METHODS: We conducted a cross-sectional study of nurses ( n  = 573) across several acute-care hospitals and nursing homes within a large healthcare organisation. Validated instruments were used to assess key constructs. Model A posited that nurses' prerequisites, the practice environment, and person-centred processes predict the perceived person-centred climate. Model B examined whether person-centred climate influences turnover intention, mediated by moral distress, coolout, and job satisfaction. Structural equation modelling was performed using the lavaan package in R.

RESULTS: Both models showed acceptable fit following theoretically justified modifications (Model A: CFI = 0.930, RMSEA = 0.060; Model B: CFI = 0.926, RMSEA = 0.047). In Model A, predictors explained 51.8% of the variance in person-centred climate. The practice environment emerged as the sole significant predictor of a person-centred climate ( β  = 0.74, p  < 0.001) and mediator ( β  = 0.50, p  < 0.001) between nurses' prerequisites and person-centred climate. In Model B, predictors explained 57.3% of the variance in turnover intention. Person-centred climate was indirectly associated with lower turnover intention via job satisfaction ( β  = -0.468, p  < 0.001) and, to a lesser extent, via both job satisfaction and coolout ( β  = -0.124, p  < 0.001). The indirect path through moral distress was negligible and non-significant ( β  = 0.043, p  = 0.067).

CONCLUSIONS: Findings can be used to inform retention strategies at both the meso and micro levels, including the development of monitoring tools for turnover intention and measures to support practice development for teams and individual practitioners. Future research should further explore mediating mechanisms to inform retention efforts.