Influence of job satisfaction, job stress, job identity and job values on turnover intention among male physician assistant nurses MZ generation nurses in South Korea

1. Introduction

Physician Assistant (PA) nurses referred to as registered nurses who perform delegated medical tasks under the supervision of physicians across various medical departments [1, 2]. In South Korea, PA nurses have been increasingly utilized as an alternative workforce for surgical specialists, responding to societal demands and workforce shortages in the healthcare sector [3, 4].

With advancements in medical technology, the demand for highly skilled healthcare professionals has risen significantly [5]. However, domestic medical institutions face persistent challenges, including an imbalance in the supply of specialists and an increasing demand for complex and specialized medical services [1]. To address the physician shortage, hospitals have adopted PA nurses—selected and trained internally as PA, dedicated or specialist nurses—rather than utilizing professionals who have undergone standardized PA training programs [1].

Since the introduction of PA nurses in 1997, their numbers have steadily increased in South Korea. As of 2021, 4721 PA nurses were employed in 105 hospitals for internal medicine, while 3340 were working in 126 hospitals for surgical departments [6]. Due to economic downturns and job market fluctuations, nursing characterized by high employment stability has gained popularity among male students. This trend reflects shifts in societal perceptions of gender roles in the workforce and the professionalization of nursing careers [7]. As a result, the cumulative number of male nurses in 2016 reached 15,420, with male PA nurses accounting for 17.6% of this workforce [1]. However, despite the increasing number of male nurses, their turnover intention remains a significant concern [7]. Turnover intention refers to an individual’s intention to voluntarily leave their job within a specified period, making it a key variable for organizational retention strategies and human resource management.

The high turnover rate among male nurses is influenced by persistent gender stereotypes that depict nursing as unsuitable for men [8], experiences of rejection from patients and caregivers, and significant workplace conflicts [9]. In this study, job satisfaction refers to the overall level of contentment an individual experience in their job, encompassing both emotional satisfaction derived from performing job duties and the degree to which the individual recognizes their value within the organization. Job satisfaction significantly impacts an employee’s productivity and organizational loyalty, and it is closely linked to turnover intention [2, 5]. Job identity represents the extent to which an individual identifies with their job, including a sense of belonging to a specific profession and the influence of that profession on the formation of their self-identity. This concept is closely related to an individual’s motivation, professional engagement and career longevity [10]. Job stress refers to the physical and psychological tension an individual experience due to various work demands, workload, role conflicts and environmental factors in the workplace. Job stress not only reduces job satisfaction but can also act as a significant factor that increases turnover intention [10]. Job value is the importance an individual place on various aspects of their job, such as personal motivation, satisfaction, job sustainability and career development [10].

Previous studies on the turnover of male nurses in Korea investigated factors such as practical experience, job satisfaction and job engagement, job identity, job stress and job values ​​ [11, 12, 13, 14]. Job satisfaction refers to the degree of satisfaction an individual feel with their job and job identity is defined as the degree to which an individual has a psychological sense of identification with their job. Higher job satisfaction and job identity were associated with lower turnover [13]. In addition, job values ​​are defined as the desires and realizations that one seeks to fulfill through one’s job, and when job values ​​are low and job stress is high, turnover is high [14].

Despite the growing academic interest in PA nurses, existing research in South Korea has largely focused on the general PA workforce, with limited studies specifically examining male PA nurses. Additionally, prior studies have predominantly explored job satisfaction among male dedicated nurses rather than PA nurses [10]. PA nurses primarily consider changing jobs to other departments within the hospital, different medical institutions, or by becoming independent with their own private clinics [15]. The typical turnover points are around 1 year and 5 years. The main reasons for turnover at the 1-year mark include work stress, burnout, disappointment with job intensity and working conditions, and dissatisfaction with organizational culture and relationships with colleagues [16]. At the 5-year mark, turnover is often driven by a lack of career growth opportunities, dissatisfaction with compensation and changes in job identity [16]. Key factors influencing turnover decisions include job satisfaction, salary, work environment, career development opportunities, training opportunities and work-life balance. Particularly, the MZ (Millennial + Generation Z) generation tends to value work-life balance and may decide to leave if the workload and stress are too high, especially when family time is compromised [15].

