Don’t Go: Examining the Relationships Between Meaning, Work Environment and Turnover Intention Across the Entire Healthcare Team

Figures & data

Table 1 Definition of Survey Measures

	Variable	Response	Reference
Dependent Variables
Turnover Intent	Do you have plans to leave your current job?	0=No, I do not have plans to leave my job; 1=Yes, within 6–36 months	TWC Tai et al, 1998
Net Promoter Score	On a scale from 0–10, how likely are you to recommend working at your organization to a friend or acquaintance?	[1–10]	MI Brown et al, 2020
Independent Variables
Perceived Organizational Support Score (3–15)	My organization values my contributions and extra efforts.	1=Strongly disagree; 2=Disagree; 3=Neutral; 4=Agree; 5=Strongly agree	R. Eisenberger Ret al 1986
	My organization cares about my well-being and satisfaction at work.
	My organization shows very little concern for me.
Sense of belonging	I feel a sense of belonging at work.	1=Strongly disagree; 2=Disagree; 3=Neutral; 4=Agree; 5=Strongly agree	National Center for Organization Development, 2020
Sense of recognition	I am satisfied with the recognition I receive for doing a good job.	1=Strongly disagree; 2=Disagree; 3=Neutral; 4=Agree; 5=Strongly agree	National Center for Organization Development, 2020
Sense of respect	At my department or unit, I am treated with respect.	1=Strongly disagree; 2=Disagree; 3=Neutral; 4=Agree; 5=Strongly agree	National Center for Organization Development, 2020
Trust and confidence in supervisor	I have trust and confidence in my direct supervisor.	1=Strongly disagree; 2=Disagree; 3=Neutral; 4=Agree; 5=Strongly agree	National Center for Organization Development, 2020
Trust and confidence in senior leadership	I have trust and confidence in senior leadership.	1=Strongly disagree; 2=Disagree; 3=Neutral; 4=Agree; 5=Strongly agree	National Center for Organization Development, 2020
Moral Distress	In the past 3 months, how often did you experience moral distress at work (ie, you were unsure about the right thing to do or could not carry out what you believed to be the right thing)?	1=None; 2=A few times or less; 3=A few times per month; 4=Once a week; 5=A few times per week; 6=Almost every workday	National Center for Organization Development, 2020
Work control (Autonomy)	I have control over how my work is carried out.	1=Strongly disagree; 2=Disagree; 3=Neutral; 4=Agree; 5=Strongly agree	National Center for Organization Development, 2020
Sense of meaning in work	The work I do is meaningful to me.	0=No; 1=Yes	LN Dyrbye et al, 2016
Resource availability	My organization is willing to extend resources in order to help me perform my job to my best ability (eg, training, supplies, equipment, funding).	1=Strongly disagree; 2=Disagree; 3=Neutral; 4=Agree; 5=Strongly agree	R Chariet al, 2021
Resilience Score (0–8)	I am able to adapt to change.	0=Not true at all; 1=Rarely True; 2=Sometimes true; 3=Often true; 4=True nearly all of the time	S Vaishnavi, S.et al, 2007
	I tend to bounce back after illness or hardship.
Burnout	Overall, based on your definition of burnout, how would you rate your level of burnout?	0=I enjoy my work. I have no symptoms of burnout.; I am under stress, and do not always have as much energy as I did, but I do not feel burned out.; 1=I am definitely burning out and have one or more symptoms of burnout, eg, emotional exhaustion.; The symptoms of burnout that I am experiencing will not go away. I think about work frustrations a lot.; I feel completely burnout out. I am at the point where I may need to seek help	American Medical Association, 2015
General Work Stressors	Discrimination at work.	0=No; 1=Yes	KA Meese et al, 2022
	Feeling that pay is inadequate.
	Lack of necessary supplies or equipment.
	Department or unit is understaffed.
	Unpredictability of schedule or work location.

