Intentions to Stay in Rural Healthcare Providers: A Preliminary Empirical Model

Background and Purpose: Rural healthcare providers are critical to addressing medically underserved place-bound populations. However, little is known about factors that promote or impede rural healthcare providers’ intentions to stay with their organizations. An intention to stay is a conscious and deliberate willingness to remain with the organization (Eom, 2015; Tett & Meyer, 1993). Strong intentions to stay may incline providers to sustained organizational practice, thus enhancing organizational, and population- and community-based knowledge. The purpose of this study was to develop a preliminary empirical model of intention to stay in rural healthcare providers from two agencies in a single county in a northeastern state.

Methods: Healthcare providers were recruited from 2019-2021. To be inclusive of the provider landscape, a provider was defined as any staff who delivered a physical, mental, or behavioral health service, professional or para-professional. A cross-sectional survey was voluntarily completed by 88 providers. The majority of participants were white (85.1%), non-Hispanic (89.5%) women (85.1%). The largest proportion were nurses (42.0%). Measures used in the study were the Intention to Stay Scale (Eom, 2015; α=.926), the Workplace Attachment Scale (Rioux, 2011; α=.864), the Job Satisfaction Survey, Nature of Work subscale (Spector, 1985; α=.763), the Organizational Citizenship Behavior Scale, Helping Behavior subscale (Le Roy & Rioux, 2012; Podsakoff et al., 1990; α=.723), the Index of Interdisciplinary Collaboration: Reflection on Process subscale (Bronstein, 2002; α=.744), and the Organizational Commitment Questionnaire (Mowday et al., 1979; α=.926). Ordinary least squares multiple regression was used to develop a statistically significant model of participants’ intentions to stay.

Results: On average, participants reported moderately-high intentions to stay. Intention to stay was correlated with perceptions of job satisfaction with the nature of the work (r=.312, p=.004), organizational commitment (r=.644, p<.001), and workplace attachment (r=.662, p<.001). Intention to stay was not statistically significantly correlated with perceptions of organizational citizenship helping behavior and reflection on team processes in interprofessional collaboration. Controlling for age and whether the survey was completed pre-pandemic or during the pandemic, regression results indicate a statistically significant model of intention to stay (F=19.081, p<.001, R²=.584) with organizational commitment (b=.441, p<.001) and workplace attachment (b=.392, p<.001) statistically significantly associated with intentions to stay. Perceptions of job satisfaction were not statistically significantly associated with intentions to stay in the regression model.

Conclusions and Implications: These results identify a preliminary empirical model of intention to stay with organizational commitment and workplace attachment as significant factors. Strong perceptions of organizational commitment may signal a fit between agency and provider goals and values that promotes retention intentions. Affective bonds between workers and workplaces may incline providers to stay as thoughts of leaving may provoke feelings of loss. Organizations may want to include assessment of fit between applicant’s values and professional goals in hiring decisions. Organizations may also create workplace policies and practices that encourage providers to personalize their workplaces. To contribute to organizational theory, future research should replicate this study with a larger, random sample of rural healthcare providers where the relative impact of factors could be clarified.