The term “MZ generation” refers to a combination of Millennials (born approximately between 1981 and 1996) and Generation Z (born approximately between 1997 and 2012). This demographic group shares common values, particularly emphasizing work-life balance, career development, and a strong professional identity. In the context of nursing, MZ-generation nurses prioritize autonomy, career growth and a positive work environment, distinguishing them from previous generations who may have placed greater emphasis on job stability and hierarchical advancement. Understanding their perspectives on job satisfaction and turnover intention is essential in adapting healthcare policies and workplace conditions to ensure workforce retention and stability.

With the increasing presence of MZ-generation male PA nurses, reducing their turnover intention is essential for maintaining workforce stability and optimizing patient care [17]. Therefore, this study adopts a descriptive cross-sectional study design to analyze the effects of job satisfaction, job stress, job identity and job value on the turnover intention of MZ-generation male PA nurses, aiming to provide foundational data for personnel management strategies. To achieve this, a survey will be conducted among male PA nurses born between 1981 and 2012 who are working in general and tertiary hospitals in South Korea. The study will utilize validated measurement scales from previous research to ensure reliability in assessing key variables. The collected data will be analyzed using descriptive statistics, correlation analysis, multiple regression analysis to examine relationships between variables and identify both direct and indirect effects, thereby offering more systematic insights. Notably, as a descriptive study aimed at exploring key factors influencing turnover intention, setting specific hypotheses is not mandatory. However, to clarify the relationships among variables, this study will establish and test hypotheses regarding the effects of job-related factors on turnover intention.

2. Materials and methods

3. Results

3.5 The impact of job satisfaction, job stress, job identity and job values on turnover intention

To identify the factors influencing turnover intention among male PAs, statistically significant differences in general characteristics such as the presence of overtime pay, on-call duty, duty shifts, position, perception of fairness in human resources, were treated as dummy variables. Job satisfaction, job stress, job identity and job values were used as independent variables for multiple regression analysis. The Durbin-Watson test showed no autocorrelation issues, with a value of 1.82. The tolerance values were below 0.1, and the Variance Inflation Factor (VIF) values were less than 10, indicating no problems with multicollinearity. Next, residual analysis confirmed linearity of the model, the normality of the errors and the homoscedasticity. The total explanatory power was 42.1%. Factors influencing turnover intention were the perception of fairness in human resources (β = −0.14, p = 0.027), job satisfaction (β = −0.49, p < 0.001) and job values (β = 0.16, p = 0.019). Job stress and job identity did not significantly influence turnover intention (Table 4, Fig. 1).

Table 4.Influencing factors of turnover intention (N = 150).

Variable	B	S.E.	ß	t	p	VIF	R2	Adj R2	F (p)
(Constant)	16.80	4.74		3.54	0.001		0.46	0.421	11.84 (<0.001)
The Perception of Fairness in Human Resources†	−1.17	0.52	−0.14	−2.23	0.027	1.06
Job Satisfaction	−0.17	0.04	−0.49	−4.82	<0.001	2.68
Job Stress	0.07	0.04	0.13	1.54	0.125	1.91
Job Identity	0.01	0.05	0.02	0.25	0.807	1.80
Job Values	0.17	0.07	0.16	2.38	0.019	1.16
†Dummy variables: the perception of fairness in human resources (None = 0). S.E.: Standard Error; B: Unstandardized Coefficient; VIF: Variance Inflation Factor; Adj R2: Adjusted R-squared.

Fig. 1.Turnover intention among MZ generation male physician assistant nurses in South Korea: influencing factors.^†: p < 0.10: Not statistically significant but indicates a potential trend.

4. Discussion

This study is a descriptive survey aimed at understanding the impact of job satisfaction, job stress, job identity and job values on turnover intention among male Physician Assistant (PA) nurses, particularly focusing on the MZ generation (millennial and Generation Z). PA nurses have emerged as key figures in healthcare institutions, addressing the shortage of physicians. However, with the recent increase in turnover rates among male nurses, it is crucial to develop systematic approaches to personnel management to mitigate this issue. Based on the findings of this study, we propose a discussion about the need for tailored personnel management strategies to reduce turnover intention among male PA nurses, especially those from the MZ generation.