Table 2 Characteristics of the Sample (n=4827)

	Administrative and Non-Clinical Staff	APP	Clinical Support Staff	Nurse	Physician and Clinical Faculty	Basic Science Personnel	Other	Total	p
	(n=1074)	(n=240)	(n=758)	(n=998)	(n=621)	(n=294)	(n=842)	(n=4827)
Variables
Turnover Intention^a %	27.7	35.8	31.1	39.7	26.6	25.2	30.5	31.3	***
Net Promoter Score^b Mean (SD)	7.63 (2.25)	6.02 (2.45)	6.60 (2.54)	6.47 (2.49)	6.90 (2.41)	7.45 (2.19)	7.52 (2.33)	7.03 (2.45)	<- this is significant if you treat NPS as the outcome
Sense of belonging^a Mean (SD)	3.82 (1.10)	3.51 (1.12)	3.60 (1.11)	3.69 (1.01)	3.71 (1.15)	3.68 (1.10)	3.87 (1.06)	3.73 (1.09)	***
Work control^a Mean (SD)	3.83 (1.03)	3.19 (1.12)	3.49 (1.17)	3.34 (1.09)	3.39 (1.19)	3.89 (0.96)	3.83 (1.00)	3.59 (1.11)	***
Sense of meaning in work^a %	85.2	83.8	87.9	87.5	91.3	91.8	84.9	87.2	***
Sense of recognition^a Mean (SD)	3.49 (1.18)	2.89 (1.17)	3.00 (1.27)	2.99 (1.22)	3.28 (1.24)	3.34 (1.14)	3.48 (1.19)	3.24 (1.23)	***
Sense of respect^a Mean (SD)	4.08 (0.96)	3.73 (1.03)	3.69 (1.14)	3.80 (1.00)	3.93 (1.11)	3.86 (1.09)	4.02 (0.97)	3.90 (1.04)	***
Resource availability^a Mean (SD)	3.77 (1.04)	3.11 (1.16)	3.30 (1.21)	3.16 (1.19)	3.22 (1.20)	3.36 (1.17)	3.68 (1.07)	3.43 (1.17)	***
Trust and confidence in supervisor^a Mean (SD)	4.10 (1.08)	3.87 (1.04)	3.68 (1.21)	3.83 (1.12)	3.90 (1.13)	3.88 (1.05)	4.11 (1.03)	3.93 (1.11)	***
Trust and confidence in senior leadership^a Mean (SD)	3.70 (1.05)	3.04 (1.12)	3.26 (1.17)	2.89 (1.22)	3.38 (1.17)	3.64 (1.05)	3.60 (1.00)	3.37 (1.16)	***
Perceived organizational support (3–15)^b Mean (SD)	10.3 (2.90)	8.33 (2.90)	8.94 (3.32)	8.29 (3.17)	9.57 (3.23)	9.86 (3.00)	9.97 (2.97)	9.39 (3.18)
Resilience score (0–8)^b Mean (SD)	6.84 (1.18)	6.78 (1.08)	6.73 (1.19)	6.67 (1.23)	6.73 (1.16)	6.47 (1.27)	6.66 (1.30)	6.72 (1.21)	**
Burnout^a %	37.0	53.3	47.6	54.5	44.6	37.8	34.8	43.7	***
Moral distress^a Mean (SD)	1.80 (1.17)	2.12 (1.31)	1.96 (1.27)	2.36 (1.43)	2.16 (1.35)	1.91 (1.18)	1.73 (1.17)	2.00 (1.29)	***
General Work Stressors^a %
Discrimination at work	4.28	3.75	5.94	6.31	7.41	9.52	4.28	5.66	**
Feeling that pay is inadequate	45.3	48.8	58.2	50.1	31.6	29.9	48.3	46.3	***
Lack of necessary supplies or equipment	7.54	30.0	25.7	42.4	20.8	29.6	16.0	23.2	***
Department or unit is understaffed	35.1	60.4	58.6	64.3	59.4	34.7	31.8	48.6	***
Unpredictability of schedule or work location	4.66	20.8	12.5	16.3	14.7	4.42	7.36	10.9	***
Gender^a %									***
Male	16.48	12.08	11.61	8.62	45.25	40.14	18.17	19.31
Gender or sexual minorities	66.57	65.00	69.92	71.24	35.59	42.52	66.75	62.56
Prefer not to answer	16.95	22.92	18.47	20.14	19.16	17.35	15.08	18.13
Race^a %									***
White	52.8	65.4	50.8	61.2	58.8	53.4	47.3	54.7
Non-white	26.8	7.92	27.3	14.9	15.6	23.5	34.2	23.1
Prefer not to answer	20.4	26.7	21.9	23.9	25.6	23.1	18.5	22.2
Age^a %									***
18–24	1.58	0	10.3	8.72	0.16	1.70	4.04	4.60
25–44	32.6	50.0	48.9	43.1	37.4	27.9	41.0	40.0
45–65	43.4	25.0	19.1	25.7	31.7	41.2	34.4	31.8
65+	3.45	2.92	0.66	1.00	7.57	7.82	4.04	3.38
Prefer not to answer	19.0	22.1	21.0	21.5	23.2	21.4	16.5	20.2

