The Impact of Organizational Culture on Career Leaving Among Nurses: Examining Global Nurses’ Shortage Through the Lenses of Organizational Culture: A Systematic Review

The Impact of Organizational Culture on Career Leaving Among Nurses: Examining Global Nurses’ Shortage Through the Lenses of Organizational Culture: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review The Impact of Organizational Culture on Career Leaving Among Nurses: Examining Global Nurses’ Shortage Through the Lenses of Organizational Culture: A Systematic Review Evans Kasmai Kiptulon, Mohammed Elmadani, Anna Szőllősi, Dahabo Adi Galgalo, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5308085/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Globally, healthcare settings are facing significant nursing staff shortages occasioned by nurse turnover and experiencing difficulties in recruitment and retention of nursing professionals. The pressure of shortage of nurses and other healthcare workforce is so severe that World Health Organization has warned European countries and the globe that this shortage is a “ticking timebomb” if an action is not taken. Organizational culture is an important antecedent of nurse turnover that remains weakly studied. Despite a plethora of research on the global shortage of nurses and turnover, there have been few dedicated systematic literature reviews, and this study aimed to fill this gap. Objective: To collect and collate evidence available in the literature on the impact of organizational culture on career and professional leaving among nurses and emphasize the critical role of organizational culture in turnover and retention of nurses. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive literature search according to the Population, Exposure and Outcome search strategy model was performed in six major electronic databases, including PubMed, Ovid Medline, Embase, CINAHL, Scopus and Web of Science, in July 2023. Studies that met the inclusion criteria set were screened using Rayyan and Covidence. Mixed Methods Appraisal Tool was used to assess the quality and risk of bias of the included articles. RESULTS: The search yielded a total of 2,396 articles, of which 30 were included. The results demonstrate that nurse turnover remains a complex issue and continues to plague nations of the world. Organizational culture is an important antecedent of nurse turnover, with different types of organizational culture affecting turnover differently. We found overall that, negative organizational culture and climate was consistently associated with nurse’s turnover while positive culture improved nurse retention. Conclusion: This study confirmed that organizational culture seriously influences nurse turnover. Nurse managers and hospital managements should strive to continuously monitor and build positive organizational cultures to raise quality of service delivery and retain nurse workforce. Nursing Organizational culture shortage of nurses turnover turnover intention leadership nurse administrators systematic literature review Figures Figure 1 INTRODUCTION Nurses are the driving force and foundational human resource for healthcare systems around the world [1, 2] .According to a report titled "The State of the World's Nursing 2020" developed by the World Health Organization(WHO) [3]and its partners from 191 countries, nurses are the largest occupational group in the global health sectors, with over 27.9 million members, and make approximately 59% of the healthcare workforce. Despite nurses being the largest professional group in global health systems, the shortage of nurses remains a global concern [4-6]. The WHO reiterates in its previous global reports and action plans that the lack of nursing personnel continues to stress global healthcare systems and has become a health catastrophe. The global shortage of nurses, estimated at 6.6 million in 2016, fell marginally to 5.9 million in 2018 but rose in 2020 to 7.07 million, with approximately 89% of this shortage concentrated in low- and lower-middle-income countries, primarily in Africa and Asia[3]. The Global Burden of Disease (GBD) study in the same year 2020 [7] estimated that the global shortage of nurses was at an alarming high of 30.6 million, which spells doom for global healthcare systems. This situation prompts us to ask the question “what’s the exact global shortage of nurses”. There are numerous factors that have been recognized as contributing to the global shortage of nurses. Many nurses are abandoning their careers and nursing profession due to organizational culture issues and other push and pull factors[8]. The ageing global population is increasing the demand for nursing care as world’s elderly population is rapidly growing, with the population aged 60 and over, in 39 countries of OECD, especially within European Union and other developed countries outpacing the total population growth in recent decades[9-11]. The worldwide human population is also increasing, particularly in Africa, putting pressure on the demand for additional nurses to provide nursing services to the growing population[12]. Furthermore, the worldwide nursing workforce is ageing. Many senior nurses are approaching retirement age, according to the International Council of Nurses (ICN) 2023. The report alludes that one out of every six nurses now employed will retire over the next ten years. This means that 4.7 million nurses must be trained, hired, and deployed to replace those who are retiring[13]. Chronic diseases and global pandemic outbreaks such as COVID-19, Ebola, Zika virus and influenza H1N1 have further increased the nursing demand. In addition, women predominate the nursing profession. Nine in every ten nurses globally are women[13, 14]. As a result, career and family conflict increases nursing shortages. For example, during childbirth years, female nurses will cut back, take maternity leave, or leave the profession altogether to take care of their babies[15]. Nurses around the world also face heavy workloads in tough working conditions, which has led to an increase in incidences of emotional distress, mental exhaustion, and nurse burnout [16]. Burnout among nurses is one of the primary causes of nurse turnover[16-20]. Aside from these issues, many countries have not spent adequately in educating an adequate number of nurses to satisfy their local demands, and many lack proper educational, financial, and other needful policies. There is a major bottleneck in nursing teaching occasioned by a shortage of nursing educators and faculty members; thus, a limited number of nursing students nursing faculties admit and sustain[13]. Professional stereotypes and media profiling nursing profession negatively have also contributed to the shortage of nurses by negatively constructing and painting images of nursing, hence dampening the young generation joining colleges from selecting nursing as a future career[21-26]. Nurses’ career leaving, also called nurse turnover, can be defined as the separation of an employee from a job or organization[27].It is an event in which an employee terminates their employment by leaving the hospital [28] . Nurses’ turnover and intention to leave their careers, the nursing profession, or the healthcare sector entirely is one of the major global nursing and public health concerns exacerbating the global nurse shortage[1, 29-31]. Although there are inconsistencies in the definition of “turnover intention” and “turnover”, turnover intention is the desire of an employee to quit their current job within a certain period of time, while turnover is the actual act of leaving or exiting the job entirely[32] .The terms “turnover intention (TI)" and "intention to leave (ITL)" are synonyms and mean having a desire to quit one’s career. The construct of turnover intention is a multistage process that starts with psychological responses to negative aspects of the current job and could lead to the decision to quit a career (turnover)[33]. Nurse turnover jeopardizes healthcare delivery in several ways. Apart from causing a global nurse shortage, it negatively influences an organization’s capacity to meet patient needs in providing quality healthcare due to the disruption of service delivery. This endangers patients’ safety[34]. It also affects the morale and productivity of the remaining nursing colleagues who are forced to work extra longer shifts and overtime to cover the workload of those who have left. This could lead to higher rates of work-related stress and burnout and worsen nurse turnover[35]. Nurse turnover is costly to organizations. It increases the cost of doing business and employing, training, and deploying new nursing staff. Indirect costs must also be borne, including the cost of termination of employees, the costs lost when the position is left unfilled, marketing costs, orientation costs and training of new employees[36]. When employees leave, employers lose not only monetarily but also valuable information and experience, skill and expertise that takes time to regain[37]. On the other hand, research has found that nurses who have high levels of intention to leave their career or organizations have high rates of absenteeism, are less committed to their work, are less engaged and commit many deadly medical errors[37] 1.1. ORGANIZATION CULTURE IN NURSING In the literal context, culture is the ideas, customs, laws, traditions, beliefs, social standards, social behaviour, architectural style and dress of a particular people or society that helps in their identity and bonding[38]. The term “culture” was first defined by the pioneer English anthropologist Edward B. Tylor in his book Primitive Culture, published in 1871: “As the complex whole which includes knowledge, belief, art, law, morals, custom, and any other capabilities acquired by man as a member of society”[39]. The term "organization" refers to a structured group of individuals who work together to achieve a similar goal, such as nurses who work together in hospitals to provide quality nursing and medical care. Organizational culture (OC) is derived from the two definitions “organization” and “culture”, and it refers to the shared values, beliefs, behaviours, and perceptions held by employees within an organization or a workplace[40-43].It may also be defined simply as “the way things are done around here”[44]. OC is a management concept, and which is communicated and learned within an organization[45]. For this review, we took OC as a key antecedent of turnover and turnover intention. Organizational culture determines how employees in the organization share values, beliefs, structures, routines, rules, and norms that serve to guide and constrain behaviour[46]. It is “the social glue holding an organization together”[47]. Schein said that organizational culture consists of artefacts, beliefs, assumptions, and shared values learned by employees as they work, and over time, they become unconsciously part of them. He further noted that, “culture is an abstraction, yet the forces that are created in social and organizational situations that derive from culture are powerful and if we don’t understand the operation of these forces, we become victim to them”[43]. An organization’s mission, vision, strategy, structure, leadership, and human resource practices are important determinants of organizational culture[47]. Leadership and organizational culture are two sides of the same coin[48]. Top management teams create organizational culture based on their histories and personalities[43]. The global crisis in the shortage of nurses due to nurse turnover can be approached with the help of positive organizational culture, good leadership, human resource practices and proper strategies. Over a long period of time, organizational culture has been in use in business contexts where business managers have used it to influence performance and productivity and raise organizations’ profits. However, little effort has addressed organizational culture and its effects in health and nursing[49], especially in relation to nurse shortages and turnover. Organizational culture is classified into two major categories: positive and negative organizational culture. A positive organizational culture in nursing promotes teamwork, unity, and communication, builds mutual trust and collaboration among nurses, enhances innovation and creativity, and treats employees as more important in the organization's life[46, 50]. It values the contributions of each individual and encourages open and honest communication. Such a culture fosters a sense of belonging and purpose among nurses and helps them feel motivated and engaged in their work, increasing job satisfaction and productivity, and hence reducing work-related stress and turnover[40, 42, 43, 47, 51, 52]. A negative organizational culture is inversely true. Research on the impact of organizational culture in nursing, although few, have focused on its impact on patient outcomes and has shown that, a positive organizational culture is related to positive patient outcomes (satisfaction, patient experiences, mortality, pain levels, cost of care, patient knowledge, quality of life, readmission rates, adverse effects, medication errors, patient falls, depression and pressure ulcers, among others[53] and that a negative organizational culture is negatively related to patient outcomes. Other studies have focused on nurses’ job satisfaction[35, 54-56] and the cost of health care services and employee performance[51]. Despite a plethora of research on the global shortage of nurses and nurse turnover, few dedicated systematic literature reviews have focused on the impact of organizational culture on nurses’ turnover and turnover intentions. This review therefore focused to fill this gap. 1.2. Aim of the review This review aimed to collect and collate evidence available in the literature on the impact of organizational culture on career and professional leaving among nurses. METHODS 2.1. Study design This study employed a systematic review, and its methods are based on the Cochrane Handbook for Systematic Reviews of Interventions[57]. The selection process is reported in PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow chart[58]. The priori protocol for the study was registered in PROSPERO with registration identification number: CRD42023440170 2.2. Search Strategy and Selection Criteria A comprehensive systematic literature search according to the Population, Exposure and Outcome (PEO) model [59] was performed in six major electronic databases, including PubMed, Ovid MEDLINE, EMBASE, CINAHL, Scopus and Web of Science, on 16 th July 2023. The PEO represents Population (nurses), Exposure (organizational culture) and Outcome (career turnover/turnover intention or intention to leave career or intention to leave profession). The search approach used the Boolean operator “OR” between key synonym words and joined them with “AND” to complete the search. For keywords used and the full search strategy used, see the supplementary File Table S1 named “search strategy”. To identify reference lists of articles included, both electronic and manual searching techniques were used. When only abstracts were found, authors of those records were contacted via email, research gate or available communication methods to request information about any published papers of the abstracts. For inclusion, all the studies needed to meet the following criteria: (a) be from any country and conducted on nursing personnel irrespective of cadre as the study population, (b) original articles in English, (c) studies that used any study design without restricting the year of publication, and (d) turnover or turnover intention as an outcome, and the turnover/turnover intention was related to organizational culture or organizational culture variables. The following studies were excluded: conference papers, systematic literature reviews and meta-analyses, letters/opinions, editorials, essays, case studies and literature, comments or narrative articles with no abstracts and full-text articles in languages other than English, studies with no nurse participants or mixed nurses and other cadres' participation, and articles without free access. The results of the database searches were transferred into EndNote and then to the RAYYAN program for deduplication and screening. After deduplication, two authors, EKK and ME, independently performed title and abstract screening for each study. Cochrane software for systematic reviews (COVIDENCE-www.covidence.org) was used for the full-text screening phase. Two authors working together for each study, among, EKK, ME, GAW, AS and DAG, conducted independent reviews of each article to determine its eligibility for inclusion. Disagreements on the articles during screening were resolved through discussion and consensus by the two authors. Where consensus was not reached, a third reviewer was engaged. 2.3. Data Extraction and Data Synthesis Data extraction was performed using a standardized Excel form that extracted the following data from the included articles: the main author, year of publication, the country where the research was conducted, main objective/aim of the study, study design, sample size, study population, study setting, response rate, exposure characteristics (organizational culture type or variable) and instruments used for measurement, outcome characteristics (turnover or turnover intention) and instruments used for measurement and key findings. The data were organized into tables . Data synthesis was done qualitatively and narratively . 2.4. Risk of bias (quality) assessment The Mixed Methods Appraisal Tool (MMAT)[60] was used to evaluate the quality of the included studies. MMAT is a critical appraisal tool that is designed for the appraisal stage of systematic mixed studies reviews, i.e., reviews that include qualitative, quantitative, and mixed methods studies. It has 5 sections that allow to appraise the methodological quality of five categories of studies: qualitative research, randomized controlled trials, nonrandomized studies, quantitative descriptive studies, and mixed methods studies. This tool comprises two parts: a checklist (Part I) and an explanation of the criteria (Part II). Part I has two checklist questions that an article must fulfil for it to be subjected to Part II’s main appraisal. Part II contains 5 questions for each type of study, and responses are given in the form of “Yes’ ‘No’ or ‘Can’t tell’. “Yes” is scored 1 or one star (*), which represents 20%, and ‘No’ or ‘Can’t tell’ both are scored 0, which is 0%. For this research, included articles that scored below 60% were not reported. All our articles were assessed using section 4 (for quantitative descriptive studies), as all the studies fulfilled the requirements for this section. EKK and ME independently appraised the articles and discussed the adopted results. RESULTS The comprehensive search produced a sum of 2,396 articles. A total of 1,010 studies (839 duplicates and 171 other articles) were removed, and 1,386 studies were screened for title and abstract. After title and abstract screening, 1273 studies were excluded, 113 were sought for retrieval, and ninety-five articles were assessed for eligibility by full-text screening. Thirty-three articles were included, while 62 studies were excluded ( see figure 1. PRISMA flow diagram ). 3.1. Characteristics of the included studies Out of 95 articles that were assessed through full-text eligibility, 30 articles fully met the inclusion criteria. The articles were from 17 different countries, with the majority coming from South Korea (5), China (3), Saudi Arabia (3), Hong Kong, Jordan, Turkey, Pakistan and the USA having two articles each. The rest of the countries had one article each. These articles were published between 2006 and 2023, with 80% (n=24) published between 2017 and 2023. Most of the studies (n=6) were published in 2020, followed by 2017 (n=5), and 2021 and 2022 had four articles each published (see supplementary file Figure S1, S2 and supplementary file of raw data Table S2). The cumulative sample size for all the studies was 16,429 nurses. The study setting for all studies was a hospital setup except for[40], which was done in a nursing home, and[61], which was done among infection control nurses (ICNs) who were attending the 2018 ICNs summer conference held in Korea. All 30 articles scored between 60%-100% in quality, indicating a high-quality index ( see Table 1 below). TABLE 1. Appraisal of the methodological quality of included studies ( Mixed Methods Appraisal Tool MMAT) (n = 30) Question Criteri Included Studies Choi,et al 2022. Munir et al,2018. Lee et al,2022 Wubetie et al, 2020. Alsufyani et al, 2021. Çaylak et al, 2017 Stone et al,2006 Galletta et al, 2011 Cao et al,2020 Lee et al,2020 Huang et al, 2019 Zahednezhad et al,2021 Alharbi 2020 Wan et al, 2018 Ishihara et al, 2014 Alilyyani et al, 2022 Labrague et al,2017 Banaszak-Holl et al, 2015 Widodo et al,2021 Majeed et al,2021 Jacobs et al,2011 Goyal et al, 2023 Kharabsheh et al., 2017) ArslanYürümezoğlu 2019 Choi et al, 2022 Choi et al,2020 AbouHashish 2017 Park et al,2009 Siket Ujváriné et al,2020 AbuAl Rub et al,2017 Choi,et al 2022. Munir et al,2018. S.1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y S.2 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 4.1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4.2 0 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 1 4.3 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 4.4 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 0 0 1 0 1 1 0 1 1 1 1 1 1 0 1 4.5 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 Quality 60% 60% 100% 100% 100% 100% 80% 100% 100% 100% 100% 100% 80% 100% 100% 80% 100% 80% 60% 100% 80% 100% 100% 80% 100% 100% 100% 100% 100% 100% 60% 60% 5***** or 100% quality criteria met, 4**** or 80% quality criteria met, 3*** or 60% quality criteria met, 2** or 40% quality criteria met and 1* or 20% quality criteria met. KEY S.1 Are there clear research question? S.2 Do data collected allow to address the research questions? 