Journal of Nursing Management, 2011, 19, 4149

The mediating role of job satisfaction between leader-member

exchange and turnover intentions
GUOHONG (HELEN) HAN

PhD

and MARC JEKEL

Dipl.-Psych.

Assistant Professor, Department of Management, Williamson College of Business Adminstration, Youngstown State
University, Youngstown, OH, USA and 2Research Fellow, Department of Psychology, University of Bonn, Bonn,
Germany

Correspondence
Guohong (Helen) Han
Department of Management
Williamson College of Business
Adm.
Youngstown State University
One University Plaza
Youngstown, OH 44555
USA
E-mail: ghan@ysu.edu

H A N G . ( H E L E N ) & J E K E L M . (2011) Journal of Nursing Management 19, 4149

The mediating role of job satisfaction between leader-member exchange and
turnover intentions

Aim The aim of the present study was to investigate whether job satisfaction
mediates between leader-member exchange and nurse turnover intentions.
Background Limited knowledge is available on the mediating role of job satisfaction between leader-member exchange and turnover intentions in the nursing field.
Method This is a cross-sectional survey study. Data were collected in a US hospital.
Results Higher leader-member exchange was associated with lower turnover intentions (b = )0.41, P < 0.001). Leader-member exchange was positively related to ones
job satisfaction (b = 0.50, P < 0.001). Job satisfaction was negatively related to
turnover intentions (b = )0.64, P < 0.001). When leader-member exchange and job
satisfaction were both controlled for, the link between leader-member exchange and
turnover intentions was no longer significant (b = )0.12, P > 0.05).
Conclusion Job satisfaction mediates the link between leader-member exchange and
turnover intentions.
Implications for nursing management The present study reinforces the significant
role of managers. Nurse managers can try to cultivate a good relationship with the
nurses. This can enhance nurses job satisfaction and in turn lower their turnover
intentions.
Keywords: job satisfaction, LMX, turnover intentions
Accepted for publication: 23 August 2010

Introduction
An abundance of studies (e.g. McGowan 2001, Trinkoff et al. 2006) have been devoted to understanding
nursing shortages in terms of what contributes to nurse
turnover, a very costly problem that will continue along
with the substantial global nurse shortage (World
Health Organization 2006). Retention is critical for the
health-care sector, where employees who leave are
DOI: 10.1111/j.1365-2834.2010.01184.x
2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd

difficult and expensive to replace (e.g. Waldman et al.

2004). A variety of variables have been found to predict
nurse turnover. These include poor or inflexible work
schedules (Simons 2008), work stress (Ramrup & Pacis
2008) and heavy workloads (McGowan 2001). Turnover intentions, meaning the conscious and deliberate
willingness to leave the organization (Tett & Meyer
1993), have been shown to be highly correlated with
actual turnover (Hom & Hulin 1981).
41

G. Han and M. Jekel

Researchers have argued that there has been a paucity

of research on turnover intentions despite its critical
importance in predicting actual turnover (McCarthy
et al. 2007). In order to address this gap, the present
study focuses on turnover intentions and particularly
how leadership and job satisfaction can work synergistically to impact turnover intentions in the field of
nursing.
Employees usually do not quit their companies, they
quit their bosses instead (Smith 2000). Leader-member
exchange (LMX) refers to the quality of the relationship
between an individual and his/her supervisor (Graen
1976). In spite of the number of research studies
exploring the consequences of LMX, the link between
LMX and turnover intentions has been unclear and
equivocal (Gerstner & Day 1997). Gerstner and Day
(1997) called for research to examine more closely by
looking at variables that mediate or moderate this
process and proposed that LMX might affect turnover
through work attitudes, including satisfaction (Gerstner
& Day 1997).
Responding to their call, the present paper aims to
study the mediating role of job satisfaction on the
relationship of LMX and turnover intentions. To the
best of our knowledge, the present study will be the first
study that investigates the above mediation model in the
nursing field. We intend to address the following research questions: Will high-quality LMX lead to higher
job satisfaction? If so, will this lead to lower turnover
intentions?

accordingly (Thibault & Kelley 1959). High-quality

LMX employees are more likely to get attention and
support from their supervisors as an exchange for their
hard work. This kind of social exchange will ultimately
lead to higher job satisfaction (Podsakoff et al. 1996).
Empirical studies have confirmed that high-quality
LMX contributes to favourable employee attitudes and
behaviours, including organizational citizenship behaviours (e.g. Deluga 1994), higher performance (Dunegan
et al. 2002) and organizational commitment (Scandura
& Graen 1984, Dienesch & Liden 1986). Research has
also demonstrated that LMX is positively related to
employee job satisfaction (Graen et al. 1982a,b, Scandura & Graen 1984, Sparrow 1994, Gerstner & Day
1997).
In the field of nursing, Tangirala et al. (2007) found
that high-quality LMX was positively related to subordinates work attitudes. Spence-Laschinger et al.
(2001) also found that subordinates would display positive work attitudes if supervisors provided them with a
supportive work environment. Another study by Chen
et al. (2008) found that LMX was significantly associated with nurses perception of trust in their supervisors
and ultimately their engagement in organizational citizenship behaviours. Likewise, Laschingers (2007) study
on 141 hospital-based nurse managers found the significant and positive correlation between LMX and job
satisfaction.
Hence, our first hypothesis is:
H1: LMX is positively related to ones job satisfaction.