Notes: ^aChi-squared. ^bANOVA. *p<0.05, **p<0.01, ***p<0.001.

Abbreviations: APP, Advanced Practice Provider; SD, Standard deviation.

Table 3 Logistic Regression Predicting the Odds of Turnover Intent Across the Entire Healthcare Team (n=4827)

Turnover Intention	OR	SE	95% CI		p
Job Role (Ref. = Administrative and Non-Clinical Staff)
APP	0.82	(0.15)	0.578	1.165	0.269
Clinical Support Staff	0.68	(0.09)	0.534	0.877	0.003**
Nurse	0.93	(0.11)	0.737	1.177	0.550
Physician and Clinical Faculty	0.58	(0.08)	0.439	0.762	0.000***
Basic Science Personnel	0.70	(0.12)	0.494	0.988	0.042*
Other	1.13	(0.13)	0.901	1.426	0.285
Sense of belonging	0.80	(0.04)	0.731	0.872	0.000***
Work control (Autonomy)	0.95	(0.04)	0.881	1.035	0.259
Sense of meaning in work	0.67	(0.07)	0.545	0.831	0.000**
Sense of recognition	0.92	(0.04)	0.848	0.999	0.047*
Sense of respect	0.97	(0.05)	0.877	1.065	0.488
Resource availability	0.94	(0.04)	0.869	1.024	0.161
Trust and confidence in supervisor	0.91	(0.04)	0.843	0.985	0.019*
Trust and confidence in senior leadership	0.80	(0.04)	0.735	0.879	0.000***
Perceived Organizational Support Score (3–15)	0.95	(0.02)	0.911	0.986	0.008**
Resilience Score (0–8)	1.05	(0.03)	0.992	1.117	0.089
Burnout	2.08	(0.17)	1.763	2.445	0.000***
Moral distress	1.11	(0.03)	1.049	1.179	0.000***
General Work Stressors
Discrimination at work	1.17	(0.18)	0.870	1.584	0.294
Feeling that pay is inadequate	1.56	(0.12)	1.342	1.825	0.000***
Lack of necessary supplies or equipment	1.14	(0.10)	0.956	1.355	0.146
Department or unit is under-staffed	1.17	(0.09)	1.006	1.369	0.042*
Unpredictability of schedule or work location	1.28	(0.14)	1.025	1.595	0.030*
Gender (Ref. = Male)
Gender or sexual minorities	0.75	(0.08)	0.617	0.919	0.005**
Prefer not to answer	0.83	(0.16)	0.569	1.220	0.347
Race (Ref. = White)
Non-white	1.20	(0.11)	0.996	1.440	0.055
Prefer not to answer	1.27	(0.20)	0.933	1.732	0.128
Age (Ref. = 18–24)
25–44	0.45	(0.08)	0.321	0.626	0.000***
45–65	0.53	(0.09)	0.374	0.752	0.000***
65+	2.47	(0.62)	1.518	4.030	0.000***
Prefer not to answer	0.45	(0.10)	0.293	0.699	0.000***
Model Fit
Pseudo-R square	0.2134
AIC	4783.458
BIC	4990.881

Notes: *p<0.05, **p<0.01, ***p<0.001.