4.1 Is the sampling strategy relevant to address the research question? 4.2 Is the sample representative of the target population? 4.3 Are the measurements appropriate? 4.4 Is the risk of nonresponse bias low? 4.5 Is the statistical analysis appropriate to answer the research question? 3.2 Career and professional turnover among nurses Of the included articles, more than half (n=16) reported the rate of nurse turnover. The other articles measured turnover through structural equation modelling and other methods; hence, turnover is indicated as “Not Reported”, i.e., (NR). The nurse turnover rate was highest in South Korea (41.13 ± 6.40 out of 50 as high TI or 3.18 ± 0.84 out of 5 possible as high TI), followed by Ethiopia (77%), Iran (65.4%), Saudi Arabia (56.1%-63.3%), Hong Kong (36.5%-60%), China (22.3%-50%) and Turkey (49.5%) while lowest in the USA (17%-19.4%). A study in Italy, which was the only included country within the European Union, found 36.6% turnover intention[62]. (See Table 2, and Supplementary file Figures S1 and Figure S2) TABLE.2. Characteristics of included studies AUTHOR, YEAR & COUNTRY STUDY DESIGN N SETTING TURNOVER (%) 1. P. P. Choi et al., 2022.Hong Kong Cross-sectional survey 698 Hospital 36.3% 2. Munir et al., 2018 .Pakistan Quantitative study 668 Hospital NR 3. Y. H. Lee et al., 2022. South Korea Descriptive correlation survey 170 Hospital 3.18 ± 0.84 out of possible 5 as high TI 4. Wubetie et al., 2020 Ethiopia A cross-sectional study 102 Hospital 77% 5. Alsufyani et al., 2021 Saudi Arabia Predictive correlational study 367 Hospital NR 6. Çaylak & Altuntaş, 2017 Turkey Descriptive and correlational study 323 Hospital 49.5%. 7. Stone et al., 2006 USA Cross-sectional study 2,323 Hospital 17% 8. Galletta et al., 2011 .Italy Cross sectional study 1,938 Hospital 1.83± 1.22) out of Possible 5 as high TI 9. Cao et al., 2020 China Descriptive cross-sectional 569 Hospital 22.3% 10. E. Lee & Jang, 2020 . South Korea Cross-sectional survey 255 Hospital 3.52 (±0.93) out of possible 5 as high TI 11. Huang et al., 2019 China Descriptive cross‐sectional 410 H. Centres 2.50 ± 0.75 out of 5 as High TI 12. Zahednezhad et al., 2021. Iran Cross-sectional study 317 Hospital 3.27 (± 1.01) out of possible 5 as high TI 13. Alharbi et al., 2020 Saudi Arabia Correlational study 497 Hospital 56.1% 14. Wan et al., 2018. China Cross-sectional survey 778 Hospital 35.9%) 15. Ishihara et al., 2014) .Hong Kong. Cross-sectional survey 1271 Hospital 60% 16. Alilyyani et al., 2022). Saudi Arabia Cross-sectional Study 456 Hospital NR 17. Banaszak-Holl et al., 2015) .USA Survey 419 Nursing homes 19.5% for LPNs & 19.3% for RNs 18. Widodo et al., 2021.Indonesia Quantitative-Cross sectional design 160 Hospital NR 19. Majeed & Jamshed, 2021 .Pakistan. A survey 344 Hospital NR 20. Jacobs & Roodt, 2011 .South Africa Cross-sectional survey 530 Hospital NR 21. Goyal & Kaur, 2023) .India Cross-sectional study 628 Hospital NR 22. Kharabsheh et al., 2017.Jordan Quantitative study 354 Hospital NR 23. Arslan Yürümezoğlu & Kocaman, 2019 Turkey Cross‐sectional Correlational 574 Hospital NR 24. H. Choi & Shin, 2022. South Korea Descriptive study 153 Hospital 41.13 ± 6.40 out of 50 as high TI 25. J. S. Choi & Kim, 2020.Korea Cross-sectional study 230 Conference/Hospital NR 26. Abou Hashish, 2017 . Egypt Descriptive correlational study 550 Hospital 33% 27. Park & Kim, 2009. Korea Survey among 527 Hospital NR 28. Labrague et al., 2017. Philippines Descriptive, cross-sectional 166 Hospital NR 29. Siket Ujváriné et al., 2020. Hungary cross-sectional Study 367 Hospital NR 30. AbuAlRub & Nasrallah, 2017. Jordan Correlational Study 285 Hospital NR NR *=Not Reported. TI*=Turnover Intention 3.3. Organizational Culture and its impact on career leaving among nurses. The findings on impact of organizational culture on career leaving was summarized using the below data extraction table 3 for all included intervention studies. Six main themes were identified. Impact of (1) specific types of organizational culture, (2) Leadership and Management as key aspect of Organizational culture, (3) Organizational climate, (4) Nurses working environment and working cultures, (5) Organizational justice and (6) other variables grouped as “Others) see table 3. TABLE 3. SUMMARY OF THE FINDINGS(n=30) Author, Year, Country Organizational culture type /Variable studied Impact on Nurse turnover 1. Organizational culture types Y. H. Lee et al., 2022. South Korea[52] Examined effects of types of Nursing organizational culture namely (Hierarchical-oriented Culture (HC), relationship -oriented Culture (RC), innovation-oriented Culture (IC), Task-oriented culture (TC)) on workplace incivility and TI. A full mediating effect of workplace incivility (Incivility by patients or caregivers, co-workers’ incivility, superiors’ incivility, and doctors’ incivility) on the association between relationship-oriented culture and turnover intention and a partial mediating effect of workplace incivility on the association between hierarchy-oriented culture and turnover intention. Banaszak-Holl et al., 2015) .USA[40] Tracked effects of organizational culture types (group culture, developmental culture, hierarchical culture, and market culture) on nurse turnover in nursing homes in USA. Facilities with stronger market values had increased turnover among Registered Nurses (RNs) and Licenced Practice Nurses (LPNs), and among Nurse Assistants when turnover was adjusted for facilities with few staff. Facilities emphasizing hierarchical internal processes had lower RN turnover. Group and developmental values focusing on staff and innovation only lowered LPN turnover. Widodo et al., 2021.Indonesia[45] Identified effects of organizational culture types (orientation culture, consistency culture, involvement culture, and adaptability culture on pay satisfaction, job satisfaction and intention to leave career among nurses This study used Structural Equation Modelling in analysis. The results showed that there is a positive effect of positive organizational culture (c.r. 5.048, P=0.000) and nurse pay satisfaction (c.r. 3.713, P=0.000) on nurse job satisfaction. There is a negative effect of organizational culture (c.r. -3,123, P=0.002) and nurse pay satisfaction (c.r. -2.336, P=0.019) on the nurse intention to leave. There is no effect of nurse job satisfaction (c.r. -0.916, P= 0,36) to nurse intention to leave. Kharabsheh et al., 2017.Jordan[63] Examined mediating effect of organisational culture namely (Clan, adhocracy, Market and Hierarchy) with authentic leadership (4 constructs: self-awareness, balance processing, relational transparency, and internalised moral perspective) and turnover intention Authentic leadership and organisational culture statistically significant and negatively correlated with turnover intention. The result also showed a significant positive effect of authentic leadership on organisational culture. Employees are more committed to the organization and trust the leaders who are perceived to be authentic, therefore less likely to result in negative outcome, for example, turnover intention. J. S. Choi & Kim, 2020.Korea[61] Evaluated effects of organizational culture types (Relation-oriented culture, Task-oriented culture, Innovation-oriented culture, and Hierarchy-oriented culture) and work-related stress on nurses’ turnover intentions. A correlation analysis between turnover intention and the sub-domains of nursing organizational culture revealed that turnover intention in nursing is negatively correlated with relation-oriented and innovation-oriented cultures, but positively correlated with task-oriented, hierarchy-oriented cultures, and job stress. Job stress is a significant factor contributing to turnover intention, explaining 19.2% of the variance. Park & Kim, 2009. Korea[35] Examined whether different types of organizational culture (consensual culture, developmental culture, hierarchical culture and rational culture) are associated with job satisfaction and turnover intention. Analysis was by structural equation modelling. A direct association between organizational culture with job satisfaction and turnover intention was found. Also, a mediating role of job satisfaction in the relationship between organizational culture and turnover intention was found. Among the different types of culture, consensual culture and rational culture had significant, positive associations with the nurses’ job satisfaction. In addition, consensual culture exhibited the strongest, negative association with the turnover intention of the nurses, while hierarchical culture showed a significant, positive association. 2. Leadership and Management as key aspect of Organizational culture .P. P. Choi et al., 2022.Hong Kong[64] Studied effects of Manager competency (staff advocacy and Development, Team Communication and Collaboration, Change and Resource Management, Quality Monitoring and Pursuance and Personal Mastery) on Job satisfaction & turnover intention. Manager competency was a significant predictors of staff nurses’ job satisfaction and turnover intention. Galletta et al., 2011 .Italy[62] Examined Perceived Organizational support (POS) and Perceived Supervisor Support (PSS) on nurses’ perception of care adequacy, Job satisfaction and Turnover intention. The supervisor support and organizational support act differently as moderators of the care adequacy–job satisfaction–turnover intention relationship. Job satisfaction was a mediating variable between care adequacy and turnover intention. Alilyyani et al., 2022). Saudi Arabia[65] Influence of Authentic Leadership (relational transparency, internalized moral perspective, balanced information processing and self-awareness sub-scales) on nurse psychological safety, Work engagement, Team, Nurse satisfaction with quality of care and Turnover Intentions. Structural equation modelling analysis indicated a good fit for the hypothesized model. Authentic leadership which is an aspect of organizational culture had a positive, significant, and direct relationship with team effectiveness, nurses’ work engagement and psychological safety. Team effectiveness was found to be negatively related to job turnover intentions but positively related to nurse satisfaction with quality of care. Majeed & Jamshed, 2021 .Pakistan[66] Explored nurse leader emotional intelligence, on the working culture prevailing in nursing teams and turnover intention. Analysis was done through structural Equation modelling. Leader emotional intelligence had a significant positive influence on turnover intentions (β = 0.152, p < .0.01) Further results revealed that leader emotional intelligence has a significant variation on team culture (β = 0.137, p < .05). Team culture had a strong influence on the turnover intention of the staff (β = 0.667, p < .05) Abu Al Rub & Nasrallah, 2017. Jordan[67] Investigated the impact of leadership behaviours(challenging the process, inspiring a shared vision, enabling others to act, modelling the way, and encouraging the hear ) of nurse managers and organizational culture( leadership/supervision, collegial sharing/support and professional commitment ) on Jordanian nurses’ intention to stay at work. Nurse managers’ Transformational leadership behaviours and positive organizational culture were positively associated with the level of intention to stay at work. The study variables explained almost 43% of the variance in nurses’ intention to stay at work. A strong, positive relationship was found between positive perception of organizational culture and intent to stay at work (r = 0.587, P = 0.000); that entails; nurses who perceived their organizational culture as positive intended to stay at work more than their counterparts. 3. Organizational Climate Munir et al., 2018 .Pakistan[68] Perception of ethical climate (caring climate, law and code climate, rules climate, instrumental climate, and independent climate) and the mediating variable organizational cynicism (cognitive, affective, behavioral) Organizational cynicism had full mediating effect between the relationship of perception of ethical climate and turnover intention. The positive ethical climate negatively and significantly correlated with organizational cynicism and turnover intention. Stone et al., 2006 USA[69] Organizational Climate (7 subscales namely, Professional practice, staffing/resource adequacy, nurse management, nursing process, Nurse/physician collaboration, Clinical competence, and positive scheduling climate) Reasons given for TI included working conditions, positive career move, personal or family, reasons, retiring, and no reason given. Perceived Nurse Working Environment (professional practice and nursing competence) were negatively correlated and significantly with TI. Siket Ujváriné et al., 2020. Hungary[5] Predicted nurses’ intent to stay by examined nurse’s appraisal of Organizational Climate in relation to problem-solving (challenge and control) and communication styles (conflictual and respective communication), perceived stress and self-esteem. Correlations analysis showed that Positive appraisal of organizational climate was negatively related to locus of control, positively to self-esteem and negatively to stress. That’s, better organizational climate increased personal self-esteem and lowered stress. The more self-esteem nurses felt the less stress they also perceived. Conflictual communication and perceived stress both decreased intent to stay by 50%. Abou Hashish, 2017 . Egypt[70] Determine perception of ethical climate (5 dimensions; instrumental, caring, independence, professional law and code and rules) on nurses Perceived Organizational Support (POS), Organizational Commitment (OC) Job Satisfaction (JS) and Turnover Intention. There was a positive significant correlation between nurses’ perception of overall ethical work climate and each of their organizational support (r = 0.2, p < 0.001), their OC (r =0.3, p < 0.001), as well as JS (r = 0.161, p < 0.001) there is a positive significant correlation between POS and each of OC (r =0.6, p < 0.001) and JS (r= 0.42, p < 0.001). In addition, there was a positive strong significant correlation between OC and JS (r = 0.7, p < 0.001). However, there is a negative weak significant correlation between nurses’ intention to turnover and each of overall ethical work climate. Wubetie et al., 2020 Ethiopia[45] Job satisfaction, nurses’ characteristics, workgroup cohesion and collaboration, and nurses’ organizational commitment as predictors of TI Significant predictive factors of nurses’ intention to leave their institutions were educational, and dissatisfaction from monthly pay, and professional autonomy. 4. Nurses Working Environment and working culture Impact on Nurse turnover Alsufyani et al., 2021 Saudi Arabia[71] Alharbi et al., 2020 Saudi Arabia[72] Wan et al., 2018. China[73] Ishihara et al., 2014) .Hong Kong[74] Nurses Working Environment and working culture sub-groups. -Nurse participation in hospital affairs. -Nursing foundations for quality of care. -Nurse manager ability, leadership, and support of nurses. -staffing and resource adequacy. -collegial nurse-physician relations. Positive work environment perception increased communication satisfaction among nurses. communication satisfaction had negative impacts on the nurses’ intentions to quit (5). Positive Nurse participation in hospital affairs uniquely associated with low emotional exhaustion, higher job satisfaction and lower TI, whereas staffing and resource adequacy was associated with lower emotional exhaustion and high job satisfaction, but not intent to leave. Nurse emotional exhaustion and job satisfaction fully mediated the relationship between nurse participation in hospital affairs and intent to leave. (13) (1) work environment was positively associated with higher work engagement and lower turnover intention and work engagement partially mediated the relationship between work environment and turnover intention; and (2) job characteristics were positively related to higher work engagement and lower turnover intention and work engagement fully mediated the relationship between job characteristics and turnover intention. Logistic regression analysis identified professionalism, management, and ward practice as significant factors in predicting nurses’ turnover intention and staffing and resources as an additional factor in predicting their job satisfaction (15). Çaylak & Altuntaş, 2017 Turkey[75] Effects of Organizational Silence (2 Subscales, Issues of silence and Reasons for silence) and Organizational Cynicism on TI Administrative and organizational reasons was the most important reason why nurses remain silent with the tendency not to speak-up about ethics and responsibility issues. Organizational silence particularly influenced organizational cynicism. The reasons for organizational silence and organizational cynicism increased intent to leave work. 5. Organizational justice Cao et al., 2020 China[76] Huang et al., 2019 China[77] Zahednezhad et al., 2021. Iran[78] H. Choi & Shin, 2022. South Korea[50] Effects of perceived organizational Justice (OJ) (subscales;) -Distributive justice -Procedural justice -Leadership justice ( i.e respect of subordinates, fairness, recognition, spiritual support and encouragement) -Informational justice On Work engagement (WE) and Perception of Quality of Care, Organizational Support (OS) and TI(9,11),Job satisfaction and TI(12), Nurse competencies(24) -Positive perception of organizational Justice was directly related to high work engagement, great nurses’ perception of care quality and low turnover intention[76] -In the final structural equation model created, Work engagement had a direct negative association with TI (β = −0.096, p = .047). OS had a direct negative association with TI (β = −0.614, p < .001) and a direct positive effect on WE. OS had an indirect effect on TI (β = −0.042, p = .039) via WE. OJ had an indirect effect on TI (β = 0.621, p = .016) mediated by OS[76] -Positive perceptions of distributive justice (p < .001; β = 0.24) and interactional justice (p < .001; β = 0.44) could indirectly affect the nurses' intention to leave the nursing profession via the direct impact on job satisfaction, while job satisfaction had a significant, negative effect on the nurses' intention to leave (p < .001; β = −0.71) [78]. -The turnover intention of participants showed a statistically significant negative correlation with perceived organizational justice (r = −0.23, p = 0.004) [50] This suggests that low perceived organizational justice is associated with a high degree of turnover intention. In particular, turnover intention showed a statistically significant negative correlation with distributive justice (r = −0.35, p < 0.001), which is one of the subcategories of organizational justice. -The type of organizational justice that influenced turnover intention differed depending on clinical experience[50] 6. Other variables of organizational culture E. Lee & Jang, 2020 . South Korea[79] Effects of Nursing organizational culture (5 subdimensions: team communication and morale, information flow, employee involvement, supervision, and meetings on Job stress, nurse fatigue and turnover intention Turnover intention was negatively correlated with positive nursing organizational culture (r = –.31, p <.001), and positively correlated with job stress (r = .52, p <.001) and fatigue (r = .60, p < .001). Factors affecting nurses’ turnover intention included the organizational culture, job stress, and fatigue. In the final turnover intention model, fatigue and job stress had direct effects and the organizational culture had indirect effects on turnover. The organizational culture also had indirect effects on turnover intention through job stress and fatigue. Jacobs & Roodt, 2011 .South Africa[80] The impact of organisational Culture measure in fifteen dimensions (conflict resolution, culture management, customer orientation, disposition towards change, employee participation, goal clarity, human resource, orientation, identification with the organisation, locus of authority, management style, organisational focus, organisational integration, performance orientation, reward orientation and task structure) on knowledge sharing and Turnover intentions. The tri-variate procedure of Baron and Kenny for mediation testing was adopted. The results indicated that a positive correlation exists between organisational culture and knowledge sharing, but a significant negative correlation between organisational culture and turnover intentions, as well as between knowledge sharing and turnover intentions. The results indicated that knowledge sharing mediates the relationship between organisational culture and turnover intentions, although with a small effect size. The findings suggest that turnover intentions of nurses can be actively managed through contextual variables such as organisational culture and opportunities for knowledge sharing. Goyal & Kaur, 2023) .India[37] Determined role of employee engagement in nurses’ retention along with meditating effects of organizational culture. The results revealed that employee engagement has a significant impact on retention. Employee engagement significantly affects culture. In Structural Equation Modelling, the results showed that the inclusion of organizational culture as a mediating variable between employee engagement and retention (β = 0.24, t value = 6.5, p value = 0.000) does partially mediate the relationship Arslan Yürümezoğlu & Kocaman, 2019 Turkey[81] Examined pathway analysis between structural empowerment, workplace incivility, nurses’ intentions to leave their organization and profession: Analysis was through structural equation modelling. Structural empowerment had a significant but negative direct effect on supervisor incivility (−0.32), coworker incivility (−0.15) and ITL the organisation (−0.36). ITL the organisation had a significant and positive direct effect on and ITL the profession (0.60). Structural empowerment had a significant but negative indirect effect on ITL the organisation by influencing supervisor incivility (−0.03). It also had an indirect effect on ITL the profession by influencing ITL the organisation (−0.10). In addition, supervisor incivility had an indirect positive effect on ITL the profession by influencing ITL the organisation (0.04). Labrague et al., 2017. Philippines[82] Examined the influence of Organizational Politics (OPP) on nurses' work outcomes (job satisfaction, work stress, job burnout and turnover intention) To test for the null hypothesis ‘politics perceptions predict work outcomes in nurses’, multiple linear regression analyses were performed. The regression model shows statistically significant positive correlations between OP perceptions and job stress (beta = 0.232, P = 0.012), turnover intentions (β = 0.645, P = 0.000) and burnout (β = 0.384, P = 0.000). Further, statistically negative correlation between OP perceptions and job satisfaction (β = 0.428, P = 0.000) was found. 