The effect of transformational leadership on nurses’ turnover intention: the mediating effects of person-organization fit and career calling

The global healthcare industry continues to face an unprecedented staffing crisis, driven largely by alarmingly high rates of nurse turnover. Annual turnover rates for clinical nurses range drastically from 15.1% to 44.3% across various international jurisdictions, while comprehensive nationwide studies in China indicate that nearly half of all clinical nurses—specifically 49.58%—harbor active intentions to leave their positions. This persistent hemorrhage of skilled medical personnel exerts severe financial burdens on healthcare institutions and directly compromises patient care quality, exacerbates workloads, and accelerates burnout among the remaining staff. In response to this compounding crisis, a major new study published in Frontiers in Psychology explores the intricate psychological mechanisms through which supportive leadership styles can reverse these trends and stabilize the healthcare workforce.

Research Design and Methodology

To investigate how management behavior influences career longevity, a team of researchers conducted a large-scale, cross-sectional study across four prominent Grade A tertiary hospitals in Shandong Province. The investigation spanned from October to November 2025, utilizing a rigorous convenience sampling method to survey clinical nursing staff. Following strict methodological guidelines, the research team distributed comprehensive survey instruments designed to capture nuanced data regarding leadership dynamics, workplace compatibility, and career motivations.

From an initial pool evaluated against strict inclusion criteria—requiring a valid nursing license, a minimum of one year of clinical experience, and voluntary informed consent—the study successfully enrolled 1,342 qualified participants. The demographic profile of the cohort reflected the broader realities of the nursing profession: the sample was overwhelmingly female at 91.9% (1,233 participants), with the largest age bracket falling between 31 and 40 years old (52.0%). Furthermore, 76.3% of respondents were married, and 88.7% held a bachelor’s degree. Mid-to-senior career personnel formed the core of the respondents, with senior nurses and nursing-in-charge titles comprising nearly 75% of the total cohort.

Data collection utilized standardized, highly reliable psychometric scales. Transformational leadership was evaluated using a localized 26-item scale measuring moral exemplification, visionary inspiration, charisma, and personalized concern. Turnover intention was measured via a validated six-item scale, while person-organization fit and career calling were assessed through established multidimensional frameworks. Analytical validation via Confirmatory Factor Analysis (CFA), Harman’s single-factor tests, and structural equation modeling confirmed strong construct validity, adequate reliability, and the absence of debilitating common-method bias.

Unpacking the Pathways of Retention

Grounded in social exchange theory—which posits that individuals who receive valuable socioemotional resources feel a psychological obligation to reciprocate with positive workplace behaviors—the study examined both direct and indirect relationships. The statistical analysis revealed a powerful negative correlation between transformational leadership and nurses’ intent to leave, establishing that visionary and supportive management directly dampens the desire to resign.

However, the study’s most critical contribution lies in its mapping of indirect psychological pathways. The research demonstrated that transformational leadership does not operate in a vacuum; rather, over half of its protective effect is channeled through three distinct secondary mechanisms: person-organization fit alone, career calling alone, and a sequential chain linking the two.

Specifically, the data showed that transformational leaders significantly enhance person-organization fit by aligning institutional values with individual competencies, thereby fostering a deep sense of belonging and compatibility. Simultaneously, such leaders cultivate career calling by helping nurses find profound personal meaning, intrinsic motivation, and vocational purpose in their daily duties. Most notably, the research confirmed a sequential chain mediation pathway: when leaders successfully improve an employee’s perceived organizational fit, that enhanced alignment subsequently bolsters the nurse’s career calling, which ultimately results in a dramatic reduction in turnover intention.

Quantitative Findings and Statistical Breakdown

The empirical results provide robust mathematical backing for the hypothesized relationships. Transformational leadership exhibited a significant negative direct effect on turnover intention ($beta = -0.184, p < 0.001$). The total effect of transformational leadership on reducing intent to leave stood at $-0.088$, broken down into a direct effect of $-0.041$ (accounting for roughly 46.6% of the total impact) and a combined indirect effect of $-0.047$ (accounting for 53.4%).

Evaluating the individual indirect pathways via bootstrapping methods with 5,000 resamples revealed:

• Path 1 (Person-Organization Fit): Transformational leadership indirectly reduced turnover intention through organizational alignment, accounting for 22.50% of the total effect (point estimate $-0.020$).
• Path 2 (Career Calling): Leadership similarly influenced retention by nurturing professional purpose, contributing 23.41% to the total effect (point estimate $-0.021$).
• Path 3 (Sequential Chain): The chained mediation pathway—moving from leadership to organizational fit, then to career calling, and finally to retention—accounted for 7.95% of the total effect (point estimate $-0.007$).

All indirect pathways demonstrated strict statistical significance, as their respective 95% confidence intervals excluded zero. Furthermore, multicollinearity diagnostics confirmed that variance inflation factor (VIF) values for all variables remained well below the critical threshold of 5, ensuring the stability and reliability of the regression models.

Institutional Implications and Policy Recommendations

The implications of these findings extend far beyond academic theory, offering actionable roadmaps for hospital administrators and nursing executives grappling with staffing shortages. Given that transformational leadership accounts for nearly half of its retention power through direct socioemotional support, healthcare organizations must pivot away from purely transactional management styles. Investing in leadership training programs designed to foster empathy, intellectual stimulation, and individualized concern among nurse managers is no longer optional; it is an economic and operational imperative.

Furthermore, hospital policies must be engineered to intentionally strengthen person-organization fit. Transparent recruitment protocols, values-based onboarding, and regular alignment checks can bridge the gap between institutional objectives and nurse expectations. Concurrently, cultivating career calling requires structural interventions such as recognizing clinical excellence, providing clear pathways for professional growth, offering workload autonomy, and designing mentorship ecosystems that remind frontline staff of the profound societal value inherent in their work.

Broader Economic and Clinical Impact

Addressing the nursing shortage through leadership development and psychological alignment yields compounding benefits for the entire healthcare ecosystem. Financially, reducing turnover rates ranging up to 44% saves institutions millions of dollars annually in recruitment, onboarding, and temporary staffing expenditures. Clinically, a stable nursing workforce directly translates into enhanced continuity of care, lower medical error rates, improved patient safety metrics, and diminished burnout-related absenteeism.

As healthcare systems worldwide navigate the post-pandemic landscape, the insights provided by this study underscore a fundamental truth: retaining nurses requires more than competitive compensation. It demands relational leadership that honors the psychological contract between the worker, the institution, and the noble calling of the nursing profession itself.