Abbreviations: OR, Odds Ratio; SE, Standard Error; CI, Confidence Interval; Ref, Reference; APP, Advanced Practice Provider; AIC, Akaike’s information criteria; BIC, Bayesian information criteria.

Table 4 Linear Regression Predicting Net Promoter Score Across the Entire Healthcare Team (n=4827)

Net Promoter Score	Coef.	SE	95% CI		p
Job Role (Ref. = Administrative and Non-Clinical Staff)
APP	−0.43	(0.11)	−0.643	−0.214	0.000**
Clinical Support Staff	−0.18	(0.07)	−0.328	−0.038	0.014*
Nurse	0.02	(0.07)	−0.122	0.158	0.798
Physician and Clinical Faculty	−0.16	(0.08)	−0.320	−0.005	0.043*
Basic Science Personnel	0.11	(0.10)	−0.092	0.305	0.292
Other	0.01	(0.07)	−0.128	0.144	0.908
Sense of belonging	0.17	(0.03)	0.112	0.225	0.000***
Work control (Autonomy)	0.06	(0.03)	0.013	0.115	0.015*
Sense of meaning in work	0.25	(0.07)	0.107	0.384	0.001**
Sense of recognition	0.08	(0.03)	0.026	0.129	0.003**
Sense of respect	0.05	(0.03)	−0.013	0.112	0.124
Resource availability	0.20	(0.03)	0.143	0.247	0.000***
Trust and confidence in supervisor	0.15	(0.03)	0.100	0.200	0.000***
Trust and confidence in senior leadership	0.28	(0.03)	0.223	0.336	0.000***
Perceived organizational support (3–15)	0.30	(0.01)	0.274	0.323	0.000***
Resilience score (0–8)	0.04	(0.02)	0.009	0.080	0.013*
Burnout	−0.30	(0.05)	−0.400	−0.193	0.000***
Moral distress	−0.08	(0.02)	−0.116	−0.040	0.000***
General Work Stressors
Discrimination at work	−0.15	(0.10)	−0.342	0.045	0.132
Feeling that pay is inadequate	−0.13	(0.05)	−0.227	−0.040	0.005**
Lack of necessary supplies or equipment	0.11	(0.06)	0.000	0.216	0.051
Department or unit is under-staffed	−0.01	(0.05)	−0.107	0.078	0.753
Unpredictability of schedule or work location	−0.18	(0.07)	−0.322	−0.038	0.013*
Gender (Ref. = Male)
Gender or sexual minorities	0.12	(0.06)	0.004	0.237	0.043
Prefer not to answer	0.01	(0.12)	−0.222	0.249	0.912
Race (Ref. = White)
Non-white	−0.03	(0.05)	−0.136	0.080	0.611
Prefer not to answer	−0.22	(0.10)	−0.416	−0.032	0.022*
Age (Ref. = 18–24)
25–44	0.00	(0.11)	−0.206	0.215	0.968
45–65	0.00	(0.11)	−0.214	0.223	0.968
65+	0.23	(0.16)	−0.081	0.547	0.145
Prefer not to answer	0.07	(0.14)	−0.198	0.345	0.597
Model Fit
Pseudo R-square	0.629
AIC	17586.83
BIC	17794.25

Notes: *p<0.05, **p<0.01, ***p<0.001.

Abbreviations: OR, Odds Ratio; SE, Standard Error; CI, Confidence Interval; Ref, Reference; APP, Advanced Practice Provider; PTSD, Post-traumatic stress disorder.