In examining the age distribution, the majority of participants were in their 30s, followed by those in their 20s. This suggests that individuals in their early to mid-career stages, which are typical for PA nurses, are predominantly active in the workforce. Previous studies, such as those by Lee & Kim [2], have shown that age plays a significant role in turnover intention, with MZ generation nurses showing a higher tendency to consider leaving their job. This aligns with our findings that younger generations, such as the MZ generation, are more likely to express turnover intentions compared to older generations.

Regarding marital status, unmarried individuals outnumber married ones, which may be because unmarried nurses have fewer family caregiving responsibilities and can dedicate more time to their professional duties. Yoon & Kang [5] found that although married nurses may have lower turnover intention due to family obligations, dissatisfaction with work can still lead to high turnover intention, even among married nurses. In contrast, unmarried nurses may feel more flexible in seeking better job opportunities elsewhere, especially in the context of the MZ generation’s tendency toward career mobility.

The majority of participants were graduates of 4-year universities, followed by those from 3-year universities, reflecting the educational requirements needed to fulfill the role of a PA nurse. Research has consistently shown that nurses with higher education levels are more likely to seek job opportunities elsewhere. This finding supports the idea that as the MZ generation places a high value on career development, higher education may be correlated with a higher likelihood of turnover intention.

In terms of salary, most participants earned between 2 to 3 million won, with a significant portion earning over 3 million won. Higher salary levels are generally associated with lower turnover intention, as those earning more are more likely to remain in their current position. This finding is consistent with the broader literature that emphasizes the importance of financial compensation in reducing turnover intention. This is particularly pertinent to the MZ generation, who, according to existing research, are more financially driven when considering career moves.

The most common years of experience as a PA nurse were found to be around 2 to 4 years, suggesting that many PA nurses are in the early stages of their careers. This is consistent with the findings of previous studies, which suggest that individuals early in their careers are more likely to experience higher turnover intention as they explore different opportunities. This is especially true for the MZ generation, known for its tendency to switch jobs for better opportunities or work-life balance.

Most PA nurses wore lab coats as their primary uniform, which is standard across healthcare settings. However, the type of uniform worn can vary depending on hospital policies. The choice of uniform itself does not appear to have a significant impact on job satisfaction or turnover intention. However, it may contribute to the sense of professional identity and comfort, indirectly affecting job satisfaction. These findings align with previous studies which have emphasized the importance of uniforms in shaping professional identity, though they do not directly influence turnover intention.

Most PA nurses worked full-time, with many working more than 40 hours per week, suggesting high workload intensity. This finding is consistent with Choi & Kim [8], who found that long working hours and high workload are negatively correlated with turnover intention. Similarly, this study showed that adequate compensation for overtime work, on-call duties, and a supportive work environment can help reduce turnover intention. In line with prior research, factors such as job title differences, workspaces and job evaluations significantly influenced turnover intention. Specifically, PA nurses who perceived their job evaluations and human resource systems as unfair showed higher turnover intention, mirroring findings by Shin & Kim [14].

The participants in this study reported moderate job satisfaction, with an average score of 3.21. This level of satisfaction aligns with prior studies which suggest that job satisfaction is a crucial determinant of turnover intention. Research by Shin & Kim [14] and others has shown that higher job satisfaction is linked to lower turnover intention. Therefore, efforts to enhance job satisfaction among PA nurses through improving the work environment, establishing fair compensation systems, and providing job-related training are critical in reducing turnover intention.

Job stress was reported at a moderate level (2.89), and as expected, job stress was found to significantly influence turnover intention. Higher job stress leads to increased turnover intention, which is consistent with prior research that highlights job stress as a key factor in turnover intention. This finding also aligns with studies focusing on the MZ generation, who are known to prioritize stress-free environments and work-life balance. Reducing job stress through workload management, stress-relief programs, and effective communication channels can help mitigate turnover intention.

Job identity and job values were reported at higher levels (3.41 and 3.82, respectively). Job identity has been linked to stronger job engagement, which in turn reduces turnover intention. Our study found a significant positive correlation between job satisfaction and job identity, supporting previous research that highlights the role of job identity in reducing turnover intention. Additionally, job values were positively correlated with job satisfaction, but interestingly, they were also positively correlated with turnover intention. This suggests that nurses with higher job values might seek better working conditions or environments elsewhere, which is a unique finding in this study.