3.3.1. Types of Organizational Culture and their impact on career leaving among nurses Eight studies identified specific types of organizational cultures in nursing that influence nurse turnover and turnover intention as summarized below. Study by Y.H. Lee et al. (2022) [52] : •Identified four types of OC using Quinn and McGrath's (1985) Competing Values Model (CVM): hierarchical-oriented culture (HC), relationship-oriented culture (RC), innovation-oriented culture (IC), and task-oriented culture (TC). •Highlighted that RC values positive relationships among nurses, patients, and families, emphasizing trust and flexibility. •IC values flexibility and patient satisfaction, encouraging innovation and creativity among nurses. •HC prioritizes hierarchy, bureaucracy, and efficiency, safe work operations, rule and order while focusing on organizational stability. •TC emphasizes external goal achievement, such as patient happiness and organizational success. Ø Found that workplace incivility mediates the relationship between RC and TI, as well as partially mediates the relationship between HC and TI. Study by Banaszak-Holl et al. (2015) [40] : •Utilized the Competing Values Framework (CVF) Cameron & Quinn, 2006 to identify four OC types: group culture, developmental culture, hierarchical culture, and market culture. • Group culture emphasizes participatory leadership, unity, collaboration, and members’ attachment to the group. • Developmental culture characterized by entrepreneurial leaders, members who are motivated by the need for expansion and creativity and who place an emphasis on growth and resource acquisition. • Market culture is characterized by having leaders and members who are motivated by competition and emphasize productivity and efficiency. • Hierarchical culture emphasizes internal control and rule adherence. Ø Revealed that market-oriented values increased turnover across all nurse cadres, hierarchical internal processes had lower RN (nurse managers), while group and developmental values reduced turnover among certain nurse roles. Study by Kharabsheh et al. (2017) [63] : •Employed the Organizational Cultural Assessment Instrument (OCAI) Cameron and Quinn (1999)[83] to classify OC into clan culture, adhocracy culture, market culture, and hierarchy. Ø Found that authentic leadership and OC were negatively correlated with TI, indicating that nurses were less likely to leave hospitals with authentic and trustworthy leaders and they were more committed to and engaged with the organization. Study by J. S. Choi & Kim (2020) [61] : •Used the competing values model (CVM) developed by (Lee et al. 2022) classify OC to Relation-oriented culture, task-oriented culture, innovation-oriented culture, and hierarchy-oriented culture. Ø Discovered that turnover intention was negatively correlated with relation-oriented and innovation-oriented cultures but positively related to task-oriented and hierarchy-oriented cultures, as well as job stress. Study by Widodo et al. (2021): •Classified OC into orientation culture -emphasizes the importance of adhering to established protocols, policies, and procedures and that nurses are well trained on these components. Consistency culture- emphasizes uniformity and places a high value on maintaining consistent care standards across all patient interactions, units, and shifts) Involvement culture - encourages active participation, collaboration, and engagement among nurses in decision-making and problem-solving processes. Adaptability culture - prioritizes the ability to respond to change, innovation, and flexibility in patient care. Ø Found that positive OC positively influenced pay satisfaction, leading to increased nurse job satisfaction and reduced TI. Study by Majeed & Jamshed (2021): •Explored the relationship between leader emotional intelligence, team culture, and TI. •Revealed that leaders' emotional intelligence contributed to a positive team culture, which, in turn, reduced turnover intention among nursing staff. Study by Jacobs & Roodt (2011): Ø Identified fifteen dimensions of OC and highlighted the positive impact of these dimensions on knowledge sharing, relationships, and TI reduction among nurses. Study by Park & Kim (2009): •Utilized the competing values approach (CVA) by Quinn and McGrath (1985) to classify OC into consensual culture -characterized by collaboration, shared decision-making, open communication, respect for diversity and continuous improvement. rational culture -emphasizing evidence-based practice, critical thinking, patient-centered care, continuing education, ethical decision-making, and communication) Developmental culture and hierarchical culture characteristics as previously discussed by other studies. Ø The study discovered direct relationships between OC and job satisfaction, as well as TI, with consensual culture having the strongest negative association with nurse turnover. In summary, these studies collectively emphasize the significance of OC in influencing nurse turnover intention. Different types of OC have varying effects, and factors like workplace incivility, authentic leadership, and team culture play crucial roles in mediating these relationships. Understanding and fostering positive OC can contribute to higher job satisfaction and reduced turnover among nursing staff. 3.3.2 Impact of work environment, Leadership and management, organizational justice and other variables classified as “magnet” nursing culture on nurse turnover. We grouped work environment, leadership and management, organizational justice among other OC variables as “magnet” nursing culture. The first studies on work environment as an organizational culture variable can be traced back to the early 1980s American Academy of Nursing "magnet" hospital studies that have come to form what is now famously known as magnet culture in nursing[84]. In the late 1970s, the United States experienced a widespread hospital nursing shortage. Despite this,14 ''Magnet'' hospitals were named so because they were able to attract and retain nurses despite the widespread shortages informing the Magnet research[85]. The findings of the research revealed that these hospitals were successful in attracting and retaining nurses amid the nurse shortage in the early 1980s because they had “forces of magnetism”, which were hospital environmental and cultural values. The 14 magnetic forces that the hospitals had were quality of nursing leadership, good organizational structure, proper management style, availability of personnel policies and programs, professional models of care, quality of care, quality improvement, consultation and resources, professional autonomy for nurses, community and the hospital, nurses as teachers, good image of nursing, interdisciplinary relationships, and professional development[86]. Lake continued these studies and developed the Practice Environment Scale of the Nursing Work Index (PES-NWI 31 item scale[84], which has become an internationally recognized instrument to measure work environment characteristics, organizational culture, organizational climate and other aspects of the work environment. Of the 30 included studies in this review, majority (18) articles [37, 50, 62, 64-67, 69, 71-74, 76, 78-82, 87] described the impact of what can be summarized as “magnetic culture” components on career and professional leaving among nurses. The majority of the articles directly used, translated, or modified the PES-NWI-31 item scale[84] for data collection. Most of the magnetic components studied to find their impact on nurse turnover included the impact of leadership on turnover. Manager competency (staff advocacy and development, team communication and collaboration, change and resource management, quality monitoring and pursuance and personal mastery). They were found to strongly predict nurse turnover [64]. [75] observed that organizational silence and organizational cynicism arise in organizations due to leadership, administrative and organizational reasons and can cause nurse turnover. Authentic leadership, which is an aspect of organizational culture, creates team effectiveness, nurses’ work engagement, psychological safety and job satisfaction, hence reducing turnover[65]. Leader emotional intelligence creates a positive team culture that strongly influences the reduction of turnover intention[66]. [81] studied the effect of workplace incivility on turnover, and the results indicated that supervisor and coworker incivility adversely increase career turnover intention and professional turnover. Furthermore, the magnetic culture components studied to find their impact on nurse turnover were nursing foundations for quality of care, nurse participation in hospital affairs, nurse manager ability, leadership, and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations[71-74] and [69]. Promotion of these components creates a positive workplace culture[80] and reduces nurse emotional exhaustion and job stress while increasing communication satisfaction and job satisfaction, thereby immensely reducing career and professional nurse turnover intentions. Team communication and morale, organized information flow, employee involvement, supportive supervision and continuous meetings within organizations were found to reduce job stress, job fatigue and turnover[79]. Organizational justice (OJ) subscales (distributive justice, procedural justice, and leadership justice (respect of subordinates, fairness, recognition, spiritual support, and encouragement) and informational justice[50, 76] were directly related to high work engagement, and great nurses’ perception of care quality and low perceived OJ were associated with a high degree of turnover intention. Perceived organizational support (POS) and perceived supervisor support[62, 70, 77] act differently as moderators of the care adequacy–job satisfaction–turnover intention relationship and work engagement. The more organizational and supervisor support there is, the higher the work engagement, job satisfaction and lower turnover. 3.3.3. Impact of organizational climate as a Function of organizational culture on nurse turnover Organizational climate in nursing refers to the overall atmosphere, work mood and perceptions of work features such as leadership, culture, and working conditions within a healthcare facility or nursing organization[88]. Organizational climate should not be confused with organizational culture, as culture broadly refers to norms, values, beliefs, and assumptions shared by members or simply how things are done within an organization. The results from this review[5, 68, 70] showed that perceptions of ethical climate (caring climate, law and code climate, rules climate, instrumental climate, and independent climate) influence perceptions of organizational cynicism and mediate the relationship between the perception of ethical climate and turnover intention. It also influences perceptions of organizational support, commitment, and job satisfaction. [5] found that “a positive appraisal of organizational climate by nurses, negatively relates to locus of control, positively to self-esteem and negatively to stress. Organizational level internal locus of control (a belief that employees have control over problem-solving) doubles the probability of a nurse staying on the job". 3.4. Discussion The focus of this review was to evaluate the impact of organizational culture on the global nurse shortage and turnover. Our findings demonstrate that nurse turnover remains a complex issue that continues to plague nations of the world. Organizational culture is an important antecedent of nurse turnover. There exist different types of OC and variables that directly or indirectly through mediator variables influence nurse turnover. Clan culture and Relationship-oriented culture that emphasizes on positive human relationships at workplace, values flexibility, staff unity, teamwork, trust respect, mentoring, coaching, mutual support is the glue that holds people together and other relationships at workplace among nurses. [52] found that workplace incivility (low-level aberrant behaviours with dubious intentions that are characterized by a lack of mutual respect) has a full mediating effect on the correlation between relationship-oriented culture and turnover intention and a partial mediating impact on the association between hierarchy-oriented culture and turnover intention. Organizations with poor relationship-oriented culture between staff end up losing workers through turnover and the opposite is true [45, 52]. Our review also showed that, market culture , characterized by having nurse managers and members who rely and focus on important external hospital factors, motivated by competition, and emphasize on productivity and efficiency, had increased turnover among all nurse cadres[40]. Globally, patients and their relatives now demand accessibility to high-quality, worldclass services, given faster, accurately and with high precision. With technology, they know their conditions and rights at sometimes more than the healthcare workers. Hospitals are in a race to fulfil their obligations of health service delivery but faced with several daunting difficulties which includes shortage of resources. To achieve this, hospital management at times spend considerable amount of time and resources on improving the quality of service, focusing on patient outcomes, patient relatives, and organizational profits (external factors) at the expense of its nursing staff (internal factor) ending up losing them though nurse turnover. Organizations that had stronger h ierarchical culture only had reduced nurse managers’(RNs) turnover. h ierarchical culture characterized by having conservative leaders, members motivated to strictly follow rules, regulations and maintain law and order in the organization, only favoured the nurse managers retention probably because it protected and made their jobs easier. However,[52] found that hierarchy-oriented culture led to general nurses’ turnover especially when nurse leaders impose punitive and unfavourable workplace rules and policies to general ward nurses. These policies are source of work-related stress and burnout. On the other hand , innovation-oriented culture , that promotes flexibility and agility, creativity and problem solving, openness to new ideas, cross-functional collaboration, flat hierarchy, continuous learning, change, risk tolerance, patient satisfaction focus and nurse growth and development as a goal of nursing care and essential values, reduced nurse turnover. Nursing can often be a boring profession characterized by routinely repetitive tasks, long shifts, lack of variety with less autonomy in the same place and environment. While nursing is known for its strict intolerance of medical errors and reluctance to embrace non-evidence-based practices, this study highlights the potent role of an innovation-oriented culture in mitigating nurse turnover. Therefore, it is imperative for nurses to embrace innovation and apply it more extensively in patient care. The results further underscore the importance of good leadership in nursing and the role of nurse leaders in reducing turnover among nurses. Managers’ competency and self-mastery, i.e., the ability to create a strong nursing team, emotional intelligence and reactions to workplace issues, and the ability to monitor and diagnose workplace problems (e.g., work incivility, organizational cynicism, workplace politics and organizational silence), were highlighted by the studies and showed that if a nurse manager is competent enough, it could reduce nurse turnover, and the inverse is true. Leadership and the organization are closely related and inseparable; therefore, leadership and organizational support were emphasized as a source of satisfaction that reduced nurse turnover. As a result, organizations should provide adequate resources for nurses to work. Leaders enhance workplace relations by promoting a positive culture through continuous open genuine team communication and meetings. There must be an organized information flow to avoid task confusion. Furthermore, leadership justice, where the leader practices fair play in staff recognition, respects subordinates, practices fairness in all aspects of the job, spiritually supports nursing staff and offers staff encouragement, was proven to strongly enhance work engagement and reduce nurse turnover intentions[45]. Authentic leaders who collaborate, motivate, and advocate for junior nurses and manage resources prudently earn trust from subordinates and make organizations more habitable for nurses. Our systematic review underpins the importance as well of all “magnet forces”, (earlier discussed in results section), the values of success for hospitals in attracting and retaining nurses first recognized by the American Academy of Nursing in the 1980s, and puts keen emphasize on nurse participation in hospital affairs, delivery of quality service, nurse manager ability, leadership, and support of nurses, staffing and adequacy of resources and collegial nurse–physician relations. The more these forces were present in organizations, the more the turnover was lower. Organizational climate which primarily encompasses employees’ perceptions of various work aspects including leadership, leadership style, communication, trust and respect, workloads and job demands, culture, and working conditions, recognition and rewards, conflict resolution, job security and inclusion and diversity[41, 68-70, 88-93] was found to strongly influence nurse turnover and turnover intentions. Studies by[70] and [68] observed that perceptions of ethical climate (caring climate, law and code climate, rules climate, instrumental climate, and independent climate) play a crucial role in influencing perceptions of organizational cynicism and mediate effect between the relationship of perception of ethical climate and turnover intention. Organizational cynicism is a term used to describe negative attitudes or mindset that employees may have towards their organization[75] It is characterized by sense of distrust, scepticism, disillusionment with organization’s policies, leadership, practices, and overall culture. [5] found that, a positive appraisal of organizational climate by nurses doubles the probability of a nurse staying on their job. CONCLUSIONS In conclusion, this comprehensive review has shed light on the critical role of organizational culture in shaping the career trajectories of nurses. As healthcare systems grapple with the multifaceted challenges of nurse shortages and high turnover rates, recognizing organizational culture as a pivotal determinant of turnover becomes paramount. Our review underscores the significance of fostering positive organizational cultures and climates to mitigate nurse turnover and turnover intentions, ultimately benefiting both healthcare institutions and the well-being of nursing professionals. Healthcare organizations are constantly evolving, and it is imperative that we continue to delve deeper into this subject matter. Future research endeavours should aim to provide a more nuanced understanding of the interplay between organizational culture and nurse turnover, particularly in regions grappling with persistently high rates of nursing turnover. Lastly, this review serves as a call to action for healthcare leaders and researchers alike to cultivate positive organizational cultures and create environments where nurses thrive, patients receive exceptional care, and the healthcare system as a whole can achieve greater resilience and sustainability. More studies also need to be done to generate more information on organizational culture in nursing. Limitation Studies included in this review were mainly free access articles published in English language. We excluded conference papers, other systematic literature reviews and meta-analyses, letters/opinions, editorials, essays, case studies and literature, comments or and studies with mixed nurses and other cadres' participation as well as articles without free access. Therefore, potentially important studies with vital information might have been excluded. Declarations Ethics approval and consent to participate. Not applicable. Consent for publication Not applicable. Availability of data and materials Further to the data available in the supplementary files, other datasets supporting the conclusions of this article are not publicly available but are available from the corresponding author on reasonable request. Conflict of Interest disclosure The authors of this article declare no conflicts of interest. Funding This study did not receive any funding. Author Contributions EKK : Conceived the research idea, designed the search strategy, participated in search and screening, analysis and wrote the paper. ME: Contributed to the development of the search strategy; performed the search, screening and editing; and proofread the manuscript. GAD, GAW, AS & SK : Participated in search and screening and edited the paper. Dr. Habil. Adrienn Ujváriné Siket: Supervisor and advisor,reviewed and edited this manuscript and approved it for publication. Dr. Habil. 