How Does Job Dissatisfaction Fuel Nurse Exit, Voice, Loyalty, and Neglect (EVLN) Behaviours? Insights From Dynamic Game Theory and a Cross-Sectional Survey.
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| Title: | How Does Job Dissatisfaction Fuel Nurse Exit, Voice, Loyalty, and Neglect (EVLN) Behaviours? Insights From Dynamic Game Theory and a Cross-Sectional Survey. |
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| Authors: | Li JZ; Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China., Chen M; Hong Kong Metropolitan University School of Nursing and Health Sciences, Hong Kong, China.; Department of Rehabilitation Medicine, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China., Lao Y; The First Affiliated Hospital of Guilin Medical University, Guilin, China., Hu W; Hong Kong Metropolitan University School of Nursing and Health Sciences, Hong Kong, China. |
| Source: | Nursing open [Nurs Open] 2025 Oct; Vol. 12 (10), pp. e70313. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: John Wiley & Sons, Inc Country of Publication: United States NLM ID: 101675107 Publication Model: Print Cited Medium: Internet ISSN: 2054-1058 (Electronic) Linking ISSN: 20541058 NLM ISO Abbreviation: Nurs Open Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [Hoboken, NJ] : John Wiley & Sons, Inc., [2014]- |
| MeSH Terms: | Job Satisfaction* , Game Theory* , Nurses*/psychology , Nurses*/statistics & numerical data , Personnel Loyalty* , Personnel Turnover*/statistics & numerical data , Nursing Staff, Hospital*/psychology, Humans ; Cross-Sectional Studies ; Female ; Adult ; Male ; China ; Surveys and Questionnaires ; Middle Aged |
| Abstract: | Aims: This study explores how nurses' job dissatisfaction influences their behavioural responses-exit, voice, loyalty, and neglect (EVLN)-within the framework of organisational behaviour, focusing on the Chinese cultural context using dynamic game theory. The goal is to provide insights for reducing nurse shortages. Design: A cross-sectional quantitative design was employed to assess the relationships between nurses' job dissatisfaction and EVLN behaviours in public hospitals in Chongqing, China, between January and May 2024. Methods: Data were collected using a structured questionnaire administered to registered nurses across tertiary public hospitals. The study combined Farrell's EVLN framework with dynamic game theory to analyse behavioural evolution. Quantitative analysis included descriptive statistics, reliability checks, correlation tests, multiple regression analyses, robustness checks, and heterogeneity analysis. Results: This study involved 1132 registered nurses, primarily female (94.88%), aged 20-39. Findings show that job dissatisfaction is positively correlated with exit (β = 0.3924, p < 0.01) and neglect (β = 0.6603, p < 0.01) behaviours, and negatively correlated with voice (β = -0.1483, p < 0.01) and loyalty (β = -0.1714, p < 0.01). Gender and education level significantly influenced the relationship between dissatisfaction and EVLN behaviours, while age and marital status showed partial heterogeneity. Dynamic game modelling revealed that nurses initially showing loyalty may shift to voice if dissatisfaction persists, and if voice is ignored, they may either transition to exit or move gradually to neglect. Conclusion: This study contributes to nursing management by applying dynamic game theory to the EVLN framework, revealing the evolutionary mechanisms through which nurses respond to job dissatisfaction and highlighting the cultural specificity of these behaviours in China's healthcare setting. Implications for the Profession: Understanding the dynamic responses to job dissatisfaction can assist hospital administrators in developing strategies that promote nurse retention, encourage voice and loyalty behaviours, and mitigate exit and neglect. Impact: This study enriches the application of EVLN theory in China and Greater China, supporting hospital management and optimizing nursing strategies for sustainable hospital development. Patient or Public Contribution: No direct patient or public contribution. (© 2025 The Author(s). Nursing Open published by John Wiley & Sons Ltd.) |
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| Contributed Indexing: | Keywords: China; decision theory; health workforce; job dissatisfaction; nurses; organisational behaviour |
| Entry Date(s): | Date Created: 20251009 Date Completed: 20251009 Latest Revision: 20251012 |
| Update Code: | 20251012 |
| PubMed Central ID: | PMC12507537 |
| DOI: | 10.1002/nop2.70313 |
| PMID: | 41063357 |
| Database: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Aims: This study explores how nurses' job dissatisfaction influences their behavioural responses-exit, voice, loyalty, and neglect (EVLN)-within the framework of organisational behaviour, focusing on the Chinese cultural context using dynamic game theory. The goal is to provide insights for reducing nurse shortages.<br />Design: A cross-sectional quantitative design was employed to assess the relationships between nurses' job dissatisfaction and EVLN behaviours in public hospitals in Chongqing, China, between January and May 2024.<br />Methods: Data were collected using a structured questionnaire administered to registered nurses across tertiary public hospitals. The study combined Farrell's EVLN framework with dynamic game theory to analyse behavioural evolution. Quantitative analysis included descriptive statistics, reliability checks, correlation tests, multiple regression analyses, robustness checks, and heterogeneity analysis.<br />Results: This study involved 1132 registered nurses, primarily female (94.88%), aged 20-39. Findings show that job dissatisfaction is positively correlated with exit (β = 0.3924, p < 0.01) and neglect (β = 0.6603, p < 0.01) behaviours, and negatively correlated with voice (β = -0.1483, p < 0.01) and loyalty (β = -0.1714, p < 0.01). Gender and education level significantly influenced the relationship between dissatisfaction and EVLN behaviours, while age and marital status showed partial heterogeneity. Dynamic game modelling revealed that nurses initially showing loyalty may shift to voice if dissatisfaction persists, and if voice is ignored, they may either transition to exit or move gradually to neglect.<br />Conclusion: This study contributes to nursing management by applying dynamic game theory to the EVLN framework, revealing the evolutionary mechanisms through which nurses respond to job dissatisfaction and highlighting the cultural specificity of these behaviours in China's healthcare setting.<br />Implications for the Profession: Understanding the dynamic responses to job dissatisfaction can assist hospital administrators in developing strategies that promote nurse retention, encourage voice and loyalty behaviours, and mitigate exit and neglect.<br />Impact: This study enriches the application of EVLN theory in China and Greater China, supporting hospital management and optimizing nursing strategies for sustainable hospital development.<br />Patient or Public Contribution: No direct patient or public contribution.<br /> (© 2025 The Author(s). Nursing Open published by John Wiley & Sons Ltd.) |
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| ISSN: | 2054-1058 |
| DOI: | 10.1002/nop2.70313 |