The importance of social exchange to nurses and nurse assistants: impact on retention factors

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The purpose of this study was to test the norm of reciprocity by examining relationships between perceived organisational support (POS), the quality of leader–member exchange (LMX) and psychological contract breach (PCB) and important nurse retention factors identified in the literature.


A major cause of turnover among nurses is related to unsatisfying workplaces. Previous research, mainly outside the nursing setting, found that social exchange affects employees’ work-related attitudes.


A cross-sectional survey was conducted on 217 nurses and nursing assistants to test and refine a model linking POS, LMX, PCB with job satisfaction, trust and turnover intentions.


Hierarchical multiple linear regression revealed that POS, PCB and LMX explained significant variance in all three retention factors: job satisfaction (adjusted R2 = 0.502), trust (adjusted R2 = 0.462) and turnover intentions (adjusted R2 = 0.196). POS and PCB predicted most strongly job satisfaction (P < 0.001) and trust (P < 0.001 and P < 0.01, respectively). LMX predicted most strongly intention to leave (P < 0.01).


In our study, POS, the quality of LMX and PCB were strongly related to job satisfaction, trust and turnover intentions.

Implications for nursing management

Nursing managers and leaders should recognize the importance of social exchange within their organisation to build trust, satisfy and retain scarce nurses and nursing assistants.

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