ArticleNursing open2025
How Does Job Dissatisfaction Fuel Nurse Exit, Voice, Loyalty, and Neglect (EVLN) Behaviours? Insights From Dynamic Game Theory and a Cross-Sectional Survey.
Article in Nursing open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Generative AI in healthcare: redefining clinical practice through digital transformation.Health economics review · 2026Article
- Historical roots of hospital-centred operational governance in China: a path dependence analysis and its implications for global health system reform.BMJ global health · 2026Article
- Historical Roots of Hospital Nursing Centrism in China (1835-Present): A Path Dependence Analysis.International nursing review · 2026Article
- How Does Job Dissatisfaction Fuel Nurse Exit, Voice, Loyalty, and Neglect (EVLN) Behaviours? Insights From Dynamic Game Theory and a Cross-Sectional Survey.Nursing open · 2025Article
- The Impact of Diversity Inclusion Practices in the Workplace Context: The Effect of Inclusive Leadership.European journal of investigation in health, psychology and education · 2025Article
- Nexus Between Operational Efficiency and New Quality Productivity in Hospitals: Does Dean Overconfidence Matter?Inquiry : a journal of medical care organization, provision and financingArticle
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Authors and funding
4 authors.
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Abstract
aimsThis study explores how nurses' job dissatisfaction influences their behavioural responses-exit, voice, loyalty, and neglect (EVLN)-within the framework of organisational behaviour, focusing on the Chinese cultural context using dynamic game theory. The goal is to provide insights for reducing nurse shortages.
designA cross-sectional quantitative design was employed to assess the relationships between nurses' job dissatisfaction and EVLN behaviours in public hospitals in Chongqing, China, between January and May 2024.
methodsData were collected using a structured questionnaire administered to registered nurses across tertiary public hospitals. The study combined Farrell's EVLN framework with dynamic game theory to analyse behavioural evolution. Quantitative analysis included descriptive statistics, reliability checks, correlation tests, multiple regression analyses, robustness checks, and heterogeneity analysis.
resultsThis study involved 1132 registered nurses, primarily female (94.88%), aged 20-39. Findings show that job dissatisfaction is positively correlated with exit (β = 0.3924, p < 0.01) and neglect (β = 0.6603, p < 0.01) behaviours, and negatively correlated with voice (β = -0.1483, p < 0.01) and loyalty (β = -0.1714, p < 0.01). Gender and education level significantly influenced the relationship between dissatisfaction and EVLN behaviours, while age and marital status showed partial heterogeneity. Dynamic game modelling revealed that nurses initially showing loyalty may shift to voice if dissatisfaction persists, and if voice is ignored, they may either transition to exit or move gradually to neglect.
conclusionThis study contributes to nursing management by applying dynamic game theory to the EVLN framework, revealing the evolutionary mechanisms through which nurses respond to job dissatisfaction and highlighting the cultural specificity of these behaviours in China's healthcare setting. IMPLICATIONS FOR THE PROFESSION: Understanding the dynamic responses to job dissatisfaction can assist hospital administrators in developing strategies that promote nurse retention, encourage voice and loyalty behaviours, and mitigate exit and neglect. IMPACT: This study enriches the application of EVLN theory in China and Greater China, supporting hospital management and optimizing nursing strategies for sustainable hospital development. PATIENT OR PUBLIC CONTRIBUTION: No direct patient or public contribution.
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