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長庚大學企業管理所
博士論文
Graduate Institute of Business and Management

Chang Gung University
Doctoral Dissertation

如何降低護理人員離職率：從新進護理人員到資深護理人員

How to Reduce Nurses’ Turnover Intentions: From New
Nurses to Experienced Nurses

指導教授：鄧景宜 博士
Advisor: Ching-I Teng, Ph.D.

研究生：Pham Thi Tuan Linh
Graduate Student: Pham Thi Tuan Linh

中華民國 109 年 4 月
April 2020



ACKNOWLEDGEMENTS
This dissertation was successfully completed thanks to all of the people
who supported me. Firstly, I would like to thank all Professors in Graduate
Institute of Business and Management of Chang Gung University, who have
provided me important and necessary knowledge during my study.
A special thank goes to my supervisor, Professor Teng Ching-I, for his
continuous instruction, supervision and support during my study and
dissertation. Professor Teng was always there to listen and to give advice to me

from the early preparation of this dissertation. He taught me how to do a
research and express the ideas in clear ways. He showed me different ways to
approach a research problem and the need to be persistent to achieve any goal.
Hence, my learning and research progress program were greatly improved.
Besides my supervisor, I would like to thank the committee members, who
gave valuable comments and contributions for my dissertation, from its
proposal version to the final one, which significantly helped improve my
dissertation.
Last, but not the least, I would like to convey my sincere thanks to my
family who supported me during my pursuit of PhD. program in Taiwan. I
would like to thank my lab-mates and international friends for unconditional
support and encouragement for me during my study and research in Taiwan.
Thank you all for enriching my doctor’s journey and my life.
Sincerely yours,
Pham Thi Tuan Linh


摘要
護理人員的缺乏是個醫療產業中國際等級的問題，指出減低護理人員
離職意願的研究之重要性。但是，目前很少研究提到護理人員中導師-導
生融洽關係，性格與人格，以及專業承諾與頭痛症狀之間的關係如何在
護理人員生涯早期、中期、發展完成後影響到護理人員離職意願。因
此，本論文旨在解釋(1) 護理人員中導師-導生關係如何影響離職意願；
(2) 性格與人格如何影響提高護理人員能力的行爲和離職意願等行動；以
及(3) 頭痛症狀與專業承諾之間的互相效應影響離職率。本論文透過釐清
護理人員離職率的潛在形成機制，為研究文獻貢獻新知識。本論文也為
護理管理者提供減低護理人員離職率的新穎見解。尤其是，護理管理者
因應創造出促進同事間融洽關係 ，提高護理人員的自我效能和職業興
趣，激發護理人員意願和行動來提升專業能力，並聆聽醫護人員對自己
健康議題的擔憂與工作環境，從而有效地保持護理專業工作人數。

關鍵字: 離職意願；護理人員； 融洽關係； 性格與人格； 專業承諾；
頭痛症狀


ABSTRACT
Nurse shortage is a global problem in healthcare industry, indicating the
importance of research on reducing nurses’ turnover intention. However, little
is known about how nursing mentor-mentee rapport, temperament and
characters, and the interaction between professional commitment and headache,
in early, developing and post-development stages of nursing career impact
nurse turnover intention. Hence, this dissertation aims to explain (1) how
rapport between nurse mentors and nurse mentees impact turnover intention, (2)
how temperament and character impact the action to improve professional
capabilities and turnover intention, and (3) how the interaction of headaches
and professional commitment impact turnover intention. The dissertation
contributes new knowledge to the literature by clarifying the mechanism
underlying the formation of nurses’ turnover intention. This dissertation offers
novel insights for nursing managers on how to reduce nurses’ turnover
intention. Specifically, nursing managers should create work environments that
facilitate rapport‐building, improve self‐efficacy and career interest among
nurses, motivate nurses’ intention and action to improve professional
capabilities, and listen to nurses’ concerns about their health issues, thus
effectively retaining nurse workforce.