Conceptual framework and hypotheses

The link between LMX and job satisfaction
LMX researchers argue that leaders display different
leadership behaviours when dealing with different
subordinates (e.g. Graen & Cashman 1975). Highquality LMX individuals go the extra mile and contribute more towards work success. As a result, they
receive greater supervisor attention and more support.
Low-quality LMX individuals, on the other hand, do
not enjoy these preferential treatments and have a more
contractual relationship with the supervisor (e.g. Graen
& Cashman 1975).
Locke (1976) defined job satisfaction as a pleasurable
or positive emotional state resulting from the appraisal
of ones job or job experiences (p. 1304). Social exchange theory (Blau 1964) holds that two or more
parties exchange with each other intangible social costs
and benefits, such as respect, honour, friendship and
caring, assuming that the other party will collaborate
42

The link between job satisfaction and turnover

intentions
Drawing upon the theory of planned behaviour (Ajzen
1985, 1991), ones attitudes towards a specific behaviour, subjective norms and perceived behavioural control are the three building blocks of a behavioural
intention that initiates actual behaviour. Employees
who are not satisfied with their jobs will experience
negative attitudes towards their jobs and positive attitudes towards the intention to quit the job. If employees
think they have resources to control the behaviour (e.g.
skill to quit and find another job) and if the turnover
behaviour does not conflict with subjective norms (e.g.
behaviour that they believe to lead to social punishment
by significant others), they will likely foster turnover
intentions that will finally motivate turnover behaviour.
In research, job satisfaction has been found to be a
significant predictor of turnover intentions (Van Dick

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 4149

LMX, job satisfaction and turnover intentions

et al. 2004, Wright & Bonett 2007, Lee et al. 2008).

Additionally, Cotton and Tuttle (1986) found that
overall job satisfaction was negatively related to turnover.
Similar findings have also been established in the
nursing field. Price and Mueller (1981) proposed and
empirically tested the causal model of turnover, in which
job satisfaction affects intention to leave and ultimately
turnover. On the basis of longitudinal data on 1091
registered nurses (RNs) in seven hospitals, they found
that RNs with higher job satisfaction are more likely to
stay and less likely to have intentions to leave (Price &
Mueller 1981). In a survey of nurses from 12 units in a
908-bed university hospital in the Southwest, Shader
et al. (2001) observed the significant negative relationship between job satisfaction and the anticipated turnover. Additionally, McCarthy et al. (2007) conducted a
survey on 352 RNs at 10 hospital sites throughout the
Republic of Ireland and found the significant association
between job satisfaction and intention to stay. Based on
the above, our second hypothesis is as follows:
H2: Job satisfaction is negatively related to turnover intentions.

turnover intentions as well as actual turnover. Highquality LMX subordinates are, therefore, more likely to
be satisfied with their jobs overall and less likely to
think about quitting.
The negative association between LMX and turnover
intentions has also solicited support from nursing field
research. Laschinger et al. (2009) found that LMX can
predict nurses organizational commitment. Likewise,
Brunetto et al. (2010) found that the supervisorsubordinate relationship was positively associated with
nurses affective commitment. Obviously, this would
indicate low intentions of turnover. Another study (Le
Blanc et al. 1993) found that LMX was negatively related to ones propensity to quit the job.
Therefore, it seems reasonable to predict the negative
relationship between LMX and ones turnover intentions. As we have hypothesized the positive relationship
between LMX and job satisfaction in H1 and the negative relationship between job satisfaction and turnover
intentions in H2, we can now predict that:
H3: Job satisfaction mediates between LMX and
turnover intentions.