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Journal : JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit), 2021. 10 (2): p. 207-216. Queen, M., K. Van Der, and W. Annatjie, THE CURRENT WORKPLACE CULTURE IN A SOUTH AFRICAN NURSING EDUCATION INSTITUTION . 2022. Körner, M., et al., Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams Organization, structure and delivery of healthcare. BMC Health Services Research, 2015. 15 (1). Chong, M.P.M., et al., Two sides of the same coin? Leadership and organizational culture. Leadership and Organization Development Journal, 2018. 39 (8): p. 975-994. McMahon, C.J., et al., Organizational Culture as a Determinant of Outcome in Teams: Implications for the Pediatric Cardiac Specialist , in Pediatric Cardiology . 2023, Springer. p. 530-539. Choi, H. and S. Shin, The Factors That Affect Turnover Intention According to Clinical Experience: A Focus on Organizational Justice and Nursing Core Competency. International Journal of Environmental Research and Public Health, 2022. 19 (6). Jaiswal, R. and P.S. Raychaudhuri, The influence of Organizational culture on Employee performance leading to Enhanced quality and Reduced cost of Healthcare service in India: Evidences from Literature Analysis Organisational commitment View project Women in advertisement View project . 2018. Lee, Y.H., J. Lee, and S.K. Lee, The mediating effect of workplace incivility on organization culture in South Korea: A descriptive correlational analysis of the turnover intention of nurses. Journal of Nursing Scholarship, 2022. 54 (3): p. 367-375. Braithwaite, J., et al., Association between organisational and workplace cultures, and patient outcomes: Systematic review , in BMJ Open . 2017, BMJ Publishing Group. Hwang, E., Effects of the organizational culture type, job satisfaction, and job stress on nurses’ happiness: A cross-sectional study of the long-term care hospitals of South Korea. Japan Journal of Nursing Science, 2019. 16 (3): p. 263-273. Roza, N., Y. Supriyati, and K. Kadir, Organizational Culture, Career Development, Job Satisfaction and Nurse Performance at Batam City Hospital . 2022. Tsai, Y., Relationship between organizational culture, leadership behavior and job satisfaction. BMC Health Services Research, 2011. 11 . Higgins, J.P.T., et al., Cochrane handbook for systematic reviews of interventions. Cochrane Handbook for Systematic Reviews of Interventions, 2019: p. 1-694. Gates, M., et al., Reporting guideline for overviews of reviews of healthcare interventions: development of the PRIOR statement. BMJ, 2022. 378 . Bettany-Saltikov, J. and R. McSherry, How to do a Systematic Literature Review in Nursing: A step-by-step guide (2nd Edition) . University of Suffolk. 2016: Open Unniversity Press. Nha Hong, Q., et al., MIXED METHODS APPRAISAL TOOL (MMAT) VERSION 2018 User guide. Choi, J.S. and K.M. Kim, Effects of nursing organizational culture and job stress on Korean infection control nurses’ turnover intention. American Journal of Infection Control, 2020. 48 (11): p. 1404-1406. Galletta, M., et al., Turnover intention among Italian nurses: The moderating roles of supervisor support and organizational support. Nursing and Health Sciences, 2011. 13 (2): p. 184-191. Kharabsheh, O.H., R. Alias, and M. Ismail, The Mediating Effect of Organisation Culture on Transformational Leadership and Turnover Intention in Jordanian Public Hospitals. SSRN Electronic Journal, 2017. Choi, P.P., et al., Competencies of Nurse Managers as Predictors of Staff Nurses’ Job Satisfaction and Turnover Intention. International Journal of Environmental Research and Public Health, 2022. 19 (18). Alilyyani, B., et al., The influence of authentic leadership on nurses' turnover intentions and satisfaction with quality of care in Saudi Arabia: A structural equation modelling study. Journal of Nursing Management, 2022. 30 (8): p. 4262-4273. Majeed, N. and S. Jamshed, Nursing turnover intentions: The role of leader emotional intelligence and team culture. Journal of Nursing Management, 2021. 29 (2): p. 229-239. AbuAlRub, R.F. and M.A. Nasrallah, Leadership behaviours, organizational culture and intention to stay amongst Jordanian nurses. International Nursing Review, 2017. 64 (4): p. 520-527. Munir, Y., M.M. Ghafoor, and A.M.D. Rasli, Perception of ethical climate and turnover intention among nursing staff: does organizational cynicism mediate? International Journal of Human Rights in Healthcare, 2018. 11 (5): p. 319-332. Stone, P.W., et al., Organizational climate and intensive care unit nurses' intention to leave. Critical Care Medicine, 2006. 34 (7): p. 1907-1912. Abou Hashish, E.A., Relationship between ethical work climate and nurses’ perception of organizational support, commitment, job satisfaction and turnover intent. Nursing Ethics, 2017. 24 (2): p. 151-166. Alsufyani, A.M., et al., Impact of work environment perceptions and communication satisfaction on the intention to quit: An empirical analysis of nurses in Saudi Arabia. PeerJ, 2021. 9 . Alharbi, A.A., V.S. Dahinten, and M. MacPhee, The relationships between nurses’ work environments and emotional exhaustion, job satisfaction, and intent to leave among nurses in Saudi Arabia. Journal of Advanced Nursing, 2020. 76 (11): p. 3026-3038. Wan, Q., et al., Effects of work environment and job characteristics on the turnover intention of experienced nurses: The mediating role of work engagement. Journal of Advanced Nursing, 2018. 74 (6): p. 1332-1341. Ishihara, I., et al., Effect of organizational factors and work environments on newly graduated nurses' intention to leave. Japan Journal of Nursing Science, 2014. 11 (3): p. 200-210. Çaylak, E. and S. Altuntaş, Organizational silence among nurses: The impact on organizational cynicism and intention to leave work. Journal of Nursing Research, 2017. 25 (2): p. 90-98. Cao, T., et al., Effects of organisational justice, work engagement and nurses' perception of care quality on turnover intention among newly licensed registered nurses: A structural equation modelling approach. Journal of Clinical Nursing, 2020. 29 (13-14): p. 2626-2637. Huang, X., Z. Li, and Q. Wan, From organisational justice to turnover intention among community nurses: A mediating model. Journal of Clinical Nursing, 2019. 28 (21-22): p. 3957-3965. Zahednezhad, H., et al., Investigating the relationship between organizational justice, job satisfaction, and intention to leave the nursing profession: A cross-sectional study. Journal of Advanced Nursing, 2021. 77 (4): p. 1741-1750. Lee, E. and I. Jang, Nurses’ Fatigue, Job Stress, Organizational Culture, and Turnover Intention: A Culture–Work–Health Model. Western Journal of Nursing Research, 2020. 42 (2): p. 108-116. Jacobs, E.J. and G. Roodt, The mediating effect of knowledge sharing between organisational culture and turnover intentions of professional nurses. SA Journal of Information Management, 2011. 13 (1). Arslan Yürümezoğlu, H. and G. Kocaman, Structural empowerment, workplace incivility, nurses’ intentions to leave their organisation and profession: A path analysis. Journal of Nursing Management, 2019. 27 (4): p. 732-739. Labrague, L.J., et al., Organizational politics, nurses' stress, burnout levels, turnover intention and job satisfaction. International Nursing Review, 2017. 64 (1): p. 109-116. Cameron, K. S. & Quinn, R. E. (2006). Diagnosing and changing organizational culture. San Francisco: Jossey-Bass. Lake, E.T., Development of the practice environment scale of the nursing work index. Research in Nursing and Health, 2002. 25 (3): p. 176-188. Schmalenberg, C. and M. Kramer, Nursing Research. 57 (1): p. 2-13. Haller, K., W. Berends, and P. Skillin, ORGANIZATIONAL CULTURE AND NURSING PRACTICE: THE MAGNET RECOGNITION PROGRAM® AS A FRAMEWORK FOR POSITIVE CHANGE. Revista Médica Clínica Las Condes, 2018. 29 (3): p. 328-335. Wubetie, A., B. Taye, and B. Girma, Magnitude of turnover intention and associated factors among nurses working in emergency departments of governmental hospitals in Addis Ababa, Ethiopia: a cross-sectional institutional based study. BMC Nursing, 2020. 19 (1). Stone, P.W., et al., Organizational Climate of Staff Working Conditions and Safety—An Integrative Model. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology), 2005. Abualrub, R.F., H.F. Gharaibeh, and A.E.I. Bashayreh, The Relationships Between Safety Climate, Teamwork, and Intent to Stay at Work Among Jordanian Hospital Nurses. Nursing Forum, 2012. 47 (1): p. 65-75. Anderson, R.A., K.N. Corazzini, and R.R. McDaniel, Complexity Science and the Dynamics of Climate and Communication: Reducing Nursing Home Turnover . 2002. Atitsogbui, J. and K. Amponsah-Tawiah, Turnover intention and job fit among nurses in Ghana: Does psychological climate matter? Nursing Open, 2019. 6 (2): p. 546-557. Hsiung, K.S., et al., Measures of Organizational Culture and Climate in Primary Care: a Systematic Review. 2020. Stone, P.W., et al., Nurse working conditions, organizational climate, and intent to leave in ICUs: An instrumental variable approach. Health Services Research, 2007. 42 (3 I): p. 1085-1104. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5308085","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":368828326,"identity":"bfb72cb9-bb2e-4c86-b648-57b26c9075f0","order_by":0,"name":"Evans Kasmai 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review\u003c/strong\u003e.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5308085/v1/65ed6941ea06a0bc9e2db620.png"},{"id":67311811,"identity":"b3a7473a-e2a6-4125-8d5d-02daf913d37b","added_by":"auto","created_at":"2024-10-23 14:10:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1416984,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5308085/v1/0880e726-2646-40a7-93e8-8554ce627a96.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe Impact of Organizational Culture on Career Leaving Among Nurses: Examining Global Nurses’ Shortage Through the Lenses of Organizational Culture: A Systematic Review\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNurses are the driving force and foundational human resource for healthcare systems around the world\u0026nbsp;[1, 2]\u0026nbsp;.According to a report titled \u0026quot;The State of the World\u0026apos;s Nursing 2020\u0026quot; developed by the World Health Organization(WHO)\u0026nbsp;[3]and its partners from 191 countries, nurses are the largest occupational group in the global health sectors, with over 27.9 million members, and make\u0026nbsp;approximately\u0026nbsp;59% of the healthcare workforce.\u003c/p\u003e\n\u003cp\u003eDespite nurses being the largest professional group in global health systems, the shortage of nurses remains a global concern\u0026nbsp;[4-6]. The WHO reiterates in its previous global reports and action plans that the lack of nursing personnel continues to stress global healthcare systems and has become a health catastrophe. The global shortage of nurses, estimated at 6.6 million in 2016, fell marginally to 5.9 million in 2018 but rose in 2020 to 7.07 million, with approximately 89% of this shortage concentrated in low- and lower-middle-income countries, primarily in Africa and Asia[3]. The Global Burden of Disease (GBD) study in the same year 2020\u0026nbsp;[7]\u0026nbsp;estimated that the global shortage of nurses was at an alarming high of 30.6 million, which spells doom for global healthcare systems. This situation prompts us to ask the question \u0026ldquo;what\u0026rsquo;s the exact global shortage of nurses\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eThere are numerous factors that have been recognized as contributing to the global shortage of nurses. Many nurses are abandoning their careers and nursing profession due to organizational culture issues and other push and pull factors[8]. The ageing global population is increasing the demand for nursing care as world\u0026rsquo;s elderly population is rapidly growing, with the population aged 60 and over, in 39 countries of OECD, especially within European Union and other developed countries outpacing the total population growth in recent decades[9-11]. The worldwide human population is also increasing, particularly in Africa, putting pressure on the demand for additional nurses to provide nursing services to the growing population[12]. Furthermore, the worldwide nursing workforce is ageing. Many senior nurses are approaching retirement age, according to the International Council of Nurses (ICN) 2023. The report alludes that one out of every six nurses now employed will retire over the next ten years. This means that 4.7 million nurses must be trained, hired, and deployed to replace those who are retiring[13]. Chronic diseases and global pandemic outbreaks such as COVID-19, Ebola, Zika virus and influenza H1N1 have further increased the nursing demand. In addition, women predominate the nursing profession. Nine in every ten nurses globally are women[13, 14]. As a result, career and family conflict increases nursing shortages. For example, during childbirth years, female nurses will cut back, take maternity leave, or leave the profession altogether to take care of their babies[15]. Nurses around the world also face heavy workloads in tough working conditions, which has led to an increase in incidences of emotional distress, mental exhaustion, and nurse burnout\u0026nbsp;[16]. Burnout among nurses is one of the primary causes of nurse turnover[16-20]. Aside from these issues, many countries have not spent adequately in educating an adequate number of nurses to satisfy their local demands, and many lack proper educational, financial, and other needful policies.\u003c/p\u003e\n\u003cp\u003eThere is a major bottleneck in nursing teaching occasioned by a shortage of nursing educators and faculty members; thus, a limited number of nursing students nursing faculties admit and sustain[13]. Professional stereotypes and media profiling nursing profession negatively have also contributed to the shortage of nurses by negatively constructing and painting images of nursing, hence dampening the young generation joining colleges from selecting nursing as a future career[21-26].\u003c/p\u003e\n\u003cp\u003eNurses\u0026rsquo; career leaving,\u0026nbsp;also called nurse turnover,\u0026nbsp;can be defined as\u0026nbsp;the separation of an employee from a job or organization[27].It is\u003cem\u003e\u0026nbsp;\u003cem\u003ean event in which an employee terminates their employment by leaving the hospital\u003c/em\u003e\u003c/em\u003e\u003cem\u003e[28]\u003c/em\u003e. Nurses\u0026rsquo; turnover and intention to leave their careers, the nursing profession, or the healthcare sector entirely is one of the major global nursing and public health concerns exacerbating the global nurse shortage[1, 29-31]. Although there are inconsistencies in the definition of \u0026ldquo;turnover intention\u0026rdquo; and \u0026ldquo;turnover\u0026rdquo;, turnover intention is the desire of an employee to quit their current job within a certain period of time, while turnover is the actual act of leaving or exiting the job entirely[32]\u0026nbsp;.The terms \u0026ldquo;turnover intention (TI)\u0026quot; and \u0026quot;intention to leave (ITL)\u0026quot; are synonyms and mean having a desire to quit one\u0026rsquo;s career. The construct of turnover intention is a multistage process that starts with psychological responses to negative aspects of the current job and could lead to the decision to quit a career (turnover)[33].\u003c/p\u003e\n\u003cp\u003eNurse turnover jeopardizes healthcare delivery in several ways. Apart from causing a global nurse shortage, it negatively influences an organization\u0026rsquo;s capacity to meet patient needs in providing quality healthcare due to the disruption of service delivery. This endangers patients\u0026rsquo; safety[34]. It also affects the morale and productivity of the remaining nursing colleagues who are forced to work extra longer shifts and overtime to cover the workload of those who have left. This could lead to higher rates of work-related stress and burnout and worsen nurse turnover[35]. Nurse turnover is costly to organizations. It increases the cost of doing business and employing, training, and deploying new nursing staff. Indirect costs must also be borne, including the cost of termination of employees, the costs lost when the position is left unfilled, marketing costs, orientation costs and training of new employees[36]. When employees leave, employers lose not only monetarily but also valuable information and experience, skill and expertise that takes time to regain[37]. On the other hand, research has found that nurses who have high levels of intention to leave their career or organizations have high rates of absenteeism, are less committed to their work, are less engaged and commit many deadly medical errors[37]\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e1.1. ORGANIZATION CULTURE IN NURSING\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eIn the literal context, culture is the ideas, customs, laws, traditions, beliefs, social standards, social behaviour, architectural style and dress of a particular people or society that helps in their identity and bonding[38]. The term \u0026ldquo;culture\u0026rdquo; was first defined by the pioneer English anthropologist Edward B. Tylor in his book Primitive Culture, published in 1871: \u0026ldquo;As the complex whole which includes knowledge, belief, art, law, morals, custom, and any other capabilities acquired by man as a member of society\u0026rdquo;[39].\u0026nbsp;The term \u0026quot;organization\u0026quot; refers to a structured group of individuals who work together to achieve a similar goal, such as nurses who work together in hospitals to provide quality nursing and medical care. Organizational culture (OC) is derived from the two definitions \u0026ldquo;organization\u0026rdquo; and \u0026ldquo;culture\u0026rdquo;, and it\u0026nbsp;refers to the shared values, beliefs, behaviours, and perceptions held by employees within an organization or a workplace[40-43].It may\u0026nbsp;also\u0026nbsp;be defined simply as \u0026ldquo;the way things are done around here\u0026rdquo;[44].