Keywords: Turnover intention; nurse; rapport; temperament and characters;
professional commitment; headache


TABLE OF CONTENT

ACKNOWLEDGEMENTS .................................................................................................
CHINESE ABSTRACT .......................................................................................................
ABSTRACT .........................................................................................................................
TABLE OF CONTENT .......................................................................................................
LIST OF FIGURES .............................................................................................................
LIST OF TABLES ................................................................................................................
CHAPTER 1: Overall Introduction .............................................................................. - 1 1.1 Background ............................................................................................................ - 1 1.2. Structure of the Dissertation .................................................................................. - 4 CHAPTER 2: How Can Mentors Help Retain Nurses? Perspectives of Social Capital
Theory and Social Cognitive Career Theory ................................................................ - 6 Abstract ....................................................................................................................... - 6 K2.1. Introduction ........................................................................................................ - 7 2.2. Literature Review ................................................................................................ - 10 2.2.1 Social Capital Theory and Mentorship in Nursing .......................................... - 10 2.2.2 Rapport and Willingness to Mentor/Willingness to be Mentored .................... - 11 2.2.3 Social Cognitive Career Theory ..................................................................... - 12 2.2.4 Self‐efficacy, Outcome Expectations and Career Interest ............................... - 12 2.3. Methods .............................................................................................................. - 16 2.3.1 Sample and Data Collection Process .............................................................. - 16 2.3.2 Instrument ..................................................................................................... - 18 2.3.3 Data Analysis ................................................................................................ - 20 2.4. Results ................................................................................................................ - 21 2.4.1 Sample Profile ............................................................................................... - 21 2.4.2 Hypothesis Testing for the Mentors Sample ................................................... - 29 2.4.3 Hypothesis Testing for the Mentees Sample ................................................... - 30 2.5. Discussion ........................................................................................................... - 31 2.5.1 Main Findings and Contributions ................................................................... - 31 2.5.2 Discussion on the Non-supported Hypotheses ................................................ - 31 2.5.3 Theoretical Implications ................................................................................ - 32 2.5.4 Relevance to Clinical Practice........................................................................ - 33 2.5.5 Research Limitations and Future Research Directions .................................... - 34 -


2.6. Conclusion .......................................................................................................... - 35 CHAPTER 3: Impact of Temperament and Character on Action to Improve
Professional Capabilities and Reduce Nurse Turnover .............................................. - 36 Abstract ..................................................................................................................... - 36 3.1. Introduction ......................................................................................................... - 38 3.2. Literature Review and Hypotheses ...................................................................... - 40 3.2.1 Improvement in Professional Capabilities ...................................................... - 40 3.2.2 Nurse Turnover .............................................................................................. - 41 3.2.3 Temperament and Character Dimensions ....................................................... - 42 3.3. Methods .............................................................................................................. - 47 3.3.1 Sample and Data Collection Process .............................................................. - 47 3.3.2 Instruments .................................................................................................... - 49 3.3.3 Psychometric Properties ................................................................................ - 50 3.3.3 Data Analysis ................................................................................................ - 54 3.4. Results ................................................................................................................ - 54 3.4.1 Sample Profile ............................................................................................... - 54 3.4.2 Hypothesis Testing ........................................................................................ - 56 3.5. Discussion ........................................................................................................... - 58 3.5.1 Main Findings and Contributions ................................................................... - 58 3.5.2 Theoretical Implications ................................................................................ - 59 3.5.3 Managerial Implications ................................................................................ - 60 3.5.4 Research Limitations and Future Research Directions .................................... - 61 3.6. Conclusions ......................................................................................................... - 62 CHAPTER 4: How Professional Commitment and Headaches Interact to Impact Nurse
Professional Turnover Intention: Perspective of the Processing Efficiency Theory .. - 64 Abstract ..................................................................................................................... - 64 4.1. Introduction ......................................................................................................... - 65 4.2. Literature Review and Hypotheses ...................................................................... - 69 4.2.1 Professional Turnover Intention ..................................................................... - 69 4.2.2 Professional Commitment .............................................................................. - 70 2.3 Headache and Processing Efficiency Theory..................................................... - 71 4.3. Methods .............................................................................................................. - 74 4.4.4.3.1 Sample and Data Collection Process ........................................................ - 74 4.3.2 Instrument ..................................................................................................... - 75 4.3.3 Psychometric Properties ................................................................................ - 77 4.3.4 Data Analyses ................................................................................................ - 79 4.4. Results ................................................................................................................ - 79 -


