title: Nurse working conditions, organizational climate, and intent to leave in ICUs: an instrumental variable approach.
abstract: OBJECTIVE
  To investigate causes of nurse intention to leave (ITL) while simultaneously considering organizational climate (OC) in intensive care units (ICUs) and identify policy implications.
  
  
  METHODS
  Data were obtained from multiple sources including nurse surveys, hospital administrative data, public use, and Medicare files. Survey responses were analyzed from 837 nurses employed in 39 adult ICUs from 23 hospitals located in 20 separate metropolitan statistical areas.
  
  
  METHODS
  We used an instrumental variable technique to assess simultaneously the relationship between OC and ITL. We estimated ordinary least squares and reduced form regressions to determine the extent of simultaneity bias as well as the sensitivity of our results to the instrumental variable model specification.
  
  
  RESULTS
  Fifteen percent of the nurses indicated their ITL in the coming year. Based on the structural model, we found that nurses' ITL contributed little if anything directly to OC, but that OC and the tightness of the labor market had significant roles in determining ITL (p values <.05). Furthermore, OC was affected by the average regionally adjusted ICU wages, hospital profitability, teaching, and Magnet status (p values <.05).
  
  
  CONCLUSIONS
  OC is an important determinant of ITL among ICU nurses. Because higher wages do not reduce ITL, increased pay alone without attention to OC is likely insufficient to reduce nurse turnover. Implementing interventions aimed at creating a positive OC, as found in Magnet hospitals, may be a more effective strategy.
authors.affiliation: Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032, USA.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
authors.forename: Cathy
authors.initials: C
authors.lastname: Mooney-Kane
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
authors.forename: Diane K
authors.initials: DK
authors.lastname: Pastor
authors.forename: Jack
authors.initials: J
authors.lastname: Zwanziger
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D033182:Intention; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000600:supply & distribution; D015279:Organizational Culture; D016134:Organizational Policy; D010563:Personnel Turnover; D013997:Time Factors; D014481:United States; D000078329:Workforce; D017132:Workplace