\u003c/p\u003e\n\u003cp\u003eOC is a management concept, and which is communicated and\u0026nbsp;learned within an organization[45].\u0026nbsp;For this review, we took OC as a key\u0026nbsp;antecedent of turnover and turnover intention.\u0026nbsp;Organizational culture\u0026nbsp;determines how employees in the organization share values, beliefs, structures, routines, rules, and norms that serve to guide and constrain behaviour[46]. It\u0026nbsp;is \u0026ldquo;the social glue holding an organization together\u0026rdquo;[47].\u0026nbsp;Schein\u0026nbsp;said that organizational culture\u0026nbsp;consists of artefacts, beliefs, assumptions, and shared values learned by employees as they work, and over time, they become unconsciously part of them.\u0026nbsp;He further noted that,\u0026nbsp;\u0026ldquo;culture is an abstraction, yet the forces that are created in social and organizational situations that derive from culture are powerful and if we don\u0026rsquo;t understand the operation of these forces, we become victim to them\u0026rdquo;[43]. An organization\u0026rsquo;s\u0026nbsp;mission, vision, strategy, structure, leadership, and human resource practices are important determinants of organizational culture[47].\u003c/p\u003e\n\u003cp\u003eLeadership and organizational culture are two sides of the same coin[48].\u0026nbsp;Top management teams create organizational culture based on their histories and personalities[43].\u0026nbsp;The global crisis in the shortage of nurses due to nurse turnover can be\u0026nbsp;approached\u0026nbsp;with the help of positive organizational culture, good leadership, human resource practices and proper strategies.\u003c/p\u003e\n\u003cp\u003eOver a long period of time, organizational culture has been in use in business contexts where business managers have used it to influence performance and productivity and raise organizations\u0026rsquo; profits. However, little effort has addressed organizational culture and its effects in health and nursing[49], especially in relation to nurse shortages and turnover. Organizational culture is classified into two major categories: positive and negative organizational culture.\u0026nbsp;A positive organizational culture in nursing promotes teamwork, unity, and communication,\u0026nbsp;builds mutual trust\u0026nbsp;and collaboration among nurses, enhances innovation and creativity, and treats employees as more important in the organization\u0026apos;s life[46, 50]. It values the contributions of each individual and encourages open and honest communication. Such a culture fosters a sense of belonging and purpose among nurses and helps them feel motivated and engaged in their work, increasing job satisfaction and productivity, and hence reducing work-related stress and turnover[40, 42, 43, 47, 51, 52]. A negative organizational culture is inversely true.\u003c/p\u003e\n\u003cp\u003eResearch on the impact of organizational culture in nursing, although few, have focused on its impact on patient outcomes and has shown that,\u0026nbsp;a positive organizational culture is related to positive patient outcomes\u0026nbsp;(satisfaction, patient experiences, mortality, pain levels, cost of care, patient knowledge, quality of life, readmission rates, adverse effects, medication errors, patient falls, depression and pressure ulcers, among others[53]\u0026nbsp;and that a negative organizational culture is negatively related to patient outcomes. Other studies have focused on nurses\u0026rsquo; job satisfaction[35, 54-56]\u0026nbsp;and \u0026nbsp;the cost of health care services and employee performance[51]. Despite a plethora of research on the global shortage of nurses and nurse turnover,\u0026nbsp;few dedicated systematic literature reviews have focused on the impact of organizational culture on nurses\u0026rsquo; turnover and turnover intentions. This review therefore focused to fill this gap.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e1.2. Aim of the review\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis review aimed to collect and collate evidence available in the literature on the impact of organizational culture on career and professional leaving among nurses.\u003c/p\u003e"},{"header":"METHODS","content":"\u003ch2\u003e\u003cstrong\u003e2.1. Study design\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study employed a systematic review, and its methods are based on the Cochrane Handbook for Systematic Reviews of Interventions[57]. The selection process is reported in PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow chart[58]. The priori protocol for the study was registered in PROSPERO with registration identification number: CRD42023440170\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e2.2.\u003c/strong\u003e\u003cstrong\u003eSearch Strategy and Selection Criteria\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA comprehensive systematic literature search according to the Population, Exposure and Outcome (PEO) model\u0026nbsp;[59]\u0026nbsp;was performed in six major electronic databases, including PubMed, Ovid\u0026nbsp;MEDLINE, EMBASE,\u0026nbsp;CINAHL, Scopus and Web of Science,\u0026nbsp;on 16\u003csup\u003eth\u003c/sup\u003e July 2023.\u0026nbsp;The PEO represents Population (nurses), Exposure (organizational culture) and Outcome (career turnover/turnover intention or intention to leave career or intention to leave profession). The search approach used the Boolean operator \u0026ldquo;OR\u0026rdquo; between key synonym words and joined them with \u0026ldquo;AND\u0026rdquo; to complete the search.\u0026nbsp;\u003cem\u003eFor keywords used and the full search strategy used, see the supplementary File Table S1 named \u0026ldquo;search strategy\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo identify reference lists of articles included, both electronic and manual searching techniques were used.\u0026nbsp;When only abstracts were found, authors of those records were contacted\u0026nbsp;via email, research gate or available communication methods to request information about any\u0026nbsp;published papers of the abstracts. For inclusion, all the studies needed to meet the following criteria:\u003cstrong\u003e\u0026nbsp;(a)\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;be\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003efrom any country and conducted\u003c/strong\u003e on nursing personnel irrespective of cadre as the study population,\u0026nbsp;(b)\u0026nbsp;original articles in English,\u0026nbsp;(c)\u0026nbsp;studies that used any study design without restricting the year of publication,\u0026nbsp;and\u0026nbsp;(d)\u0026nbsp;turnover or turnover intention as an outcome, and the turnover/turnover intention was related to organizational culture or organizational culture variables. The following studies were excluded: conference papers, systematic literature reviews and meta-analyses, letters/opinions, editorials, essays, case studies and literature, comments or narrative articles with no abstracts and full-text articles in languages other than English, studies with no nurse participants or mixed nurses and other cadres\u0026apos; participation, and articles without free access.\u003c/p\u003e\n\u003cp\u003eThe results of the database searches were transferred into EndNote and then to the RAYYAN program for deduplication and screening. After deduplication, two authors, EKK and ME, independently performed title and abstract screening for each study. Cochrane software for systematic reviews (COVIDENCE-www.covidence.org)\u0026nbsp;was used for the full-text screening phase. Two authors working together for each study, among, EKK, ME, GAW, AS and DAG, conducted independent reviews of each article to determine its eligibility for inclusion. Disagreements on the articles during screening were resolved through discussion and consensus by the two authors. Where consensus was not reached, a third reviewer was engaged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Data Extraction and Data Synthesis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData extraction was performed using a standardized Excel form that extracted the following data from the included articles: the main author, year of publication, the country where the research was conducted, main objective/aim of the study, study design, sample size, study population, study setting, response rate, exposure characteristics (organizational culture type or variable) and instruments used for measurement, outcome characteristics (turnover or turnover intention) and instruments used for measurement and key findings. The data were\u0026nbsp;organized into tables\u003cem\u003e.\u003c/em\u003e Data\u0026nbsp;synthesis was done qualitatively and narratively\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Risk of bias (quality) assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Mixed Methods Appraisal Tool (MMAT)[60] was used to evaluate the quality of the included studies. MMAT is a critical appraisal tool that is designed for the appraisal stage of systematic mixed studies reviews, i.e., reviews that include qualitative, quantitative, and mixed methods studies. It has 5 sections that allow to appraise the methodological quality of five categories of studies: qualitative research, randomized controlled trials, nonrandomized studies, quantitative descriptive studies, and mixed methods studies. This tool comprises two parts: a checklist (Part I) and an explanation of the criteria (Part II). Part I has two checklist questions that an article must fulfil for it to be subjected to Part II\u0026rsquo;s main appraisal. Part II contains 5 questions for each type of study, and responses are given in the form of \u0026ldquo;Yes\u0026rsquo; \u0026lsquo;No\u0026rsquo; or \u0026lsquo;Can\u0026rsquo;t tell\u0026rsquo;. \u0026ldquo;Yes\u0026rdquo; is scored 1 or one star (*), which represents 20%, and \u0026lsquo;No\u0026rsquo; or \u0026lsquo;Can\u0026rsquo;t tell\u0026rsquo; both are scored 0, which is 0%. For this research, included articles that scored below 60% were not reported. All our articles were assessed using section 4 (for quantitative descriptive studies), as all the studies fulfilled the requirements for this section. EKK and ME independently appraised the articles and discussed the adopted results.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe comprehensive search produced a sum of 2,396 articles. A total of 1,010 studies (839 duplicates and 171 other articles) were removed, and 1,386 studies were screened for title and abstract. After title and abstract screening, 1273 studies were excluded, 113 were sought for retrieval, and ninety-five articles were assessed for eligibility by full-text screening. Thirty-three articles were included, while 62 studies were excluded (\u003cem\u003esee\u0026nbsp;\u003c/em\u003e\u003cem\u003efigure 1. PRISMA flow diagram\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1. Characteristics of the included studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 95 articles that were assessed through full-text eligibility, 30 articles fully met the inclusion criteria. The articles were from 17 different countries, with the majority coming from South Korea (5), China (3), Saudi Arabia (3), Hong Kong, Jordan, Turkey, Pakistan and the USA having two articles each. The rest of the countries had one article each. These articles were published between 2006 and 2023, with 80% (n=24) published between 2017 and 2023. Most of the studies (n=6) were published in 2020, followed by 2017 (n=5), and 2021 and 2022 had four articles each published (see supplementary file Figure S1, S2 and supplementary file of raw data Table S2). The cumulative sample size for all the studies was 16,429 nurses. The study setting for all studies was a hospital setup except for[40],\u0026nbsp;which was done in a nursing home, and[61], which was done among infection control nurses (ICNs) who were attending the 2018 ICNs summer conference held in Korea.\u0026nbsp;All 30 articles scored between 60%-100% in quality, indicating a high-quality index (\u003cem\u003esee Table 1 below).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE 1.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Appraisal of the methodological quality of included studies (\u003c/strong\u003e\u003cstrong\u003eMixed Methods Appraisal Tool\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;MMAT) (n = 30)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"948\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion Criteri\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"32\" valign=\"top\" style=\"width: 888px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncluded Studies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eChoi,et al 2022.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eMunir et al,2018.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLee et al,2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eWubetie et al, 2020.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eAlsufyani et al, 2021.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026Ccedil;aylak et al, 2017\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eStone et al,2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eGalletta et al, 2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eCao et al,2020\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLee et al,2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eHuang et al, 2019\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eZahednezhad et al,2021\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eAlharbi 2020\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eWan \u0026nbsp; \u0026nbsp; et al, 2018\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eIshihara et al, 2014\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eAlilyyani \u0026nbsp;et al, 2022\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eLabrague \u0026nbsp;et al,2017\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eBanaszak-Holl et al, 2015\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eWidodo et al,2021\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eMajeed et al,2021\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eJacobs et al,2011\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eGoyal et al, 2023\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eKharabsheh et al., 2017)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eArslanY\u0026uuml;r\u0026uuml;mezoğlu 2019\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eChoi et al, 2022\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eChoi et al,2020\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eAbouHashish 2017\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003ePark et al,2009\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eSiket Ujv\u0026aacute;rin\u0026eacute; et al,2020\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eAbuAl Rub et al,2017\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eChoi,et al 2022.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMunir et al,2018.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eS.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eS.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eQuality\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e5***** or 100% quality criteria met, 4**** or 80% quality criteria met, 3*** or 60% quality criteria met, 2** or 40% quality criteria met and 1* or 20% quality criteria met.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003eKEY\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 5.99251%;\"\u003e\n \u003cp\u003eS.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94.0075%;\"\u003e\n \u003cp\u003eAre there clear research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 5.99251%;\"\u003e\n \u003cp\u003eS.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94.0075%;\"\u003e\n \u003cp\u003eDo data collected allow to address the research questions?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 5.99251%;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94.0075%;\"\u003e\n \u003cp\u003eIs the sampling strategy relevant to address the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 5.99251%;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94.0075%;\"\u003e\n \u003cp\u003eIs the sample representative of the target population?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 5.99251%;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94.0075%;\"\u003e\n \u003cp\u003eAre the measurements appropriate?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 5.99251%;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94.0075%;\"\u003e\n \u003cp\u003eIs the risk of nonresponse bias low?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 5.99251%;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94.0075%;\"\u003e\n \u003cp\u003eIs the statistical analysis appropriate to answer the research question?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e3.2 Career and professional turnover among nurses\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOf the included articles, more than half (n=16) reported the rate of nurse turnover. The other articles measured turnover through structural equation modelling and other methods; hence, turnover is indicated as \u0026ldquo;Not Reported\u0026rdquo;, i.e., (NR). The nurse turnover rate was highest in South Korea (41.13 \u0026plusmn; 6.40 out of 50 as high TI or 3.18 \u0026plusmn; 0.84 out of 5 possible as high\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTI), followed by Ethiopia (77%), Iran (65.4%), Saudi Arabia (56.1%-63.3%), Hong Kong (36.5%-60%), China (22.3%-50%) and Turkey (49.5%) while lowest in the USA (17%-19.4%). A study in Italy, which was the only included country within the European Union, found 36.6% turnover intention[62]. \u003cem\u003e(See Table 2, and Supplementary file Figures S1 and Figure S2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTABLE.2. Characteristics of included studies\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"673\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAUTHOR, YEAR \u0026amp; COUNTRY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSTUDY DESIGN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSETTING\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTURNOVER (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eP. P. Choi et al., 2022.Hong Kong\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e36.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eMunir et al., 2018\u0026nbsp;.Pakistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eQuantitative study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Y. H. Lee et al., 2022. South Korea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDescriptive correlation survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.18 \u0026plusmn; 0.84 out of possible 5 as high TI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Wubetie et al., 2020 \u0026nbsp;Ethiopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eA cross-sectional study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e77%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Alsufyani et al., 2021\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSaudi Arabia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePredictive correlational study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026Ccedil;aylak \u0026amp; Altuntaş, 2017 Turkey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDescriptive and correlational study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e49.5%.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Stone et al., 2006 USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2,323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Galletta et al., 2011 .Italy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross sectional study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1,938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1.83\u0026plusmn; 1.22) out of Possible 5 as high TI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Cao et al., 2020 China\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDescriptive cross-sectional\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e22.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e10. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;E. Lee \u0026amp; Jang, 2020 . South Korea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional survey\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.52 (\u0026plusmn;0.93) out of possible 5 as high TI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e11. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eHuang et al., 2019 \u0026nbsp;China\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDescriptive cross‐sectional\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eH. Centres\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e2.50 \u0026plusmn; 0.75 out of 5 as High TI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Zahednezhad et al., 2021. Iran\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3.27 (\u0026plusmn; 1.01) out of possible 5 as high TI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e13. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eAlharbi et al., 2020 Saudi Arabia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCorrelational study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e56.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e14. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Wan et al., 2018. China\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;Cross-sectional survey\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e35.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e15. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Ishihara et al., 2014) .Hong Kong.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional survey\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e16. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Alilyyani et al., 2022). Saudi Arabia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e17. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Banaszak-Holl et al., 2015) .USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSurvey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eNursing homes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e19.5% for LPNs \u0026amp; 19.3% for RNs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e18. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Widodo et al., 2021.Indonesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eQuantitative-Cross sectional design\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e19. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Majeed \u0026amp; Jamshed, 2021 .Pakistan.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eA survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Jacobs \u0026amp; Roodt, 2011 .South Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e21. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Goyal \u0026amp; Kaur, 2023) .India\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e22. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Kharabsheh et al., 2017.Jordan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eQuantitative study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e23. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Arslan Y\u0026uuml;r\u0026uuml;mezoğlu \u0026amp; Kocaman, 2019\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Turkey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross‐sectional Correlational\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e24. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;H. Choi \u0026amp; Shin, 2022. South Korea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDescriptive study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e41.13 \u0026plusmn; 6.40 out of 50 as high TI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e25. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eJ. S. Choi \u0026amp; Kim, 2020.Korea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCross-sectional study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eConference/Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e26. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Abou Hashish, 2017 . Egypt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDescriptive correlational study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e27. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Park \u0026amp; Kim, 2009. Korea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSurvey among\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e28. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eLabrague et al., 2017. Philippines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eDescriptive, cross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e29. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u0026nbsp;Siket Ujv\u0026aacute;rin\u0026eacute; et al., 2020. \u0026nbsp;Hungary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ecross-sectional Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003eAbuAlRub \u0026amp; Nasrallah, 2017.\u0026nbsp;Jordan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCorrelational Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 673px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNR\u003c/strong\u003e\u003cstrong\u003e*=Not Reported. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;TI*=Turnover Intention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003e\u003cstrong\u003e3.3.\u0026nbsp;Organizational Culture and its impact on career leaving among nurses.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe findings on impact of organizational culture on career leaving was summarized using the below data extraction \u003cem\u003etable 3\u003c/em\u003e for all included intervention studies.\u0026nbsp;Six main themes were identified. Impact of (1) specific types of organizational culture, (2)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eLeadership and Management as key aspect of Organizational culture, (3)\u0026nbsp;Organizational climate, (4)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNurses working environment and working cultures, (5)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eOrganizational justice\u0026nbsp;and (6) other variables grouped as \u0026ldquo;Others) see \u003cem\u003etable 3.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"990\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 894px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 3. SUMMARY OF THE FINDINGS(n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYear,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCountry\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOrganizational culture type /Variable studied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 636px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eImpact on Nurse turnover\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003e1.\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cstrong\u003eOrganizational culture types\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;Y. H. Lee et al., 2022.\u0026nbsp;South Korea[52]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eExamined effects of types of Nursing organizational culture namely (Hierarchical-oriented Culture (HC), relationship -oriented Culture (RC), innovation-oriented Culture (IC), Task-oriented culture (TC)) on workplace incivility and TI.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eA full mediating effect of workplace incivility (Incivility by patients or caregivers, co-workers\u0026rsquo; incivility, superiors\u0026rsquo; incivility, and doctors\u0026rsquo; incivility) on the association between relationship-oriented culture and turnover intention and a partial mediating effect of workplace incivility on the association between hierarchy-oriented culture and turnover intention.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eBanaszak-Holl et al., 2015) .USA[40]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eTracked effects of organizational culture types (group culture, developmental culture, hierarchical culture, and market culture) on nurse turnover in\u0026nbsp;nursing homes in USA.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;Facilities with stronger market values had increased turnover among Registered Nurses (RNs) and Licenced Practice Nurses (LPNs), and among Nurse Assistants when turnover was adjusted for facilities with few staff. Facilities emphasizing hierarchical internal processes had lower RN turnover. Group and developmental values focusing on staff and innovation only lowered LPN turnover.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eWidodo et al., 2021.Indonesia[45]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eIdentified effects of organizational culture types (orientation culture, consistency culture, involvement culture, and adaptability culture on pay satisfaction, job satisfaction and intention to leave career among nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eThis study used Structural Equation Modelling in analysis. The results showed that there is a positive effect of positive organizational culture (c.r. 5.048, P=0.000) and nurse pay satisfaction (c.r. 3.713, P=0.000) on nurse job satisfaction. There is a negative effect of organizational culture (c.r. -3,123, P=0.002) and nurse pay satisfaction (c.r. -2.336, P=0.019) on the nurse intention to leave. There is no effect of nurse job satisfaction (c.r. -0.916, P= 0,36) to nurse intention to leave.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eKharabsheh et al., 2017.Jordan[63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eExamined mediating effect of organisational culture namely (Clan, adhocracy, Market and Hierarchy) with authentic leadership (4 constructs: self-awareness, balance processing, relational transparency, and internalised moral perspective) and\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eturnover intention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eAuthentic leadership and organisational culture statistically significant and negatively correlated with turnover intention. The result also showed a significant positive effect of authentic leadership on organisational culture. Employees are more committed to the organization and trust the leaders who are perceived to be authentic, therefore less likely to result in negative outcome, for example, turnover intention.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eJ. S. Choi \u0026amp; Kim, 2020.Korea[61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eEvaluated effects of organizational culture types (Relation-oriented culture, Task-oriented culture, Innovation-oriented culture, and Hierarchy-oriented culture) and work-related stress on nurses\u0026rsquo; turnover intentions.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eA correlation analysis between turnover intention and the sub-domains of nursing organizational culture revealed that turnover intention in nursing is negatively correlated with relation-oriented and innovation-oriented cultures, but positively correlated with task-oriented, hierarchy-oriented cultures, and job stress. Job stress is a significant factor contributing to turnover intention, explaining 19.2% of the variance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003ePark \u0026amp; Kim, 2009. Korea[35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eExamined whether different types of organizational culture (consensual culture, developmental culture, hierarchical culture and rational culture) are associated with job satisfaction and turnover intention.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eAnalysis was by structural equation modelling. A direct association between organizational culture with job satisfaction and turnover intention was found. Also, a mediating role of job satisfaction in the relationship between organizational culture and turnover intention was found. Among the different types of culture, consensual culture and rational culture had significant, positive associations with the nurses\u0026rsquo; job satisfaction. In addition, consensual culture exhibited the strongest, negative association with the turnover intention of the nurses, while hierarchical culture showed a significant, positive association.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003e2.\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cstrong\u003eLeadership and Management as key aspect of Organizational culture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e.P. P. Choi et al., 2022.Hong Kong[64]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eStudied effects of Manager competency (staff advocacy and Development, Team Communication and Collaboration, Change and Resource Management, Quality Monitoring and Pursuance and Personal Mastery) on Job satisfaction \u0026amp; turnover intention.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eManager competency was a significant predictors of staff nurses\u0026rsquo; job satisfaction and turnover intention.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp; Galletta et al., 2011 .Italy[62]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eExamined Perceived Organizational support (POS) and Perceived Supervisor Support (PSS) on nurses\u0026rsquo; perception of care adequacy, Job satisfaction and\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTurnover intention.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eThe supervisor support and organizational support act differently as moderators of the care adequacy\u0026ndash;job satisfaction\u0026ndash;turnover intention relationship. Job satisfaction was a mediating variable between care adequacy and turnover intention.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eAlilyyani et al., 2022). Saudi Arabia[65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eInfluence of Authentic Leadership (relational transparency, internalized moral perspective, balanced information processing and self-awareness sub-scales) on nurse psychological safety, Work engagement, Team, Nurse satisfaction with quality of care and Turnover Intentions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eStructural equation modelling analysis indicated a good fit for the hypothesized model. Authentic leadership which is an aspect of organizational culture had a positive, significant, and direct relationship with team effectiveness, nurses\u0026rsquo; work engagement and psychological safety. Team effectiveness was found to be negatively related to job turnover intentions but positively related to nurse satisfaction with quality of care.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eMajeed \u0026amp; Jamshed, 2021 .Pakistan[66]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eExplored nurse leader emotional intelligence,\u0026nbsp;on the working culture prevailing in nursing teams and turnover intention.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eAnalysis was done through structural Equation modelling. Leader emotional intelligence had a significant positive influence on turnover intentions (\u0026beta; = 0.152, p \u0026lt; .0.01) Further results revealed that leader emotional intelligence has a significant variation on team culture (\u0026beta; = 0.137, p \u0026lt; .05).\u003c/p\u003e\n \u003cp\u003eTeam culture had a strong influence on the turnover intention of the staff (\u0026beta; = 0.667, p \u0026lt; .05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;Abu Al Rub \u0026amp; Nasrallah, 2017.\u0026nbsp; Jordan[67]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eInvestigated the impact of\u0026nbsp;leadership behaviours(challenging the process, inspiring a shared vision, enabling others to act, modelling the way, and encouraging the hear ) of nurse managers and organizational culture(\u0026nbsp;leadership/supervision, collegial sharing/support and \u0026nbsp;professional commitment )\u0026nbsp; on Jordanian nurses\u0026rsquo; intention to stay at work.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eNurse managers\u0026rsquo; Transformational leadership behaviours and positive organizational culture were positively associated with the level of intention to stay at work. The study variables explained almost 43% of the variance in nurses\u0026rsquo; intention to stay at work.\u003c/p\u003e\n \u003cp\u003eA strong, positive relationship was found between positive perception of organizational culture and intent to stay at work (r = 0.587, P = 0.000); that entails; nurses who perceived their organizational culture as positive intended to stay at work more than their counterparts.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cstrong\u003eOrganizational Climate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMunir et al., 2018\u0026nbsp;.Pakistan[68]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003ePerception of ethical climate (caring climate, law and code climate, rules climate, instrumental climate, and independent climate) and the mediating variable organizational cynicism (cognitive, affective, behavioral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eOrganizational cynicism had full mediating effect between the relationship of perception of ethical climate and turnover intention.\u003c/p\u003e\n \u003cp\u003eThe positive ethical climate negatively and significantly correlated with organizational cynicism and turnover intention.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eStone et al., 2006\u0026nbsp;USA[69]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eOrganizational Climate (7 subscales namely, Professional practice, staffing/resource adequacy, nurse management, nursing process, Nurse/physician collaboration, Clinical competence, and positive scheduling climate)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eReasons given for TI included working conditions, positive career move, personal or family, reasons, retiring, and no reason given. Perceived Nurse Working Environment (professional practice and nursing competence) were negatively correlated and significantly with TI.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eSiket Ujv\u0026aacute;rin\u0026eacute; et al., 2020. \u0026nbsp;Hungary[5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003ePredicted nurses\u0026rsquo; intent to stay by examined nurse\u0026rsquo;s appraisal of Organizational Climate in relation to problem-solving (challenge and control) and communication styles (conflictual and respective communication), perceived stress and self-esteem.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eCorrelations analysis showed that Positive appraisal of organizational climate was negatively related to locus of control, positively to self-esteem and negatively to stress. That\u0026rsquo;s, better organizational climate increased personal self-esteem and lowered stress. The more self-esteem nurses felt the less stress they also perceived. Conflictual communication and perceived stress both decreased intent to stay by 50%.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eAbou Hashish, 2017 . Egypt[70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eDetermine perception of ethical climate (5 dimensions; instrumental, caring, independence, professional law and code and rules) on nurses Perceived Organizational Support (POS),\u0026nbsp;Organizational Commitment (OC) Job Satisfaction (JS) and Turnover Intention.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eThere was a positive significant correlation between nurses\u0026rsquo; perception of overall ethical work climate and each of their organizational support (r = 0.2, p \u0026lt; 0.001), their OC (r =0.3, p \u0026lt; 0.001), as well as JS (r = 0.161, p \u0026lt; 0.001) there is a positive significant correlation between POS and each of OC (r =0.6, p \u0026lt; 0.001) and JS (r= 0.42, p \u0026lt; 0.001). In addition, there was a positive strong significant correlation between OC and JS (r = 0.7, p \u0026lt; 0.001). However, there is a negative weak significant correlation between nurses\u0026rsquo; intention to turnover and each of overall ethical work climate.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eWubetie et al., 2020\u0026nbsp; Ethiopia[45]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eJob satisfaction, nurses\u0026rsquo; characteristics, workgroup cohesion and collaboration, and nurses\u0026rsquo; organizational commitment as predictors of TI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eSignificant predictive factors of nurses\u0026rsquo; intention to leave their institutions were educational, and dissatisfaction from monthly pay, and professional autonomy.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003e4.\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cstrong\u003eNurses Working Environment and working culture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImpact on Nurse turnover\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eAlsufyani et al., 2021\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSaudi Arabia[71]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAlharbi et al., 2020 Saudi Arabia[72]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWan et al., 2018. China[73]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIshihara et al., 2014) .Hong Kong[74]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eNurses Working Environment and working culture sub-groups.\u003c/p\u003e\n \u003cp\u003e-Nurse participation in hospital affairs.\u003c/p\u003e\n \u003cp\u003e-Nursing foundations for quality of care.\u003c/p\u003e\n \u003cp\u003e-Nurse manager ability, leadership, and support of nurses.\u003c/p\u003e\n \u003cp\u003e-staffing and resource adequacy.\u003c/p\u003e\n \u003cp\u003e-collegial nurse-physician relations.