The straw that broke the nurse's back—Using psychological contract breach to understand why nurses leave

Daniela Pyhäjärvi, Christina B. Söderberg*

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review


Aim: To deepen our understanding of why nurses decide to leave their occupation instead of changing jobs, we examined the antecedents that led to this decision through the theoretical lens of psychological contract breach. Design: A qualitative design with semi-structured interviews.
Methods: We collected 28 interviewees from our social networks and a social media platform. We included professional nurses who had decided to leave or had left the occupation. We analysed our data with reflexive thematic analysis, thereby giving space for the interviewee voices to rise.
Results: We identified various experiences of dissonance between interviewee expectations and reality. The interviewees expressed unfulfilled expectations or psychological contract breaches in relation to their occupation on different levels and over extended time periods. The psychological contract breaches and decisions to leave the occupation were built up over time because of continuous disappointment and dissonance between expectations and reality. The frustration, dissonance and unfulfilled expectations were expressed towards the institution of nursing rather than a specific employer or organization. Conclusion: Unfulfilled expectations over a longer period might cause psychological contract breach, leading to turnover intentions. Our research brings novel insights into the psychological contract, as our findings indicate that the psychological contract can be formed and breached, also between the employee and the occupation. This means that turnover intentions might result in nurses leaving the profession rather than seeking work in new organizations. Impact: The study addresses the problem of nurse shortage by showing the root reasons for deciding to leave the occupation. Our findings show how psychological contract breaches over time erupt as turnover intentions regarding the occupation rather than a job. The results guide healthcare managers and decision-makers to recognize factors leading to a psychological contract breach, thereby enabling the retention of nurses.
Patient or Public Contribution: No patient or public contribution.

Original languageEnglish
Peer-reviewed scientific journalJournal of Advanced Nursing
Publication statusPublished - 05.03.2024
MoE publication typeA1 Journal article - refereed


  • 316 Nursing
  • 520 Other social sciences
  • nurses
  • occupation
  • organizing
  • psychological contract breach
  • turnover


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