Methods
The mediating effect of job satisfaction between
LMX and turnover intentions
High LMX employees tend to have a trust-based relationship with their supervisors (Graen & Uhl-Bien
1995), and consequently they get more resources and
information-based support from their supervisors.
High-quality LMX individuals belong to in-group
members and accordingly enjoy preferential support,
for instance, being assimilated into the leaders personal
network (Sparrow & Liden 2005). So high-quality
LMX individuals are inclined to feel more accepted and
valued. Hence, they are more likely to reap individual
and organizational benefits. Many studies have proved
significant and positive consequences of having a highquality LMX. To illustrate, Sagas and Cunningham
(2004) found that high LMX people reported greater
job and career satisfaction. Wayne et al. (1997) found
that LMX is positively related to perceived organizational support, which contributes to employee satisfaction (Matzler & Renzl 2006) and satisfying
employees socioemotional needs (Cohen & Prusak
2001). LMX has also been found to enhance work
motivation (Lagace et al. 1993) and employees wellbeing at work (Sparr & Sonnentag 2008). In a longitudinal study of 116 new executives, Bauer et al. (2006)
found that LMX is negatively related to new executive

The studied organization is a region of Catholic

Healthcare Partners, which is the largest health system
in one mid-western state in the United States. This nonprofit health care provider offers a range of services,
including skilled nursing and independent living.
Thanks to the continuous effort of the management, the
studied organization saw a steady decrease in nurse
turnover over the past few years. However, since 2007,
the organization had been experiencing another round
of high turnover. The present study was conducted
during the fall of 2008. Data collection lasted for about
2 months. This paper used a subset of data from the
project which aims to investigate what factors can help
to reduce nurse turnover rates.
The first author of the study sent out a letter, a research proposal and an Institutional Review Board
permission letter to the Vice President of the Human
Resources Department. The letter and the research
proposal presented the main aims of the study to
examine the ways to assess leadership and employee
work attitudes in a diverse working environment. The
letter also assured that the study would follow strict
guidelines of confidentiality.
Based on our request, the Human Resources Department selected seven hospital units. Two of them have an
excellent retention rate with very little attrition whereas

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 4149

43

G. Han and M. Jekel

the other five have witnessed an increase in turnover

rates. The coordinator of the Human Resources Department communicated with every nurse manager of
the seven units. The surveys were then collected on site
when the nurses were changing their shifts.

Measures
This study controlled for the following demographic
differences: age, gender, education and organization
tenure.
Turnover intentions
We used McKay et al.s (2007) scale to measure turnover
intentions. Sample items included I hardly ever think
about leaving; and It would take a lot to get me to leave
the company. Responses to the scale were scored n a sixpoint Likert scale ranging from 1 = strongly disagree to
6 = strongly agree. Intention scores were recoded so that
low scores denote lower intention to leave the firm.
Cronbachs alpha was 0.90 (McKay et al. 2007).
LMX
We used Graen et al. (1982a,b) seven-item LMX measure. Studies have shown that it has sound psychometric
validity (e.g. Graen & Uhl-Bien 1995, Gerstner & Day
1997). This variable was assessed using seven items
based on the member version of LMX questionnaires
developed and used before the research (e.g. Liden &
Graen 1980, Wayne et al. 1997). Cronbachs alpha was
0.93 (Graen et al. 1982a,b). Respondents were asked to
indicate the extent to which the items characterize the
quality of their exchange relationships with their
supervisors, using a seven-point Likert scale ranging
from 1 = strongly disagree to 7 = strongly agree. Items
included My supervisor would be personally inclined to
help me solve problems in my work; My working
relationship with my supervisor is effective; I have
enough confidence in my supervisor that I would defend
and justify his/her decisions if he/she was not present to
do so; My supervisor considers my suggestions for
change; My supervisor and I are suited to each other;
My supervisor understands my problems and needs;
My supervisor recognizes my potential. The answers
were averaged to get the final score for LMX.
Job satisfaction
According to Chen et al. (2004), we asked the participants to indicate their level of satisfaction with the
following aspects of their present job: (1) job content,
(2) supervision, (3) coworker relations, (4) opportunities for promotion, (5) pay and (6) overall satisfaction
44

with their organization. Cronbachs alpha was 0.92

(Chen et al. 2004). Respondents were asked to use a
five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. Items included Im satisfied
with the degree of challenge that my job provides; Im
satisfied with the chances/opportunities for promotion;
Im satisfied with the relationship I have with my
supervisor; Im satisfied with the relationship I have
with my co-workers; Im satisfied with the level of pay
that my job provides; Im satisfied with the amount of
recognition I get for good work (my job, overall). A
summed average of the six items was produced to form
the job satisfaction score.

Analysis
We analysed data using the software package R (R Development Core Team, 2010). R is a free statistical
analysis software and can be downloaded from the
Comprehensive R Archive Network at http://cran.
r-project.org/. To learn more about R , we propose the
free ebook introduction to R by Paradis (2005).
We evaluated descriptive statistics to describe characteristics of our participants. We excluded participants
with missing data on any of the measures (n = 16). We
evaluated Cronbachs alpha as reliability estimates
across all subscales. Statistical analyses included testing
the correlation (Pearsons r) among the various variables and running ordinary multivariate linear regressions. The mediation model was tested using the most
prevalent method (Baron & Kenny 1986) in testing
mediation. To illustrate, Baron and Kenny (1986) argued that a mediation model needs to satisfy the following four steps: (1) there is a significant effect
between the independent variable and the mediator; (2)
there is a significant effect between the mediator and the
dependent variable; (3) there is a significant effect between the independent variable and the dependent
variable; and (4) the significant relationship between the
independent and the dependent variable is reduced
(=partial mediation) or removed (=full mediation) after
controlling for the mediator. In addition to this, we also
conducted the Sobel test based on Preacher and Leonardellis (2001) procedure to confirm the significance
of the mediation model.