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003ePositive work environment perception increased communication satisfaction among nurses. communication satisfaction had negative impacts on the nurses\u0026rsquo; intentions to quit (5).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePositive Nurse participation in hospital affairs uniquely associated with low emotional exhaustion, higher job satisfaction and lower TI, whereas staffing and resource adequacy was associated with lower emotional exhaustion and high job satisfaction, but not intent to leave. Nurse emotional exhaustion and job satisfaction fully mediated the relationship between nurse participation in hospital affairs and intent to leave. (13)\u003c/p\u003e\n \u003cp\u003e(1) work environment was positively associated with higher work engagement and lower turnover intention and work engagement partially mediated the relationship between work environment and turnover intention; and (2) job characteristics were positively related to higher work engagement and lower turnover intention and work engagement fully mediated the relationship between job characteristics and turnover intention.\u003c/p\u003e\n \u003cp\u003eLogistic regression analysis identified professionalism, management, and ward practice as significant factors in predicting nurses\u0026rsquo; turnover intention and staffing and resources as an additional factor in predicting their job satisfaction (15).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026Ccedil;aylak \u0026amp; Altuntaş, 2017\u0026nbsp;Turkey[75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eEffects of Organizational Silence (2 Subscales, Issues of silence and Reasons for silence) and Organizational Cynicism on TI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eAdministrative and organizational reasons was the most important reason why nurses remain silent with the tendency not to speak-up about ethics and responsibility issues.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOrganizational silence particularly influenced organizational cynicism. The reasons for organizational silence and organizational cynicism increased intent to leave work.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.\u0026nbsp; \u0026nbsp;\u0026nbsp;Organizational justice\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eCao et al., 2020 China[76]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHuang et al., 2019 \u0026nbsp; \u0026nbsp; China[77]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Zahednezhad et al., 2021. Iran[78]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;H. Choi \u0026amp; Shin, 2022. South Korea[50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eEffects of perceived organizational Justice (OJ) (subscales;)\u003c/p\u003e\n \u003cp\u003e-Distributive justice\u003c/p\u003e\n \u003cp\u003e-Procedural justice\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;-Leadership justice ( i.e respect of subordinates, fairness, recognition, spiritual support and encouragement)\u003c/p\u003e\n \u003cp\u003e-Informational justice\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOn Work engagement (WE) and Perception of Quality of Care, Organizational Support (OS) and TI(9,11),Job satisfaction and TI(12), Nurse competencies(24)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003e-Positive perception of organizational Justice was directly related to high work engagement, great nurses\u0026rsquo; perception of care quality and low turnover intention[76]\u003c/p\u003e\n \u003cp\u003e-In the final structural equation model created, Work engagement had a direct negative association with TI (\u0026beta; = \u0026minus;0.096, p = .047). OS had a direct negative association with TI (\u0026beta; = \u0026minus;0.614, p \u0026lt; .001) and a direct positive effect on WE. OS had an indirect effect on TI (\u0026beta; = \u0026minus;0.042, p = .039) via WE. OJ had an indirect effect on TI (\u0026beta; = 0.621, p = .016) mediated by OS[76]\u003c/p\u003e\n \u003cp\u003e-Positive perceptions of distributive justice (p \u0026lt; .001; \u0026beta; = 0.24) and interactional justice (p \u0026lt; .001; \u0026beta; = 0.44) could indirectly affect the nurses\u0026apos; intention to leave the nursing profession via the direct impact on job satisfaction, while job satisfaction had a significant, negative effect on the nurses\u0026apos; intention to leave (p \u0026lt; .001; \u0026beta; = \u0026minus;0.71)\u0026nbsp;[78].\u003c/p\u003e\n \u003cp\u003e-The turnover intention of participants showed a statistically significant negative correlation with perceived organizational justice (r = \u0026minus;0.23, p = 0.004)\u0026nbsp;[50]\u003c/p\u003e\n \u003cp\u003eThis suggests that low perceived organizational justice is associated with a high degree of turnover intention. In particular, turnover intention showed a statistically significant negative correlation with distributive justice (r = \u0026minus;0.35, p \u0026lt; 0.001), which is one of the subcategories of organizational justice. -The type of organizational justice that influenced turnover intention differed depending on clinical experience[50]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003e6.\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cstrong\u003eOther variables of organizational culture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003e\u0026nbsp;E. Lee \u0026amp; Jang, 2020 . South Korea[79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eEffects of Nursing organizational culture (5 subdimensions: team communication and morale, information flow, employee involvement, supervision, and meetings on Job stress, nurse fatigue and turnover intention\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eTurnover intention was negatively correlated with positive nursing organizational culture (r = \u0026ndash;.31, p \u0026lt;.001), and positively correlated with job stress (r = .52, p \u0026lt;.001) and fatigue (r = .60, p \u0026lt; .001). Factors affecting nurses\u0026rsquo; turnover intention included the organizational culture, job stress, and fatigue. In the final turnover intention model, fatigue and job stress had direct effects and the organizational culture had indirect effects on turnover. The organizational culture also had indirect effects on turnover intention through job stress and fatigue.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eJacobs \u0026amp; Roodt, 2011 .South Africa[80]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eThe impact of organisational Culture measure in fifteen dimensions (conflict resolution, culture management, customer orientation, disposition towards change, employee participation, goal clarity, human resource, orientation, identification with the organisation, locus of authority, management style, organisational focus, organisational integration, performance orientation, reward orientation and task structure) on knowledge sharing and Turnover intentions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eThe tri-variate procedure of Baron and Kenny for mediation testing was adopted. The results indicated that a positive correlation exists between organisational culture and knowledge sharing, but a significant negative correlation between organisational culture and turnover intentions, as well as between knowledge sharing and turnover intentions. The results indicated that knowledge sharing mediates the relationship between organisational culture and turnover intentions, although with a small effect size. The findings suggest that turnover intentions of nurses can be actively managed through contextual variables such as organisational culture and opportunities for knowledge sharing.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eGoyal \u0026amp; Kaur, 2023) .India[37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eDetermined role of employee engagement in nurses\u0026rsquo; retention along with meditating effects of organizational culture.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eThe results revealed that employee engagement has a significant impact on retention. Employee engagement significantly affects culture. In Structural Equation Modelling, the results showed that the inclusion of organizational culture as a mediating variable between employee engagement and retention (\u0026beta; = 0.24, t value = 6.5, p value = 0.000) does partially mediate the relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eArslan Y\u0026uuml;r\u0026uuml;mezoğlu \u0026amp; Kocaman, 2019\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Turkey[81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eExamined pathway analysis between structural empowerment, workplace incivility, nurses\u0026rsquo; intentions to leave their organization and profession:\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eAnalysis was through structural equation modelling. Structural empowerment had a significant but negative direct effect on supervisor incivility (\u0026minus;0.32), coworker incivility (\u0026minus;0.15) and ITL the organisation (\u0026minus;0.36). ITL the organisation had a significant and positive direct effect on and ITL the profession (0.60). Structural empowerment had a significant but negative indirect effect on ITL the organisation by influencing supervisor incivility (\u0026minus;0.03). It also had an indirect effect on ITL the profession by influencing ITL the organisation (\u0026minus;0.10). In addition, supervisor incivility had an indirect positive effect on ITL the profession by influencing ITL the organisation (0.04).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.69697%;\"\u003e\n \u003cp\u003eLabrague et al., 2017. Philippines[82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0606%;\"\u003e\n \u003cp\u003eExamined the influence of Organizational Politics (OPP) on nurses\u0026apos; work outcomes (job satisfaction, work stress, job burnout and turnover intention)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64.2424%;\"\u003e\n \u003cp\u003eTo test for the null hypothesis \u0026lsquo;politics perceptions predict work outcomes in nurses\u0026rsquo;, multiple linear regression analyses were performed. The regression model shows statistically significant positive correlations between OP perceptions and job stress (beta = 0.232, P = 0.012), turnover intentions (\u0026beta; = 0.645, P = 0.000) and burnout (\u0026beta; = 0.384, P = 0.000). Further, statistically negative correlation between OP perceptions and job satisfaction (\u0026beta; = 0.428, P = 0.000) was found.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e3.3.1. Types of Organizational Culture and their impact on career leaving among nurses\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eEight studies identified specific types of organizational cultures in nursing that influence nurse turnover and turnover intention as summarized below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy by Y.H. Lee et al.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(2022)\u003c/strong\u003e\u003cstrong\u003e[52]\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;Identified four types of OC using Quinn and McGrath\u0026apos;s (1985) Competing Values Model (CVM): \u003cem\u003ehierarchical-oriented\u003c/em\u003e culture (HC), \u003cem\u003erelationship-oriented\u003c/em\u003e \u003cem\u003eculture\u003c/em\u003e (RC), \u003cem\u003einnovation-oriented culture\u003c/em\u003e (IC), and \u003cem\u003etask-oriented culture\u003c/em\u003e (TC).\u003c/p\u003e\n\u003cp\u003e\u0026bull;Highlighted that RC values positive relationships among nurses, patients, and families, emphasizing trust and flexibility.\u003c/p\u003e\n\u003cp\u003e\u0026bull;IC values flexibility and patient satisfaction, encouraging innovation and creativity among nurses.\u003c/p\u003e\n\u003cp\u003e\u0026bull;HC prioritizes hierarchy, bureaucracy, and efficiency, safe work operations, rule and order while focusing on organizational stability.\u003c/p\u003e\n\u003cp\u003e\u0026bull;TC emphasizes external goal achievement, such as patient happiness and organizational success.\u003c/p\u003e\n\u003cp\u003e\u0026Oslash;\u0026nbsp;Found that workplace incivility mediates the relationship between RC and TI, as well as partially mediates the relationship between HC and TI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy by Banaszak-Holl et al. (2015)\u003c/strong\u003e\u003cstrong\u003e[40]\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;Utilized the Competing Values Framework (CVF) Cameron \u0026amp; Quinn, 2006\u0026nbsp;to identify four OC types: group culture, developmental culture, hierarchical culture, and market culture.\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u003cem\u003eGroup culture\u003c/em\u003e emphasizes participatory leadership, unity, collaboration, and members\u0026rsquo; attachment to the group.\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u003cem\u003eDevelopmental culture\u003c/em\u003e characterized by entrepreneurial leaders, members who are motivated by the need for expansion and creativity and who place an emphasis on growth and resource acquisition.\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u003cem\u003eMarket culture\u003c/em\u003e is characterized by having leaders and members who are motivated by competition and emphasize productivity and efficiency.\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u003cem\u003eHierarchical culture\u003c/em\u003e emphasizes internal control and rule adherence.\u003c/p\u003e\n\u003cp\u003e\u0026Oslash;\u0026nbsp;Revealed that market-oriented values increased turnover across all nurse cadres, hierarchical internal processes had lower RN (nurse managers), while group and developmental values reduced turnover among certain nurse roles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy by Kharabsheh et al. (2017)\u003c/strong\u003e\u003cstrong\u003e[63]\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;Employed the Organizational Cultural Assessment Instrument (OCAI)\u0026nbsp;Cameron and Quinn (1999)[83]\u0026nbsp;to classify OC into clan culture, adhocracy culture, market culture, and hierarchy.\u003c/p\u003e\n\u003cp\u003e\u0026Oslash;\u0026nbsp;Found that authentic leadership and OC were negatively correlated with TI, indicating that nurses were less likely to leave hospitals with authentic and trustworthy leaders and they were more committed to and engaged with the organization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy by J. S. Choi \u0026amp; Kim (2020)\u003c/strong\u003e\u003cstrong\u003e[61]\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;Used the competing values model (CVM) developed by\u0026nbsp;(Lee et al. 2022) classify OC\u0026nbsp;to Relation-oriented culture, task-oriented culture, innovation-oriented culture, and hierarchy-oriented culture.\u003c/p\u003e\n\u003cp\u003e\u0026Oslash;\u0026nbsp;Discovered that turnover intention was negatively correlated with relation-oriented and innovation-oriented cultures but positively related to task-oriented and hierarchy-oriented cultures, as well as job stress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy by Widodo et al. (2021):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;Classified OC into \u003cem\u003eorientation culture\u003c/em\u003e-emphasizes the importance of adhering to established protocols, policies, and procedures and that nurses are well trained on these components.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsistency culture-\u003c/em\u003eemphasizes uniformity and places a high value on maintaining consistent care standards across all patient interactions, units, and shifts)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInvolvement culture\u003c/em\u003e-\u0026nbsp;encourages active participation, collaboration, and engagement among nurses in decision-making and problem-solving processes.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAdaptability culture\u003c/em\u003e-\u0026nbsp;prioritizes the ability to respond to change, innovation, and flexibility in patient care.\u003c/p\u003e\n\u003cp\u003e\u0026Oslash;\u0026nbsp;Found that positive OC positively influenced pay satisfaction, leading to increased nurse job satisfaction and reduced TI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy by Majeed \u0026amp; Jamshed (2021):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;Explored the relationship between leader emotional intelligence, team culture, and TI.\u003c/p\u003e\n\u003cp\u003e\u0026bull;Revealed that leaders\u0026apos; emotional intelligence contributed to a positive team culture, which, in turn, reduced turnover intention among nursing staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy by Jacobs \u0026amp; Roodt (2011):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026Oslash;\u0026nbsp;Identified fifteen dimensions of OC and highlighted the positive impact of these dimensions on knowledge sharing, relationships, and TI reduction among nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy by Park \u0026amp; Kim (2009):\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;Utilized the competing values approach (CVA)\u0026nbsp;by Quinn and McGrath (1985)\u0026nbsp;to classify OC into \u003cem\u003econsensual culture\u003c/em\u003e-characterized by collaboration, shared decision-making, open communication, respect for diversity and continuous improvement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003erational culture\u003c/em\u003e-emphasizing evidence-based practice, critical thinking, patient-centered care, continuing education, ethical decision-making, and communication)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDevelopmental culture\u003c/em\u003e and \u003cem\u003ehierarchical culture\u003c/em\u003e characteristics as previously discussed by other studies.\u003c/p\u003e\n\u003cp\u003e\u0026Oslash;\u0026nbsp;The study discovered direct relationships between OC and job satisfaction, as well as TI, with consensual culture having the strongest negative association with nurse turnover.\u003c/p\u003e\n\u003cp\u003eIn summary, these studies collectively emphasize the significance of OC in influencing nurse turnover intention. Different types of OC have varying effects, and factors like workplace incivility, authentic leadership, and team culture play crucial roles in mediating these relationships. Understanding and fostering positive OC can contribute to higher job satisfaction and reduced turnover among nursing staff.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e3.3.2\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eImpact of work environment, Leadership and management, organizational justice and other variables classified as \u0026ldquo;magnet\u0026rdquo; nursing culture on nurse turnover.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eWe grouped work environment, leadership and management, organizational justice among other OC variables as\u003cstrong\u003e\u0026nbsp;\u0026ldquo;magnet\u0026rdquo;\u0026nbsp;\u003c/strong\u003enursing culture. The first studies on work environment as an organizational culture variable can be traced back to the early 1980s American Academy of Nursing \u0026quot;magnet\u0026quot; hospital studies that have come to form what is now famously known as \u003cem\u003emagnet culture\u003c/em\u003e in nursing[84]. In the late 1970s, the United States experienced a widespread hospital nursing shortage. Despite this,14 \u0026apos;\u0026apos;Magnet\u0026apos;\u0026apos; hospitals were named so because they were able to attract and retain nurses despite the widespread shortages informing the Magnet research[85].\u0026nbsp;The findings of the research revealed that these hospitals were successful in attracting and retaining nurses amid the nurse shortage in the early 1980s because they had \u0026ldquo;forces of magnetism\u0026rdquo;,\u0026nbsp;which were hospital environmental and cultural values. The 14 magnetic forces that the hospitals had were quality of nursing leadership, good organizational structure, proper management style, availability of personnel policies and programs, professional models of care, quality of care, quality improvement, consultation and resources, professional autonomy for nurses, community and the hospital, nurses as teachers, good image of nursing, interdisciplinary relationships, and professional development[86]. Lake\u0026nbsp;continued these studies and developed the Practice Environment Scale of the Nursing Work Index (PES-NWI 31 item scale[84], which has become an internationally recognized instrument to measure work environment characteristics, organizational culture, organizational climate and other aspects of the work environment.