How Does Job Dissatisfaction Fuel Nurse Exit, Voice, Loyalty, and Neglect (EVLN) Behaviours? Insights From Dynamic Game Theory and a Cross-Sectional Survey.

AIMS: This 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. DESIGN: A 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. METHODS: Data 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. RESULTS: This 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. CONCLUSION: This 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.