4.4.1 Sample Profile ............................................................................................... - 79 4.4.2 Hypothesis Testing ........................................................................................ - 80 4.5. Discussion ........................................................................................................... - 85 4.5.1 Main Findings and Contributions ................................................................... - 85 4.5.2 Theoretical Implications ................................................................................ - 86 4.5.3 Implications for Nurse Managers ................................................................... - 87 4.5.4 Research Limitations and Future Research Directions .................................... - 88 4.6. Conclusions ......................................................................................................... - 89 CHAPTER 5: Overall Summary ................................................................................. - 90 REFERENCES ............................................................................................................ - 95 -


LIST OF FIGURES

Figure 1.1 Overall Research Framework

5

Figure 2.1: Research Framework

16

Figure 2.2: Analytical Results

29

Figure 3.1: Research Framework

46

Figure 3.2: Analytical Results

56

Figure 4.1: Research Framework

73

Figure 4.2: Interaction of Affective Commitment and Headache on

83

Online Gamer Loyalty
Figure 4.3: Analytical Results

84


LIST OF TABLES
Table 2.1: Summary of the Profile of Mentors

23

Table 2.2: Summary of the Profiles of Mentees

24

Table 2.3: Means, Standard Deviations, and Summary of Confirmatory

26

Factor Analyses (Mentor Sample)
Table 2.4: Means, Standard Deviations, and Summary of Confirmatory

27

Factor Analyses (Mentee Sample)
Table 2.5: Correlations among the Study Concepts (Mentor Sample)

28

Table 2.6: Correlations among the Study Concepts (Mentee Sample)

28

Table 3.1: Summary of Confirmatory Factor Analyses

50

Table 3.2: Correlations among the Study Constructs

52

Table 3.3: Summary of the Participant Profile

54

Table 4.1: Study Items and Summary of the Confirmatory Factor

77

Analyses
Table 4.2: Correlations among the Study Constructs

78

Table 4.3: Summary of the Participant Profile

79

Table 4.4: Sources of Professional Turnover Intention

82


CHAPTER 1: Overall Introduction

1.1 Background
The nursing workforce literature has well-established a shortage of
nurses. Recent estimates suggest that the shortage will continue to grow,
and may reach a shortage of 9 million nurses by 2030 (World Health
Organization, 2018). In a single country (i.e., United States), around 57%
of newly licensed nurses leave nursing profession within the first two
years (nurse.org, 2019). Furthermore, nurse shortage has been found as

associated with decreased patient outcomes (Aiken et al., 2017). One
strategy to address the nurse shortage is to reduce nurses’ professional
turnover intention, warranting further research into this issue.
The nursing literature has verified the antecedents of nurses’
turnover intention, including impacts of nursing school (Brown et al.,
2018), new graduate nurses’ residency mentoring program (AbuAlRub &
Alhaija’a, 2019), final clinical practicum experience, transition
experience from student to nurse (Kaihlanen et al., 2020), deteriorated
nursing work environment (Al-Hamdan, Manojlovich, & Tanima, 2017),
change-related self-efficacy (Vardaman et al., 2020), reduced
psychological capital, reduced organizational support (Brunetto, Rodwell,
Shacklock, Farr-Wharton, & Demir, 2016), continuance commitment
(Chang et al., 2015), and normative commitment (Gambino, 2010), a lack
of managerial support (Brunetto et al., 2016) and social support from
peers (Bruyneel et al., 2017; Rodwell et al., 2017). Such determinants
indicate that there are multiple factors impacting nurses’ turnover
intention, from early nurses to experienced nurses.
Nursing literature has categorized this continuum of nurse
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experience into several stages, which are: novice, advanced beginner,
competent, proficient, and expert nurses (Benner, 1984). According to this
nursing novice to expert model by Benner (1984), novice nurses and
advanced beginners have nursing experience of zero to two years, in
which nurses exhibit no or limited nursing experience. Competent nurses
and proficient nurses refer nurses who develop their nursing knowledge
and skills via professional learning. Expert nurses refer to nurses who
have accumulated solid experience and exhibit highly-proficient
performance via sufficiently long time of nursing professional practice.