Results
Participants
The survey was distributed to about 400 nurses from
seven units of the hospital in three locations. One

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 4149

LMX, job satisfaction and turnover intentions

hundred and ninety-seven nurses participated in the

present study. The response rate was 49.2%. We removed 16 individuals owing to missing data. Thus, the
final sample size was 181. Participants demographics
are displayed in Table 1. Most participants were female
(91% of all participants), more than 35 years old (62%
of all participants) and held a high school degree (42%
of all participants).

In the present study, Cronbachs alphas for LMX

(mean = 5.15, SD = 1.56), job satisfaction (mean = 3.5,
SD = 0.87) and turnover intentions (mean = 3.45,
SD = 1.47) were 0.97, 0.84 and 0.90, respectively.
Participants higher in LMX were more satisfied with
their jobs (Pearsons r = 0.5, P < 0.01) and showed less
turnover intentions (Pearsons r = )0.4, P < 0.01).
Furthermore, participants with higher job satisfaction
showed less turnover intentions (Pearsons r = )0.59,
P < 0.01).

Impact of LMX on job satisfaction

Based on linear regression, LMX was found to have a
significant and positive effect on job satisfaction
(b = 0.50, P < 0.001, Table 2). Thus, Hypothesis 1
received support. It appeared that higher-quality LMX
results in higher job satisfaction.

Table 1
Participants demographics

Gender
Female
Male
Age group (in years)*
2025
2630
3135
3640
4145
4650
5155
5660
>60
Education
High school
Associate degree
Bachelors degree
Masters degree
Continuous variable
Organization tenure (in years)

Job satisfaction was found to be negatively related to

turnover intentions (b = )0.64, P < 0.001, Table 3).
Therefore, it supported Hypothesis 2. It appeared that
higher job satisfaction results in lower turnover intentions.

Mediating effect of job satisfaction between LMX

and turnover intentions

Descriptive statistics

Categorial variables

Impact of job satisfaction on turnover intentions

164
17

91
9

19
22
27
16
35
29
20
11
2

10
12
15
9
19
16
11
6
1

76
45
57
3
Mean
6.09

42
25
31
2
SD
7.19

*Percentages do not add to 100% as a result of rounding.

The mediation was tested by adopting the procedure

suggested by Baron and Kenny (1986). As displayed in
Table 4, regression results showed that LMX was negatively linked to turnover intentions (b = )0.41, P <
0.001). When job satisfaction was added in (see
Table 5), LMX became insignificant (b = 0.12, P >
0.05). However, job satisfaction was significantly and
negatively related to turnover intentions (b = )0.58,
P < 0.001). This fully supported Hypothesis 3 about the
mediating effect of job satisfaction between LMX and
turnover intentions.
To further test the mediation effect, the Sobel test was
conducted according to Preacher and Leonardellis
(2001) method. The results indicated that the indirect
Table 2
Regression results of leader-member exchange (LMX) on job satisfaction
Variables

Standardized betas

Intercept
Focus variable
LMX
Control variables
Gender
Female
Age group
2630 years
3135 years
3640 years
4145 years
4650 years
5155 years
5660 years
>60 years
Education
Associate degree
Bachelors degree
Masters degree
Organization tenure
Summary statistics
R2
Adjusted R2
F14,166

)0.56

Standard error
0.31

0.50***

0.06

0.28

0.22

0.07
)0.29
0.31
0.11
0.14
0.31
0.74*
0.93

0.27
0.25
0.29
0.25
0.26
0.30
0.33
0.64

0.35*
0.36*
0.01
)0.06

0.16
0.15
0.51
0.07

0.35
0.29
6.26***

*P < 0.05, ***P < 0.001; Gender, age group and education were
dummy coded, i.e., the intercept is the mean of the standardized job
satisfaction for male participants of the age group 2025 years with a
high school degree.

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 4149

45

G. Han and M. Jekel

Table 3
Regression results of job satisfaction on turnover intentions
Variables
Intercept
Independent variables
Job satisfaction
Control variables
Gender
Female
Age group
2630 years
3135 years
3640 years
4145 years
4650 years
5155 years
5660 years
>60 years
Education
Associate degree
Bachelors degree
Masters degree
Organization tenure
Summary statistics
R2
Adjusted R2
F14,166

Standardized betas

Standard error

)0.87**

0.28

)0.64***

0.07

Variables

0.49*

0.20

0.07
0.40
0.29
0.27
0.68**
0.09
0.78*
0.82

0.24
0.23
0.27
0.23
0.24
0.27
0.30
0.59

)0.03
0.34*
)0.14
)0.10

Table 4
Regression results of leader-member exchange (LMX) on turnover
intentions

0.15
0.14
0.46
0.07

0.46
0.41
9.90***

*P < 0.05, **P < 0.01, ***P < 0.001; Gender, age group and education were dummy coded, i.e., the intercept is the mean of the
standardized turnover intentions for male participants of the age
group 2025 years with a high school degree.

