This dissertation represents an exploration of the significantly growing nursing turnover problem that presently confronts health care management. This study begins with an applied, qualitative inquiry of job satisfaction, commitment to an organization and their relationship to voluntary turnover. The goal of this study is to provide a basis for moral, ethical, and legal philosophy to help deal with the crisis of voluntary turnover in a hospital setting. This research was done at a 1,500 bed metropolitan county hospital in southeastern America before and after a downsizing project.

Survey data were collected from in-depth interviews of twenty-seven staff nurses' in the fall, 1995. Assumptions were tested by reviewing nurses stories, or critical incidents (CIs) about their work life. Sample analysis consisted of identifying the conditions for job satisfaction, commitment, and turnover using a qualitative coding method. The CI's were analyzed to the point of redundancy.

The objective of the research was to empirically test Tett and Meyer (1993) integrated theory of job satisfaction, organizational commitment, and the relationship to voluntary turnover in order to find answers to the following quandary: (1) Is there a significant difference in organizational commitment to the hospital developed from job satisfaction such that commitment mediates the effects of satisfaction on withdrawal variables? (2) Does satisfaction and commitment contribute uniquely to the turnover process with no particular causality? (3) Is there a significant difference in organizational commitment to the hospital to engender a positive attitude toward the job through a rationalization process and nurses leave or stay based on how they feel about their jobs? Tett and Meyer (1993) show the correlation between value and continuance commitment suggests that the dimensions represent overlapping conceptual space. Even though affective and continuance commitment may increase the likelihood that an employee will remain with a company, the reasons for doing so are different. Individuals with a high degree of affective commitment remains because they choose to, and the those who have a strong continuance commitment stay because they fear a costly loss.