Obviously, the above stages in Benner (1984) can be merged into
three stages that are more manageable and easier to distinguish nurses
who have varied experiences. Specifically, novice nurses and advanced
beginners could be merged as in their early stage; competent and
proficient nurses could be merged as in their developing stage; and expert
nurses should be in their post-development stage.
The previous nursing studies have investigated nurses in one of the
stages of nursing career, motivating the investigation in all the stages.
However, previous studies on nurses in each stages suffer from some
insufficiency. First, nurses in the early stage need to work under
supervision by their mentor nurses. Specifically, Tiew et al. (2017)
examined how nurse mentors can help mentees and recommended
mentorship as an effective retention strategy, suggesting the importance of
rapport between mentor nurses and mentee nurses. However, Tiew et al.
(2017) fell short of indicating how such rapport impacts the turnover
intentions of mentor nurses and mentee nurses. This insufficiency
warrants the first study of this dissertation.
Second, in the developing stage, nurses need to improve their
professional capabilities. To improve such capabilities, nurses need to
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devote much time and efforts, in together with their current nursing
workloads, posing much pressures. In this case, nurses’ personality traits
(e.g., temperament and character, a widely used typology) would affect
whether and how they persist in the actions to improve their professional
capabilities. Specifically, Eltaybani et al. (2018) examined the
relationship between educational opportunities (which can improve
professional capabilities) and nurses’ intention to stay in nursing
profession. However, Eltaybani et al. (2018) suffered an insufficiency of

not identifying which personality traits may motivate or hinder nurses to
utilize their educational opportunities and persist in the process of
improving their professional capabilities. This insufficiency warrants the
second study of this dissertation.
Third, in the post-development stage, nurses usually work in
high-pressure environments, exhibiting threats to their health, particularly
in the psychological aspect. Individuals work in high-pressure
environments likely have headaches, while some nurses have strong
professional commitment which may change nurses’ responses to
headaches. This potential interaction and its impact on nurses’ turnover
intention have not received any attention from the literature. Specifically,
Guerrero et al. (2017) identified the sources of professional commitment
and how it impacts nurses’ professional turnover intention, but was
insufficient in testing whether nurses’ headaches impacts the link between
their professional commitment and turnover intention. This insufficiency
warrants the third study of this dissertation.
To summarize, this dissertation has three purposes that aim to
address the above three insufficiencies, respectively: (1) examine how
rapport between nurse mentors and nurse mentees impact turnover
intention; (2) examine how temperament and character impact the action
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to improve professional capabilities and turnover intention; and (3)
examine how the interaction of headaches and professional commitment
impact turnover intention.
In sum, this dissertation comprises three studies, as above. Overall,
these studies are academically significant and practically relevant.
Academically, this dissertation clarifies the mechanisms underlying the
formation of turnover intention among nurses in three stages, i.e., early

stage, developing stage, and post-development stage. Practically, this
dissertation assists nursing managers to effectively retain nurses across all
the three nursing stages, thus offsetting the severe impact of nurse
shortage, i.e., maintaining nursing quality and patient health.
1.2. Structure of the Dissertation
Chapter 1 makes sense of the entire dissertation and its structure.
Chapter 2 describes the first study examining how the rapport between
nurse mentors and nurse mentees impacts turnover intention. Chapter 3
describes how nurses’ temperament and character impacts their action to
improve professional capabilities and turnover intention. Chapter 4
describes how headaches and nurses’ professional commitment determine
their turnover intention. Chapter 5 summarizes these studies, discuss on
their findings, and draw the conclusion.
Figure 1.1 illustrates the proposed research framework of this
dissertation.