Standardized betas

Intercept
Focus variable
LMX
Control variables
Gender
Female
Age group
2630 years
3135 years
3640 years
4145 years
4650 years
5155 years
5660 years
>60 years
Education
Associate degree
Bachelors degree
Masters degree
Organization tenure
Summary statistics
R2
Adjusted R2
F14,166

Standard error

)0.53

0.33

)0.41***

0.07

0.32

0.24

0.12
0.61*
0.10
0.19
0.61*
)0.05
0.30
0.28

0.29
0.27
0.31
0.27
0.28
0.32
0.35
0.68

)0.26
0.11
)0.07
)0.07

0.17
0.17
0.55
0.08

0.25
0.18
3.88***

*P < 0.05, ***P < 0.001; Gender, age group and education were
dummy coded, i.e., the intercept is the mean of the standardized
turnover intentions for male participants of the age group 20
25 years with a high school degree.

effect as a result of mediation was significant

(Z = )5.64, P < 0.001). This confirmed the full mediation effect of job satisfaction between LMX and
turnover intentions.
For an overview of the central results reported, the
mediated and unmediated model with the respective b
weights is displayed in Figure 1. In the upper part of the
figure, b weights for the mediated model are displayed,
i.e. b weights for the link between LMX and job satisfaction (b = 0.50), job satisfaction and turnover intentions (b = )0.64) and LMX and turnover intentions
when controlled for job satisfaction (b = )0.12) are
displayed. In the lower part of the figure, the b weight
for the unmediated model is displayed, i.e. the b weight
for the link between LMX and turnover intentions
(b = )0.41). In total, the model with all variables included explained 42% of the variance in turnover
intentions and the mediator (job satisfaction) explained
an additional 24% unique variance.

related to turnover intentions via the mediator of job

satisfaction. The positive association between LMX and
job satisfaction is consistent with the current research
(e.g. Sparrow 1994, Laschinger 2007). If employees
have a good quality relationship with their bosses, they
are more likely to be happy with their jobs. The negative linkage between job satisfaction and turnover
intentions provides further support to the extant literature (e.g. Shader et al. 2001, McCarthy et al. 2007;). If
employees are happy with their work overall, they are
less likely to contemplate quitting. As previously argued, to the best of our knowledge, this is the first study
that has examined the mediating role of job satisfaction
between LMX and turnover intentions in the nursing
field. Therefore, cultivating and enhancing nurses job
satisfaction plays a crucial rule in nurse retention. These
findings have both theoretical and practical implications.

Discussion

Theoretical implications

We made a contribution to the LMX literature by

introducing a potential mediator between LMX and
turnover intentions. We found that LMX is negatively

The present study contributes to the leadership

literature. Theoretically, LMX has been shown to be
related to a number of favourable organizational and

46

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 4149

LMX, job satisfaction and turnover intentions

Table 5
Regression results of leader-member exchange (LMX) on turnover
intentions (controlling for job satisfaction)
Variables
Intercept
Focus variables
LMX
Job satisfaction
Control variables
Gender
Female
Age group
2630 years
3135 years
3640 years
4145 years
4650 years
5155 years
5660 years
>60 years
Education
Associate degree
Bachelors degree
Masters degree
Organization tenure
Summary statistics
R2
Adjusted R2
F14,166

Standardized betas

Standard error

)0.85**

0.28

)0.12
)0.58***

0.07
0.07

0.48*

0.20

0.09
0.44
0.28
0.26
0.70**
0.13
0.73*
0.82

0.24
0.23
0.27
0.23
0.24
0.27
0.30
0.58

)0.06
0.32*
)0.06
)0.10

0.14
0.14
0.46
0.06

0.47
0.42
9.57***

*P < 0.05, **P < 0.01, ***P < 0.001; Gender, age group and education were dummy coded, i.e., the intercept is the mean of the
standardized turnover intentions for male participants of the age
group 2025 years with a high school degree.

individual outcomes. However, there has not been a

clear picture about the impact of LMX on turnover.
Responding to the researchers call (Gerstner & Day
1997) for the potential mediator between LMX and
turnover, this study found that having a quality relationship with ones boss does help the organization to
retain talent by enhancing employees job satisfaction.

