Job Satisfaction, Leadership Behaviors, and Turnover Intention Among Nurses in Saudi Arabia: A Mediation Analysis

To examine the associations among nurses' perceived leadership behavior, job satisfaction, and turnover intention in Saudi Arabia and to determine whether perceived leadership behavior mediates the relationship between job satisfaction and turnover intention.

Nurses' turnover intention remains a major challenge for healthcare systems worldwide. High turnover contributes to nursing shortages, negatively affects patient outcomes, and increases healthcare costs. Although job satisfaction is a well-established predictor of turnover intention, limited research has explored the potential mediating role of perceived leadership behavior in this relationship.

An advanced correlational design was used. Data were collected via online questionnaires completed by nurses working in selected hospitals. Leadership behavior, job satisfaction, and turnover intention were measured using the Leader Behavior Description Questionnaire, Job Satisfaction Survey, and turnover intention scale, respectively. Descriptive statistics, Pearson's correlation, and multiple linear regression were used. Mediation was tested using Hayes' PROCESS Macro, Version, 5 Model 4, with bootstrap procedures. Turnover intention was designated as the primary outcome because it is the most proximal and modifiable behavioral predictor of actual turnover.

Nurses reported moderate levels of job satisfaction, turnover intention, and perceived leadership behavior. Turnover intention was moderately and negatively correlated with perceived leadership behavior (r = -0.481, p < 0.001). Perceived leadership behavior partially mediated the relationship between job satisfaction and turnover intention (B = -0.036, 95% CI [-0.066, -0.012]) and accounted for 30.3% of the total effect.

Lower job satisfaction was associated with higher turnover intention. Perceived leadership behavior statistically mediated part of this relationship. Supportive, well-structured leadership independently increases and reduces turnover intentions. Therefore, strengthening leadership behavior is a practical approach for improving nurse retention.

Implementing effective leadership strategies and leadership development programs may improve nurses' job satisfaction and reduce their intention to leave.