\u003c/p\u003e\n\u003cp\u003eOf the 30 included studies in this review, majority (18) articles\u0026nbsp;[37, 50, 62, 64-67, 69, 71-74, 76, 78-82, 87]\u0026nbsp;described the impact of what can be summarized as \u0026ldquo;magnetic culture\u0026rdquo; components on career and professional leaving among nurses. The majority of the articles directly used, translated, or modified\u0026nbsp;the\u0026nbsp;PES-NWI-31 item scale[84]\u0026nbsp;for data collection. Most of the magnetic components studied to find their impact on nurse turnover included\u0026nbsp;the impact of leadership on turnover. Manager competency (staff advocacy and development, team communication and collaboration, change and resource management, quality monitoring and pursuance and personal mastery). They were found to strongly predict nurse turnover\u0026nbsp;[64].\u0026nbsp;[75]\u0026nbsp;observed that organizational silence and organizational cynicism arise in organizations due to leadership, administrative and organizational reasons and can cause nurse turnover. Authentic leadership, which is an aspect of organizational culture, creates team effectiveness, nurses\u0026rsquo; work engagement, psychological safety and job satisfaction, hence reducing turnover[65]. Leader emotional intelligence creates a positive team culture that strongly influences the reduction of turnover intention[66].\u0026nbsp;[81]\u0026nbsp;studied the effect of workplace incivility on turnover, and the results indicated that\u0026nbsp;supervisor and coworker incivility adversely increase career turnover intention and professional turnover.\u003c/p\u003e\n\u003cp\u003eFurthermore, the magnetic culture components studied to find their impact on nurse turnover were nursing foundations for quality of care, nurse participation in hospital affairs, nurse manager ability, leadership, and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations[71-74]\u0026nbsp;and\u0026nbsp;[69]. Promotion of these components creates a positive workplace culture[80]\u0026nbsp;and reduces nurse\u0026nbsp;emotional exhaustion and job stress while increasing communication satisfaction and job satisfaction, thereby immensely reducing career and professional nurse turnover intentions. Team communication and morale, organized information flow, employee involvement, supportive supervision and continuous meetings within organizations were found to reduce job stress, job fatigue and turnover[79].\u003c/p\u003e\n\u003cp\u003eOrganizational justice (OJ) subscales (distributive justice, procedural justice, and leadership justice (respect of subordinates, fairness, recognition, spiritual support, and encouragement) and informational justice[50, 76]\u0026nbsp;were directly related to high work engagement, and great nurses\u0026rsquo; perception of care quality and low perceived OJ were associated with a high degree of turnover intention.\u003c/p\u003e\n\u003cp\u003ePerceived organizational support (POS) and perceived supervisor support[62, 70, 77]\u0026nbsp;act differently as moderators of the care adequacy\u0026ndash;job satisfaction\u0026ndash;turnover intention relationship and work engagement. The more organizational and supervisor support there is, the higher the work engagement, job satisfaction and lower turnover.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e3.3.3. Impact of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eorganizational climate\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;as a Function of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eorganizational\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;culture on\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003enurse\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;turnover\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOrganizational climate in nursing refers to the overall atmosphere, work mood and perceptions of work features such as leadership, culture, and working conditions within a healthcare facility or nursing organization[88]. Organizational climate should not be confused with organizational culture, as culture broadly refers to norms, values, beliefs, and assumptions shared by members or simply how things are done within an organization. The results from this review[5, 68, 70]\u0026nbsp;showed that perceptions of ethical climate (caring climate, law and code climate, rules climate, instrumental climate, and independent climate) influence perceptions of organizational\u0026nbsp;cynicism and mediate the relationship between the perception of ethical climate and turnover intention. It also influences perceptions of organizational support, commitment, and job satisfaction.\u0026nbsp;[5]\u0026nbsp;found that \u0026ldquo;a positive appraisal of organizational climate by nurses, negatively relates to locus of control, positively to self-esteem and negatively to stress. Organizational level internal locus of control (a belief that employees have control over problem-solving) doubles the probability of a nurse staying on the job\u0026quot;.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e3.4. Discussion\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe focus of this review was to evaluate\u0026nbsp;the impact of organizational culture on the\u0026nbsp;global nurse shortage and turnover. Our findings demonstrate that nurse turnover remains a complex issue that continues to plague nations of the world. Organizational culture is an important antecedent of nurse turnover. There exist different types of OC and variables that directly or indirectly through mediator variables influence nurse turnover. \u003cem\u003eClan culture and Relationship-oriented culture\u003c/em\u003e that emphasizes on positive human relationships at workplace,\u0026nbsp;values flexibility, staff unity, teamwork, trust respect, mentoring, coaching, mutual support is the glue that holds people together and other relationships at workplace among nurses.\u0026nbsp;[52]\u0026nbsp;found that workplace incivility (low-level aberrant behaviours with dubious intentions that are characterized by a lack of mutual respect) has a full mediating effect on the correlation between relationship-oriented culture and turnover intention and a partial mediating impact on the association between hierarchy-oriented culture and turnover intention. Organizations with poor relationship-oriented culture between staff end up losing workers through turnover and the opposite is true\u0026nbsp;[45, 52].\u003c/p\u003e\n\u003cp\u003eOur review also showed that,\u003cem\u003e\u0026nbsp;market culture\u003c/em\u003e, characterized by having nurse managers and members who rely and focus on important external hospital factors, motivated by competition, and emphasize on productivity and efficiency,\u0026nbsp;had increased turnover among all nurse cadres[40].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Globally, patients and their relatives now demand accessibility to high-quality, worldclass services, given faster, accurately and with high precision. With technology, they know their conditions and rights at sometimes more than the healthcare workers. Hospitals are in a race to fulfil their obligations of health service delivery but faced with several daunting difficulties which includes shortage of resources. To achieve this,\u0026nbsp;hospital management at times spend considerable amount of time and resources on improving the quality of service, focusing on patient outcomes, patient relatives, and organizational profits (external factors) at the expense of its nursing staff (internal factor) ending up losing them though nurse turnover.\u003c/p\u003e\n\u003cp\u003eOrganizations that had stronger \u003cem\u003eh\u003c/em\u003e\u003cem\u003eierarchical culture\u0026nbsp;\u003c/em\u003eonly had\u003cem\u003e\u0026nbsp;\u003c/em\u003ereduced nurse managers\u0026rsquo;(RNs) turnover.\u0026nbsp;\u003cem\u003eh\u003c/em\u003e\u003cem\u003eierarchical culture\u0026nbsp;\u003c/em\u003echaracterized by\u003cem\u003e\u0026nbsp;\u003c/em\u003ehaving conservative leaders, members motivated to strictly follow rules, regulations and maintain law and order in the organization, only favoured the nurse managers retention probably because it protected and made their jobs easier. However,[52]\u0026nbsp;found that\u0026nbsp;hierarchy-oriented culture led to general nurses\u0026rsquo; turnover especially when nurse leaders impose punitive and unfavourable workplace rules and policies to general ward nurses. \u0026nbsp;These policies are source of work-related stress and burnout. On the other hand\u003cem\u003e,\u0026nbsp;innovation-oriented culture\u003c/em\u003e, that promotes flexibility and agility, creativity and problem solving, openness to new ideas, cross-functional collaboration, flat hierarchy, continuous learning, change, risk tolerance, patient satisfaction focus and nurse growth and development as a goal of nursing care and essential values, reduced nurse turnover. Nursing can often be a boring profession characterized by routinely repetitive tasks, long shifts, lack of variety with less autonomy in the same place and environment. While nursing is known for its strict intolerance of medical errors and reluctance to embrace non-evidence-based practices, this study highlights the potent role of an innovation-oriented culture in mitigating nurse turnover. Therefore, it is imperative for nurses to embrace innovation and apply it more extensively in patient care.\u0026nbsp;The results further underscore the importance of good leadership in nursing and the role of nurse leaders in reducing turnover among nurses. Managers\u0026rsquo; competency and self-mastery, i.e., the ability to create a strong nursing team, emotional intelligence and reactions to workplace issues, and the ability to monitor and diagnose workplace problems (e.g., work incivility, organizational cynicism, workplace politics and organizational silence), were highlighted by the studies and showed that if a nurse manager is competent enough, it could reduce nurse turnover, and the inverse is true. Leadership and the organization are closely related and inseparable; therefore, leadership and organizational support were emphasized as a source of satisfaction that reduced nurse turnover. As a result, organizations should provide adequate resources for nurses to work. Leaders enhance workplace relations by promoting a positive culture through continuous open genuine team communication and meetings. There must be an organized information flow to avoid task confusion. Furthermore, leadership justice, where the leader practices fair play in staff recognition, respects subordinates, practices fairness in all aspects of the job, spiritually supports nursing staff and offers staff encouragement, was proven to strongly enhance work engagement and reduce nurse turnover intentions[45].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthentic leaders who collaborate, motivate, and advocate for junior nurses and manage resources prudently earn trust from subordinates and make organizations more habitable for nurses.\u003c/p\u003e\n\u003cp\u003eOur systematic review underpins the importance as well of all \u0026ldquo;magnet forces\u0026rdquo;, (earlier discussed in results section), the values of\u0026nbsp;success for hospitals in attracting and retaining nurses first recognized by the\u0026nbsp;American Academy of Nursing in the 1980s, and puts keen emphasize on nurse participation in hospital affairs, delivery of quality service,\u0026nbsp;nurse manager ability, leadership, and support of nurses, staffing and adequacy of resources and collegial nurse\u0026ndash;physician relations. The more these forces were present in organizations, the more the turnover was lower.\u003c/p\u003e\n\u003cp\u003eOrganizational climate which primarily encompasses employees\u0026rsquo; perceptions of various work aspects including leadership, leadership style, communication, trust and respect, workloads and job demands, culture, and working conditions, recognition and rewards, conflict resolution, job security and inclusion and diversity[41, 68-70, 88-93]\u0026nbsp;was found to strongly influence nurse turnover and turnover intentions. Studies by[70]\u0026nbsp;and\u0026nbsp;[68]\u0026nbsp;observed that perceptions of ethical climate (caring climate, law and code climate, rules climate, instrumental climate, and independent climate) play a crucial role in influencing perceptions of organizational\u0026nbsp;cynicism and mediate effect between the relationship of perception of ethical climate and turnover intention. Organizational\u0026nbsp;cynicism\u0026nbsp;is a term used to describe negative attitudes or mindset that employees may have towards their organization[75]\u003c/p\u003e\n\u003cp\u003eIt is characterized by sense of distrust, scepticism, disillusionment with organization\u0026rsquo;s policies, leadership, practices, and overall culture. [5] found that, a positive appraisal of organizational climate by nurses doubles the probability of a nurse staying on their job.\u0026nbsp;\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion, this comprehensive review has shed light on the critical role of organizational culture in shaping the career trajectories of nurses. As healthcare systems grapple with the multifaceted challenges of nurse shortages and high turnover rates, recognizing organizational culture as a pivotal determinant of turnover becomes paramount. Our review underscores the significance of fostering positive organizational cultures and climates to mitigate nurse turnover and turnover intentions, ultimately benefiting both healthcare institutions and the well-being of nursing professionals. Healthcare organizations are constantly evolving, and it is imperative that we continue to delve deeper into this subject matter. Future research endeavours should aim to provide a more nuanced understanding of the interplay between organizational culture and nurse turnover, particularly in regions grappling with persistently high rates of nursing turnover. Lastly,\u003c/p\u003e\n\u003cp\u003ethis review serves as a call to action for healthcare leaders and researchers alike to cultivate positive organizational cultures and create environments where nurses thrive, patients receive exceptional care, and the healthcare system as a whole can achieve greater resilience and sustainability. More studies also need to be done to generate more information on organizational culture in nursing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies included in this review were mainly free access articles published in English language. We excluded conference papers, other systematic literature reviews and meta-analyses, letters/opinions, editorials, essays, case studies and literature, comments or and studies with mixed nurses and other cadres\u0026apos; participation as well as articles without free access. Therefore, potentially important studies with vital information might have been excluded.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFurther to the data available in the supplementary files, other datasets supporting the conclusions of this article are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edisclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors of this article declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEKK\u003c/strong\u003e:\u0026nbsp;Conceived the research idea, designed the search strategy, participated in search and\u0026nbsp;screening, analysis and wrote the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eME:\u003c/strong\u003e Contributed to the development of the search strategy; performed the search, screening and editing; and proofread the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGAD, GAW, AS \u0026amp; SK\u003c/strong\u003e: Participated in search and\u0026nbsp;screening\u0026nbsp;and edited the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Habil. Adrienn Ujv\u0026aacute;rin\u0026eacute; Siket:\u003c/strong\u003e Supervisor and advisor,reviewed and edited this manuscript\u0026nbsp;and approved it for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Habil. Orsolya M\u0026aacute;t\u0026eacute;\u003c/strong\u003e:The supervisor and advisorreviewed and edited this manuscript\u0026nbsp;and approved it for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;We want to acknowledge and thank all the authors of the reviewed articles. Specifically, we thank The Doctoral School of Health Sciences, the University of P\u0026eacute;cs and The Stipendium Hungaricum Program-Hungarian Government for their support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAljedaani, S.M., \u003cem\u003eNurses\u0026rsquo; Perceptions of Nursing as a Profession and Its Impact on Their Intention to Leave Their Career: Staff Nurses in Jeddah City.\u003c/em\u003e IOSR Journal of Nursing and Health Science, 2017. \u003cstrong\u003e06\u003c/strong\u003e(02): p. 13-23.\u003c/li\u003e\n\u003cli\u003eSang J, C., et al., \u003cem\u003eExodus of Healthcare Professionals: Antecedents of Occupational Turnover Among Nurses in Kenya.\u003c/em\u003e International Journal of Academic Research in Business and Social Sciences, 2021. \u003cstrong\u003e11\u003c/strong\u003e(2).\u003c/li\u003e\n\u003cli\u003eBuchan, J., J. Campbell, and C. 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Amponsah-Tawiah, \u003cem\u003eTurnover intention and job fit among nurses in Ghana: Does psychological climate matter?\u003c/em\u003e Nursing Open, 2019. \u003cstrong\u003e6\u003c/strong\u003e(2): p. 546-557.\u003c/li\u003e\n\u003cli\u003eHsiung, K.S., et al., \u003cem\u003eMeasures of Organizational Culture and Climate in Primary Care: a Systematic Review.\u003c/em\u003e 2020.\u003c/li\u003e\n\u003cli\u003eStone, P.W., et al., \u003cem\u003eNurse working conditions, organizational climate, and intent to leave in ICUs: An instrumental variable approach.\u003c/em\u003e Health Services Research, 2007. \u003cstrong\u003e42\u003c/strong\u003e(3 I): p. 1085-1104.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Organizational culture, shortage of nurses, turnover, turnover intention, leadership, nurse administrators, systematic literature review","lastPublishedDoi":"10.21203/rs.3.rs-5308085/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5308085/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eGlobally, healthcare settings are facing significant nursing staff shortages occasioned by nurse turnover and experiencing difficulties in recruitment and retention of nursing professionals. The pressure of shortage of nurses and other healthcare workforce is so severe that World Health Organization has warned European countries and the globe that this shortage is a “ticking timebomb” if an action is not taken. \u0026nbsp;Organizational culture is an important antecedent of nurse turnover that remains weakly studied. Despite a plethora of research on the global shortage of nurses and turnover, there have been few dedicated systematic literature reviews, and this study aimed to fill this gap.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To collect and collate evidence available in the literature on the impact of organizational culture on career and professional leaving among nurses and emphasize the critical role of organizational culture in turnover and retention of nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive literature search according to the Population, Exposure and Outcome search strategy model was performed in six major electronic databases, including PubMed, Ovid Medline, Embase, CINAHL, Scopus and Web of Science, in July 2023. Studies that met the inclusion criteria set were screened using Rayyan and Covidence. Mixed Methods Appraisal Tool was used to assess the quality and risk of bias of the included articles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS:\u003c/strong\u003e The search yielded a total of 2,396 articles, of which 30 were included. The results demonstrate that nurse turnover remains a complex issue and continues to plague nations of the world. Organizational culture is an important antecedent of nurse turnover, with different types of organizational culture affecting turnover differently. We found overall that, negative organizational culture and climate was consistently associated with nurse’s turnover while positive culture improved nurse retention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study confirmed that organizational culture seriously influences nurse turnover. Nurse managers and hospital managements should strive to continuously monitor and build positive organizational cultures to raise quality of service delivery and retain nurse workforce.\u003c/p\u003e","manuscriptTitle":"The Impact of Organizational Culture on Career Leaving Among Nurses: Examining Global Nurses’ Shortage Through the Lenses of Organizational Culture: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-23 14:01:55","doi":"10.21203/rs.3.rs-5308085/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a7ac734b-d1e0-413d-9b19-8834bd4b2c23","owner":[],"postedDate":"October 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":39246322,"name":"Nursing"}],"tags":[],"updatedAt":"2024-10-23T14:01:55+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-23 14:01:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5308085","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5308085","identity":"rs-5308085","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}