Practical implications for nursing management

Practically, the study reinforced the significance of the
role of managers. This study found that cultivating a
good relationship with staff nurses can greatly help to
reduce ones intention to leave. Just as Andrews and
Dziegielewski (2005) pointed out, given the time constraint, that the first-line nurse managers, should make
an attempt to identify factors that precipitate low satisfaction. This undoubtedly is very challenging to nurse
managers, especially against the background of the diverse workforce (Carver & Candela 2008). Diversity
training should be provided to nurse managers in terms
of how to cater to different peoples needs and raise their
level of job satisfaction. The rating method in which the

Figure 1
Mediating role of job satisfaction between leader-member exchange
and turnover intentions. Displayed is the mediated (upper part) and
unmediated (lower part) linear model.

leader receives feedback from multi-sources, which is

named 360 degree feedback (Atwater et al. 2007), can
be utilized to improve nurse managers leadership skills
(Grant et al. 2009, Karsten 2010). For example, nurse
managers can be assessed in terms of LMX via the ratings of their subordinates to diagnose their leadership
behaviour. On the basis of the results, nurse managers
can modify their behaviour accordingly.
These findings also help us to better understand how
to reduce turnover rates among nurses. Nurses and
nurse aides make up a large percentage of the workers
in the healthcare system in the United States. However,
there have been a lot of concerns about the shortage of
nurses over the last couple of years in spite of the overall
unfavourable economy. The United States is expected to
have a shortage of about 340 000 nurses by the year
2020 (Auerbach et al. 2007). Research showed one in
five nurses reporting an intention to leave their job
within a year (Aiken et al. 2001, 2002). If those intentions are carried out, it can be an alarming prospect for
the health care work force in America. The shortage
will not only make the hospitals suffer as a whole, but
also cause a great deal of inconvenience to patients. A
nursing shortage coupled with the aging population
with an increasing need for healthcare creates a perfect
storm (Hernandez 2005), which will result in an
unprecedented difficult situation. The present study
makes an effort to investigate how to retain nurses by
highlighting the importance of having a good relationship with their bosses and reinforces the role of job
satisfaction in ones turnover intentions. Management

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 4149

47

G. Han and M. Jekel

hence needs to be trained to work on cultivating good

relationships with employees and increasing employees
perception of job satisfaction.

Limitations
Notwithstanding, this study has a few limitations that
should be noted. First, this study was a cross-sectional
study, which did not provide us with confidence about
the causality of the model. Longitudinal research is thus
called for in the future to investigate this. Second, the
study was based on self-report survey responses, which
was liable to common method variance bias.
To conclude, we found that high-quality LMX can
lead to greater job satisfaction, which in turn results in
less turnover intentions. We made a great effort to
contribute to the nursing research by examining the
mediating role of job satisfaction between LMX and
turnover intentions. Given the poor economy and budget constraint, fostering a good relationship between a
nurse manager and staff nurses might be a cost-effective
and efficient strategy to cut back on nurse turnover rate.

References
Aiken L.H., Clarke S.P., Sloane D.M. et al. (2001) Nurse reports
on hospital care in five countries. Health Affairs 20, 4353.
Aiken L.H., Clarke S.P., Sloane D.M., Sochalski J. & Silber J.H.
(2002) Hospital nurse staffing and patient mortality, nurse
burnout, and job dissatisfaction. Journal of the American
Medical Association 288, 19871993.
Ajzen I. (1985) From intentions to actions: a theory of planned
behavior. In Action Control: From Cognition to Behavior
(J. Kuhl & J. Beckmann eds), pp. 1139. Springer-Verlag,
Heidelberg.
Ajzen I. (1991) The theory of planned behavior. Organizational
Behavior and Human Decision Processes 50, 179211.
Andrews D.R. & Dziegielewski S.F. (2005) The nurse manager:
job satisfaction, the nursing shortage and retention. Journal of
Nursing Management 13, 286295.
Atwater L.E., Brett J.F. & Charles A.C. (2007) Multisource
feedback: lessons learned and implications for practice. Human
Resource Management 46, 285307.
Auerbach D., Buerhaus P. & Staiger D. (2007) Better late than
never: workforce supply implications of late entry into nursing.
Health Affairs 26, 178185.
Baron R.M. & Kenny D.A. (1986) The moderator-mediator
variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 11731182.
Bauer T.N., Erdogan B., Liden R.C. & Wayne S.J. (2006) A
longitudinal study of the moderating role of extraversion: leader-member exchange, performance, and turnover during new
executive development. Journal of Applied Psychology 91,
298310.
Blau P.M. (1964) Exchange and Power in Social Life. Wiley, New
York, NY.

