Internal marketing, nurse loyalty and relationship marketing: an exploratory study of German nurses.

Nurse loyalty and retention are critical issues facing the healthcare industry. A lack of continuity in the nursing staff compromises the quality of the care, results in significant costs, and leads to patient concerns about the viability of the healthcare facility. Conversely, a motivated and committed nursing staff creates a solid foundation for implementing initiatives for the improvement of healthcare quality. This article employs the "Relationship Marketing Paradigm" as a framework to understand and enhance nurse loyalty through internal marketing efforts. The results indicate that financial, social and structural bonds have significant, albeit different, impacts on nurse loyalty. Managerial implications and future research directions are discussed.