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Figure 1.1 Overall Research Framework
Note: WTM=Willingness to Mentor/Be Mentored, IIPC=Intention to
Improve Professional Capabilities, APC=Affective Professional
Commitment, CPC=Continuance Professional Commitment,
NPC=Normative Professional Commitment.
The illustration of proposed hypotheses will be specified in the detailed
research frameworks of Study 1 (Chapter 2), Study 2 (Chapter 3), and
Study 3 (Chapter 4), respectively.

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CHAPTER 2: How Can Mentors Help Retain Nurses?
Perspectives of Social Capital Theory and Social Cognitive
Career Theory

Abstract
Aims and objectives: This study examines the impacts of mentor–mentee
rapport on willingness to mentor/be mentored, self‐efficacy, outcome
expectations, career interest and subsequently on nurses’ professional turnover
intention.
Background: Workplace relationships, whether positive or negative, influence
nurse turnover within an organisation. Yet little is known about the effects of
mentoring on nurses’ intentions to leave the nursing profession.
Design: A cross‐sectional, survey‐based research design was used to collect
data from a large medical centre in Northern Taiwan.
Methods: Study concepts were measured using scales from social capital
theory (SCT), social cognitive career theory (SCCT) and the nursing literature.
Partial least square structural equation modelling was used to test all study
hypotheses.
Results: For mentors, rapport was positively related to willingness to mentor,
which was positively related to outcome expectations, and further, positively
related to career interest and negatively related to professional turnover
intention. For mentees, rapport was positively related to willingness to be
mentored, which was positively related to self‐efficacy, outcome expectations
and ultimately to career interest. Career interest was negatively related to
professional turnover intentions.
Conclusions: Rapport between mentors and mentees may be an important
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means to retain nurses in the profession.
Relevance to clinical practice: Managers should consider taking steps to
enhance rapport between mentors and mentees. In doing so, managers improve
nurse retention, a critical component of providing high‐quality patient care.
Keywords: Nurse; social cognitive career theory; structural equation modeling;
survey.1

1

Acknowledgement: An early version of this chapter has been published by Journal of

Clincal Nursing (Pham, T. T. L., Teng, C.-I., Friesner, D., Li, K., Wu, W.-E., Liao, Y.-N.,
Chang Y.-T., & Chu, T.-L. (2019). The impact of mentor–mentee rapport on nurses’
professional turnover intention: Perspectives of social capital theory and social cognitive
career theory. Journal of Clinical Nursing, 28, 2669-2680.)1

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2.1. Introduction
Internationally, 87 countries have fewer than three nurses per 1,000
population (World Health Organization, 2018), making nursing one of the most
needed, and yet under‐staffed, professions (American Nurses Association, 2018)
and creating a critical nursing shortage. This shortage severely impacts clinical
practice (Buchan & Aiken, 2008), including the quality and safety of patient
care (Gilmartin, 2013). This shortage is exacerbated by the fact that, in some
countries, the existing workforce is either shrinking or not growing fast enough
to meet the needs of their patient populations. Retaining nurses who are
currently employed in the profession is an obvious, initial strategy to mitigate
the effects of the nursing shortage.