48

Brunetto Y., Farr-Wharton R. & Shacklock K. (2010) The impact

of supervisor-subordinate relationships on moral: implications
for public and private sector nurses commitment. Human Resource Management Journal 20, 206225.
Carver L. & Candela L. (2008) Attaining organizational commitment across different generations of nurses. Journal of
Nursing Management 16, 984991.
Chen T.Y., Chang P.L. & Yeh C.W. (2004) An investigation of
career development programs, job satisfaction, professional
development and productivity: the case of Taiwan. Human
Resource Development International 7, 441463.
Chen C.-H.V., Wang S.-J., Chang W.-C. & Hu C.-S. (2008) The
effect of leader-member exchange, trust, supervisor support on
organizational citizenship behavior in nurses. The Journal of
Nursing Research 16, 321328.
Cohen D. & Prusak L. (2001) In Good Company: How Social
Capital Makes Organizations Work. Harvard Business School
Press, Boston, MA.
Cotton J. & Tuttle J. (1986) Employee turnover: a meta-analysis
and review with implications for research. Academy of Management Review 11, 5570.
Deluga R.J. (1994) Supervisor trust building, leader-member exchange and organizational citizenship behavior. Journal of
Occupational and Organizational Psychology 67, 315326.
Dienesch R.M. & Liden R.C. (1986) Leader-member exchange
model of leadership: a critique and further development.
Academy of Management Review 11, 618634.
Dunegan K.J., Uhl-Bien M. & Duchon D. (2002) LMX and
subordinate performance: the moderating effects of task characteristics. Journal of Business and Psychology 17, 275285.
Gerstner C.R. & Day D.V. (1997) Meta-analytic review of leadermember exchange theory: correlates and construct issues.
Journal of Applied Psychology 82, 827844.
Graen G.B. (1976) Role making processes within complex organizations. In Handbook of Industrial and Organizational Psychology (M.D. Dunnette ed.), pp. 12011245. Rand McNally,
Chicago, IL.
Graen G.B. & Cashman J.F. (1975) A role making model in
formal organizations: a developmental approach. In Leadership
Frontiers (J.G. Hunt & L.L. Larson eds), pp. 143165. Kent
State Press, Kent, OH.
Graen G.B. & Uhl-Bien M. (1995) Relationship-based approach
to leadership: development of leader-member exchange (LMX)
theory of leadership over 25 years: applying a multilevel
multidomain perspective. Leadership Quarterly 6, 219247.
Graen G.B., Liden R.C. & Hoel W. (1982a) Role of leadership in
the employee withdrawal process. Journal of Applied Psychology 67, 868872.
Graen G.B., Novak M.A. & Sommerkamp P. (1982b) The effects
of leader-member exchange and job design on productivity and
satisfaction: testing a dual attachment model. Organizational
Behavior and Human Performance 30, 109131.
Grant A.M., Curtayne L. & Burton G. (2009) Executive coaching
enhances goal attainment, resilience and workplace well-being:
a randomized controlled study. The Journal of Positive Psychology 4, 396407.
Hernandez S.R. (2005) The perfect storm: nursing in the twentyfirst century America. Health Affairs 24, 13721373.
Hom P.W. & Hulin C.L. (1981) A competitive test of the prediction of reenlistment by several models. Journal of Applied
Psychology 66, 2339.

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 4149

LMX, job satisfaction and turnover intentions

Karsten M.A. (2010) Coaching: an effective leadership intervention. Nursing Clinics of North America 45, 3948.
Lagace R.R., Castleberry S.B. & Ridnour R.E. (1993) An
exploratory salesforce study of the relationship between
leader-member exchange and motivation, role stress, and
manager evaluation. Journal of Applied Business Research 9,
110119.
Laschinger H. (2007) The impact of leader-member exchange
quality, empowerment, and core self-evaluation on nurse
managers job satisfaction. Journal of Nursing Administration
37, 221229.
Laschinger H.K., Finegan J. & Wilk P. (2009) Context matters:
the impact of unit leadership and empowerment on nurses
organizational commitment. Journal of Nursing Administration 39 (5), 228235.
Le Blanc P.M., De Jong R.D., Geersing J., Furda J. & Komproe
I.H. (1993) Leader member exchanges: distinction between two
factors. European Work & Organizational Psychologist 3,
297309.
Lee T.H., Gerhart B., Weller I. & Trevor C.O. (2008) Understanding voluntary turnover: path-specific job satisfaction effects and the importance of unsolicited job offers. Academy of
Management Journal 51, 651671.
Liden R.C. & Graen G. (1980) Generalizability of the vertical
dyad linkage model of leadership. Academy of Management
Journal 23, 451465.
Locke E.A. (1976) The nature and causes of job satisfaction. In
Handbook of Industrial and Organizational Psychology (M.D.
Dunnette ed.), pp. 12971349. Rand McNally, Chicago, IL.
Matzler K. & Renzl B. (2006) The relationship between interpersonal trust, employee satisfaction, and employee loyalty.
Total Quality Management 17, 12611271.
McCarthy G., Tyrrell M. & Lehane E. (2007) Intention to leave
or stay in nursing. Journal of Nursing Management 15, 248
255.
McGowan B. (2001) Self-reported stress and its effects on nurses.
Nursing Standard 15, 3338.
McKay P.F., Avery D.R., Tonidandel S., Morris M.A., Hernandez
M. & Hebl M.R. (2007) Racial differences in employee
retention: are diversity climate perceptions the key? Personnel
Psychology 60, 3562.
Paradis E. (2005) R for beginners [WWW document]. Available
at: http://cran.r-project.org/doc/contrib/Paradis-rdebuts_en.pdf,
accessed 21 July 2010.
Podsakoff P.M., MacKenzie S.B. & Bommer W.H. (1996) Tranformational leader behaviors and substitutes for leadership as
determinants of employee satisfaction, commitment, trust, and
organizational citizenship behaviors. Journal of Management
22, 259298.
Preacher K.J. & Leonardelli G.J.. (2001) Calculation for the sobel
test [WWW document]. Available at: http://people.ku.edu/
~preacher/sobel/sobel.htm, accessed 9 September 2009.
Price J.L. & Mueller C.W. (1981) A causal model of turnover for
nurses. Academy of Management Journal 24, 543565.
R Development Core Team (2010) R: A Language and Environment for Statistical Computing. R Foundation for Statistical
Computing, Vienna, Austria.
Ramrup N. & Pacis M. (2008) The relationship between job
satisfaction and job-related stress and how it influences
retention to leave oncology nursing. Oncology Nursing Forum
35, 538.