Perceived organizational justice had a significant negative impact on turnover intention (β = −0.14, p = 0.027), supporting existing literature that suggests fair human resource management and evaluation systems reduce turnover intention. As the MZ generation values fairness and transparency in the workplace, establishing fair systems is crucial in retaining them.

This study found that job satisfaction and job values all significantly influence turnover intention among PA nurses. The MZ generation, in particular, exhibits a higher turnover intention due to factors such as career development opportunities and work-life balance. These findings align with previous research while providing new insights into the specific needs and characteristics of MZ generation PA nurses. To reduce turnover intention, it is essential to improve job satisfaction, establish fair evaluation systems, and provide career development opportunities that align with the values of the MZ generation.

Job stress was correlated with turnover but was not a factor affecting turnover in male nurses. Similarly, in Kim’s study [23], the effect of job stress on turnover was not significant [23]. Regarding this, Kim pointed out that previous studies have shown conflicting results when comparing the job stress of male and female nurses, and therefore, more research should be conducted. In this study, the level of job satisfaction was found to be high, and the level of stress was found to be low, which is why it is thought that it was not found to be a significant factor influencing turnover. In addition, job identity was not a significant factor, and the sub-factors of the job identity tool include belief in autonomy and sense of calling. The scope of autonomy in nursing work in Korea is a subject of ongoing legal and academic debate, and personal perceptions vary. Accordingly, it is thought that it is necessary to review once again whether the results measured by the tool in this study appropriately measured Job Identity.

However, it is important to note that this study targeted PA male nurses in some medical institutions, limiting the generalizability and interpretation of the study results. The findings may not fully represent the experiences of PA nurses in other healthcare settings or regions. Future research should aim to include a broader sample of PA nurses from various institutions, including those of different genders, to enhance the generalizability and applicability of the results. Additionally, further studies could explore the differences in turnover intention among various demographic groups within the nursing profession to better address the diverse needs and expectations of nurses across different contexts.

5. Conclusions

Considering the negative impact of perceived organizational justice on turnover intention, it is essential to establish and maintain a fair human resource management system within the organization. This should be done by enhancing the transparency and fairness of evaluation and reward systems. Additionally, given that job satisfaction emerged as the most significant factor influencing turnover intention, various strategies are needed to increase job satisfaction among PA nurses, particularly those from the MZ generation. Specifically, this may include improving working conditions, providing appropriate compensation, redesigning job roles, and offering continuous education and training.

Reflecting the result that PA nurses with higher job values are more likely to consider turnover, it is crucial to provide working conditions and opportunities that fulfill their professional values. For instance, opportunities to demonstrate professionalism and programs supporting career development can be implemented. For the MZ generation, who place a high value on work-life balance, providing flexible working hours and remote work options could be important to address their expectations.

While this study did not find a direct impact of job stress on turnover intention, organizational efforts to manage and reduce job stress are still necessary based on previous research. This is especially relevant for the MZ generation, who may experience higher stress levels due to work overload and unclear role boundaries. Additionally, although job stress and occupational identity did not directly influence turnover intention in this study, further research considering various conditions and contexts, especially focusing on the MZ generation’s unique expectations, is needed to explore their potential indirect effects.

In conclusion, organizations should focus on establishing fair human resource management systems, enhancing job satisfaction, managing job stress, and providing opportunities that fulfill nurses’ professional values, particularly for the MZ generation, to reduce turnover intention among PA nurses. Further research exploring these relationships under different conditions and contexts, with a focus on generational differences, is warranted.

Availability of data and materials

Not applicable.

Author contributions

SJP, YL, HC, HK—Study conception and design acquisition. SJP, YL, MJK—Drafting and critical revision of the manuscript. HC, HK, MJK—Data collection; Abstract and References and Final Submission. SJP, YL—Analysis and interpretation of the data. SJP, MJK—Discussion and conclusions, suggestions. HC, HK—English review. All authors contributed to editorial changes in the manuscript. All authors read and approved of the final manuscript.

Ethics approval and consent to participate

This study was approved by the Clinical Trial Review Committee of Catholic Kwandong University, Korea (IRB No: CKU-24-01-0707). Informed consent was obtained from all participants involved.

Acknowledgment

Not applicable.

Funding

This research received no external funding.

Conflict of interest

The authors declare no conflict of interest.