Occupational commitment and job satisfaction mediate effort–reward imbalance and the intention to continue nursing

Aim: Occupational commitment and job satisfaction are major predictors of the intention to continue nursing. This study's purpose was to verify the mediating effects of job satisfaction and three components of occupational commitment on the relationship between effort–reward imbalance and the intention to continue nursing. Methods: A self-report questionnaire was distributed to 3977 nurses by the nursing department of 12 hospitals in the Tohoku and Kanto districts of Japan in 2013. Of these, 1531 (response rate: 38.5%) nurses returned the questionnaire by mail and the complete data that were provided by 1241 nurses (valid response rate: 31.2%) were analyzed. Results: Structural equation modeling showed that the effort–reward ratio had negative effects on job satisfaction and affective and normative occupational commitment. Job satisfaction and affective and normative occupational commitment had positive effects on the intention to continue nursing, whereas the effort–reward ratio had no direct effect on the intention to continue nursing. Continuance occupational commitment was not a mediator, but it positively influenced the intention to continue nursing. Conclusion: The findings suggest that it is important to increase job satisfaction and affective and normative occupational commitment in order to enhance their buffering effects on the relationship between job stress and the intention to continue nursing. Measures to increase continuance occupational commitment also would be an effective method of strengthening the intention to continue nursing. Improvements in these areas should contribute to an increase in nurses’ intention to continue nursing and prevent the loss of this precious human resource from the health sector.