The nursing literature has explored the antecedents of nurses’ intentions to
leave an organisation and/or the profession, including a deteriorating work
environment (Al‐Hamdan, Manojlovich, & Tanima, 2017), workplace violence
(Zhao et al., 2018), psychological capital (Brunetto, Rodwell, Shacklock,
Farr‐Wharton, & Demir, 2016), quality of work life (Lee et al., 2017), job
satisfaction (Tsai & Wu, 2010), organisational commitment (Cheng & Liou,
2011), affective commitment (Perreira, Berta, & Herbert, 2018), continuance
commitment (Chang et al., 2015) and normative commitment (Gambino, 2010).
Among the aspects of deteriorated work environment, a lack of managerial
support (Brunetto et al., 2016; Gillet et al., 2018) and social support from peers
(Bruyneel, Thoelen, Adriaenssens, & Sermeus, 2017; Rodwell, McWilliams, &
Gulyas, 2017) motivated nurses to leave the profession.
Support from peers frequently takes the form of peer‐mentoring, which has
been shown to reduce stress, improve professional social development
(Sprengel & Job, 2004) and enhance professional socialisation (Bahn, 2001).
However, little is known about the impact of peer‐mentoring - either from the
perspectives of the mentors (the senior nurses who cultivate the capabilities of
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the recipients) or from mentees (the junior nurses who receive guidance) - on
nurses’ professional turnover intentions. A greater understanding of this
relationship may provide managers with additional tools to retain nurses.
To address this issue, this study focuses on the drivers of nurse retention.
Retaining nurses in the workforce requires considerable social capital (Read &
Laschinger, 2015). Hence, we adopt Social Capital Theory (SCT) as one
theoretical framework for our study. SCT formally defines social capital as
resources embedded in interpersonal networks that facilitate future
collaborations (Coleman, 1988). Social capital may include positive
mentor-mentee relationships, in terms of rapport and willingness to mentor/be

mentored (Pullins et al., 1996), motivating us to include rapport and
willingness to mentor/be mentored. Additionally, nurses’ interest in a nursing
career is critical in retaining them in the nursing profession (Gambino, 2010;
Thungjaroenkul et al., 2016). The key elements of Social Cognitive Career
Theory (SCCT) include self-efficacy, outcome expectations, and career interest.
In nursing contexts, these elements can be outcomes of nurses’ social capital,
justifying our adoption of SCCT and the inclusion of these elements.
Hence, the purpose of this study was to use concepts from social capital
theory (SCT) and SCCT to examine the effects of mentor–mentee rapport on
willingness to mentor/be mentored, self‐efficacy, outcome expectations, career
interest and consequently on nurses’ professional turnover intentions. The
overall contribution of this study is to demonstrate the importance of mentor mentee relationships in nurse retention, by theoretically and empirically
embedding the concept of mentoring (which is most frequently discussed in the
nursing education literature) within nursing management literature.
This study makes several unique contributions to the literature. First,
Thungjaroenkul, Cummings, and Tate (2016) applied SCCT to examine the
decisions of nurses to become nurse educators. This study also uses SCCT to
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examine career decisions (i.e., intentions to leave) among nurses, but it extends
previous studies by examining the impact of interpersonal factors (i.e., rapport,
willingness to mentor/be mentored) on intentions to leave the nursing
profession.
Second, Brunetto et al. (2016) examined psychological capital and
organisational support as antecedents of nurses’ intentions to quit. While our
study also examines the antecedents of nurses’ professional turnover intentions,
it adopts both SCT and SCCT to identify novel predictors of intentions to leave.
Third, Al‐Hamdan et al. (2017) identified work environment, job
satisfaction and managers’ dominant style as predictors of intentions to stay

among nurses. Our study also examines predictors of intentions to stay among
nurses (i.e., a weak intention to leave), but further postulates rapport in the
mentor–mentee relationship, and willingness to mentor/be mentored, as
predictors of these intentions.
2.2. Literature Review
2.2.1 Social Capital Theory and Mentorship in Nursing
Social capital refers to the resources accumulated from interpersonal
relationships. SCT posits that social capital facilitates collaboration in the
future (Coleman, 1988). These relationships are important to nurses, as greater
social capital improves mental health and enhances job satisfaction (Read &
Laschinger, 2015).
Social capital among nurses frequently develops through mentorship.
Mentorship (or peer‐mentoring) refers to the structural support that a mentor
provides to ensure role transition and talent development among mentees (Tiew,
Koh, Creedy, & Tam, 2017). Mentorship has been shown as crucial to nursing
students during clinical placement (Jack et al., 2018). Effective mentorship
could reduce anxiety among nursing students (Sprengel & Job, 2004) and helps
them persist in their educational programmes (ten Hoeve, Castelein, Jansen, &
- 10 -


