Examining the Impact of Person-Centred Climate on Nurses’ Turnover Intention Using Structural Equation Modelling

A supportive practice environment is essential for effective person-centred care. When nurses are not enabled to act according to their professional values, they may experience moral distress, potentially leading to disengagement and increased turnover intention. Although the impact of the practice environment on nurse outcomes is well documented, the pathways linking person-centred climate to turnover intention remain underexplored. This study aimed to test theoretical models linking these factors. Methods: We conducted a cross-sectional study of nurses (n=573) from multiple acute care hospitals and long-term care facilities within a major healthcare organization. Validated instruments were used to assess key constructs. Model A posited that nurses’ prerequisites, the practice environment, and person-centred processes predict the perceived person-centred climate. Model B examined whether person-centred climate influences turnover intention, mediated by moral distress, cool-out, and job satisfaction. Model B was cross-validated in a second sample (n=593) with shortened instruments. Structural equation modelling was performed using the lavaan package in R. Results: Both models showed acceptable fit after minor, theoretically justified modifications (Model A: CFI=0.930, RMSEA=0.060; replicated Model B: CFI=0.951, RMSEA=0.049). In Model A, predictors explained 51.8% of the variance in person-centred climate. The practice environment emerged as the sole significant predictor of a person-centred climate (β=0.74, p<0.001) and mediator (β=0.50, p<0.001) between nurses’ prerequisites and person-centred climate. Model B replicated well, with consistent structural relationships, explaining 59.4% of the variance in turnover intention. Person-centred climate was indirectly associated with lower turnover intention via job satisfaction (β=-0.42, p<0.001) and, to a lesser extent, via both job satisfaction and cool-out (β=-0.17, p<0.001). The indirect path through moral distress was negligible and non-significant (β=-0.007, p=0.757). Conclusions: Fostering person-centred environments is important to support nurse retention. Future research should further explore mediating mechanisms to inform retention efforts.