Sagas M. & Cunningham G.B. (2004) Treatment discrimination

in college coaching: its prevalence and impact on the career
success of assistant basketball coaches. International Sports
Journal 8, 7688.
Scandura T.A. & Graen G.B. (1984) Moderating effects of initial
leader-member exchange status on the effects of a leadership
intervention. Journal of Applied Psychology 69, 428436.
Shader K., Broome M.E., West M.E. & Nash M. (2001) Factors
influencing satisfaction and anticipated turnover for nurses in
an academic medical center. Journal of Nursing Administration
31, 210216.
Simons S.R. (2008) Workplace bullying experienced by nurses
newly licensed in Massachusetts and the relationship to intention to leave the organization. Advances in Nursing Science 31,
4859.
Smith G.P. (2000) Keeping good employees means having good
managers [WWW document]. Available at: http://www.
managerwise.com/article.phtml?id=32, accessed 21 June 2010.
Sparr J.L. & Sonnentag S. (2008) Fairness perceptions of supervisor feedback, LMX, and employee well-being at work.
European Journal of Work and Organizational Psychology 17,
198225.
Sparrow R.T. (1994) Empowerment in the hospital industry: an
exploration of antecedents and outcomes. Hospitality Research
Journal 17, 5173.
Sparrow R.T. & Liden R.C. (2005) Two routes to influence:
integrating leader-member exchange and social network perspectives. Administrative Science Quarterly 50, 505535.
Spence-Laschinger H.K., Finegan J. & Shamian J. (2001) The
impact of workplace empowerment, organizational trust on
staff nurses work satisfaction and organizational commitment.
Health Care Management Review 26, 724.
Tangirala S., Green S.G. & Ramanujam R. (2007) In the shadow
of the bosss boss: effects of supervisors upward exchange
relationships on employees. Journal of Applied Psychology 92,
309320.
Tett R.P. & Meyer J.P. (1993) Job satisfaction, organizational
commitment, turnover intention, and turnover: path analyses
based on meta-analytic findings. Personnel Psychology 46,
259293.
Thibault J.W. & Kelley H.H. (1959) The Social Psychology of
Groups. Wiley, New York, NY.
Trinkoff A., Geiger-Brown J., Brady B., Lipscomb J. & Muntaner
C. (2006) How long and how much are nurses now working?
Too long, too much, and without enough rest between shifts, a
study finds. American Journal of Nursing 106, 6072.
Van Dick R., Christ O., Stellmacher J. et al. (2004) Should I stay or
go? Explaining intentions with organizational idemtification and
job satisfaction. British Journal of Management 15, 351360.
Waldman J.D., Kelly F., Arora S. & Smith H.L. (2004) The
shocking cost of turnover in healthcare. Health Care Management Review 29, 27.
Wayne S.J., Shore L.M. & Liden R.C. (1997) Perceived organizational support and leader-member exchange: a social
exchange perspective. Academy of Management Journal 40,
82111.
World Health Organization (2006) The World Health Report
2006: Working Together for Health. WHO, Geneva.
Wright T.A. & Bonett D.G. (2007) Job satisfaction and psychological well-being as nonadditive predictors of workplace
turnover. Journal of Management 33, 141160.

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 4149

49

Copyright of Journal of Nursing Management is the property of Wiley-Blackwell and its content may not be
copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use.