Roodbol, 2017). As nursing students graduate and enter into professional
practice, they may continue to value peer‐mentoring. Clinical supervisors who
mentor newly licensed nurses may help these new nurses alleviate job‐related
stress (Blomberg et al., 2016).
2.2.2 Rapport and Willingness to Mentor/Willingness to be Mentored
Rapport refers to effective interpersonal communication that facilitates
shared decision‐making (Hutchinson et al., 2017). Rapport between patients
and nurses is central to the care experience (Jangland, Kitson, & Muntlin Athlin,
2016). However, the relationship between rapport and mentoring among nurses

has not been extensively explored in the literature.
Rapport with a mentee may contribute to the willingness to mentor, that is,
a mentor's motivation to support a mentee (Pullins, Fine, & Warren, 1996).
Concomitantly, a willingness to be mentored refers to a mentee's readiness to
receive instructions and training (Pullins et al., 1996). Willingness to be
mentored has not been extensively examined in the nursing literature, except
that mentees value constructive feedback to ensure effective learning (Tiew et
al., 2017). That is, mentors who build a rapport with their mentees may find
that their mentees have enhanced willingness to be mentored, increasing the
intrinsic rewards that accrue from mentoring and the willingness to mentor.
Rapport reflects intangible resources in interpersonal relationships and
represents social capital, facilitating shared decisions (Hutchinson et al., 2017)
and collaboration (Coleman, 1988). Within the context of nursing mentoring,
social capital (including rapport) helps facilitate cooperative learning. Positive
collaborations with their mentors may enhance mentees’ willingness to be
mentored (Pullins et al., 1996). Hence, we hypothesise:
H1: Mentor–mentee rapport is positively related to (a) mentors’
willingness to mentor and (b) mentees’ willingness to be mentored.

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2.2.3 Social Cognitive Career Theory
Social cognitive career theory (SCCT) posits that self‐efficacy and
outcome expectations play major roles in forming career interests (Lent, Brown,
& Hackett, 1994). Self‐efficacy characterises individuals’ beliefs about abilities
to succeed in particular activities related to their career; outcome expectations
represent individuals’ beliefs about the outcomes in the chosen career (Lent et
al., 2015).
Social cognitive career theory has been employed to characterise the

associations among career interest, self‐efficacy and perceptions between
nursing students and undecided students groups. SCCT could also explain the
impacts of past performance in teaching, social influence and supervision on
self‐efficacy, outcome expectations and students’ interests in becoming nurse
educators (Thungjaroenkul et al., 2016). The wide application of SCCT in
nursing supports the use of SCCT as a theoretical underpinning for this study.
2.2.4 Self‐efficacy, Outcome Expectations and Career Interest
Willingness to mentor represents a mentor's motivation to support a mentee
(Pullins et al., 1996). Nurses’ support for the mentees could include sharing
professional experiences, including how these mentors overcame workplaces
challenges. Sharing experiences reminds mentors of exemplary past
performances, which reinforces the mentors’ self‐confidence. Self‐confidence
is the core of self‐efficacy (Lent et al., 2015); hence, we hypothesise a positive
link between willingness to mentor and self‐efficacy among nurse mentors.
A mentee's willingness to be mentored is the readiness to receive formal or
informal instruction from a mentor (Pullins et al., 1996). In nursing, readiness
to receive instruction prepares mentees to observe and imitate the professional
practice of their mentors, that is
vicarious learning (Lent et al., 1994). Vicarious learning helps mentees achieve
a desired level of performance in an efficient manner. This instills confidence
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in mentees and is core to self‐efficacy (Lent et al., 2015). Hence, we
hypothesise:
H2a: Willingness to mentor is positively related to self‐efficacy in mentors.
H2b: Willingness to be mentored is positively related to self‐efficacy in
mentees.

Willingness to mentor represents a mentor's motivation to help improve the

skills and knowledge of a mentee (Pullins et al., 1996). Improved skills and
knowledge facilitate enhanced workplace performance. As nursing mentorships
are formally recorded, mentees’ successes imply that the mentors are successful
in mentoring. This benefits both the organisation (which retains two
employees), and the mentor, who may be rewarded intrinsically or extrinsically
(through recognition, promotions or salary increases), leading mentors to
expect greater outcomes (Cunningham, Bruening, Sartore, Sagas, & Fink,
2005), supporting a positive link between willingness to mentor and outcome
expectations among mentors.
Mentees’ willingness to be mentored is their readiness to acquire skills and
knowledge from mentors (Pullins et al., 1996). In nursing, skills and knowledge
acquisition should significantly improve mentees’ performance. Improved
performance also enhances mentees’ expectations of intrinsic and extrinsic
rewards (e.g., salary increases and promotions), that is, enhanced outcome
expectations (Cunningham et al., 2005). Therefore, we hypothesise:
H3a: Willingness to mentor is positively related to outcome expectations in
mentors.
H3b: Willingness to be mentored is positively related to outcome
expectations in mentees.
Self‐efficacy is the belief in one's capability to achieve success (Lent et al.,
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2015). Perceived capabilities (if accurate) are realized through exemplary
performance, which further contributes to a positive perception of one's
capabilities. Positive feedback reinforces confidence in one's capabilities, and
the willingness to engage in the activity (Bandura, 1986). Hence, positive
self‐efficacy should create a sustained interest in a nursing career, which is
defined as career interest (Lent et al., 2015). Therefore, we hypothesise:
H4: Self‐efficacy is positively related to career interest.

Self‐efficacy represents the belief in one's capability to succeed in a career
(Lent et al., 2015). Nurses with high self‐efficacy are more likely to expect to
perform (and actually perform) their workplace tasks successfully. Over time,
positive performance should increase one's salary, create promotion
opportunities and generate other rewards such as job satisfaction. Expectation
of these rewards is an outcome expectation (Cunningham et al., 2005).
Therefore, we hypothesise:
H5: Self‐efficacy is positively related to outcome expectations.

Individuals who experience success in an endeavour are more likely to find
that endeavour rewarding and are likely to undertake similar endeavours in the
future (Bandura, 1986). If a nurse experiences both workplace success and
outcome expectations based on that success, that nurse may be more motivated
to continue the chosen area of practice (Cunningham et al., 2005). Thus, nurses
with higher outcome expectations are more likely to be retained in the
profession. An interest in, or willingness to, remain in a profession is defined as
career interest (Thungjaroenkul et al., 2016). Hence, we hypothesise:
H6: Outcome expectations are positively related to career interest.

Hypotheses 4–6 have been empirically examined among nursing students
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(Thungjaroenkul et al., 2016). However, H4–H6 have not been thoroughly
vetted among practicing nurses. Given their relevance to SCCT, and the paucity
of research testing these hypotheses among practicing nurses, we retain these
hypotheses in our study.

2.2.5 Intention to Leave
Nurses’ professional turnover intentions are of vital importance to nurse

managers and health policymakers (Chang et al., 2015). Mitigating professional
turnover intentions are an important first step in ameliorating the shortage of
nurses in many countries, which is, in turn, critical in ensuring population
health (Brunetto & Teo, 2013).
Career interest represents nurses’ interests to continue working in the
profession (Thungjaroenkul et al., 2016). A sustained interest in the profession
simultaneously suggests a reduced professional turnover intention, posing a
negative link between career interest and professional turnover intention. This
relationship stems directly from SCCT, which posits that career interest results
in outstanding job performance (Lent et al., 1994), which should increase the
value of these nurses to others in the organisation (e.g., supervisors, peers) and
to their patients. Organisations likely take steps to retain them within the
organisation, further reducing these nurses’ professional turnover intentions.
Hence, we hypothesise:
H7: Career interest is negatively related to professional turnover
intentions.

Figure 2.1 illustrates the research framework. This framework augments
the propositions of SCCT (i.e., H4, H5 and H6) with novel antecedents rapport and willingness to mentor/be mentored – through their impacts on
self‐efficacy and outcome expectations.
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