The Impact of Changes in Professional Autonomy and Occupational Commitment on Nurses’ Intention to Leave: A Two-Wave Longitudinal Study in Japan

Round 1

Reviewer 1 Report

The introduction provides sufficient background. However, the authors have included a section for the purpose of the study and a section for hypotheses. It would be good if both were integrated into the introduction or included in the method section.
Regarding the method, how was the contact with the participants and the selection?
Regarding the results, most of them are very elementary, including 3 tables to talk about the descriptive ones, 3 for correlations and the last one of Generalized estimating equation results.
Are the descriptive data really necessary? Especially, the first table can be used to characterize the sample. Why don't you include the figure of the equations?
Does the discussion really contrast with the findings included in the results section?
The sections on limitations and implications for practice are very appropriate.

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for the opportunity to review the interesting manuscript entitled "The Impact of Changes in Professional Autonomy and Occupational Commitment on Nurses’ Intention to Leave: A Two-wave Longitudinal Study in Japan". 

I enjoyed reading this manuscript. I believe it is, in general well-written, scientifically sound, relevant and interesting to the reader. I have some minor comments that I feel ought to be taken into account prior to the manuscript being publishable in IJERPH. 

Introduction 

• l. 42. What is meant by "mental health is worse" and "ordinary people"? Please try to rephrase and use more neutral language. 
• l. 42 (and elsewhere). The authors refer to "positive" and "negative" impact on intention to leave and other variables. In this context this might be perceived as arbitrary; please try to rephrase. 
• l. 43. What do the authors mean by "success rate for rescue"? Do they mean "successful recovery?"
• l. 44 and throughout the manuscript: one of my major concerns with this manuscript is the authors' usage of 'autonomy'. The authors provide an interesting (an accurate) theoretical overview of autonomy, and factors that potentially influence autonomy levels (age, culture, SES, etc). The authors do, however, state that they feel nurses "have" a certain level of autonomy. However, considering that they use self-report measures for autonomy, are they not measuring "perceived autonomy"? or "attitudes towards autonomy" (as the authors themselves specify further in the manuscript. In other words: do the nurses have a certain level of autonomy, or experience a certain level of autonomy? Although it might seem like a slight difference, it is important, nonetheless, in my humble opinion, and deserves to be mentioned in the introduction and/or discussion. 
• l. 151 contains a minor type --> "leads to actually leaving". 

Method, results and discussion

In general these sections are clear, and sound. However, upon reading the method section as well as the demographic data collection I cannot help but wonder why the authors did not correct for/take into account certain variables that likely play a role in the perceived levels of autonomy and intention to leave, including the type of nurse (midwife, etc.), work setting (large or small teams), gender differences, number of years employed as a nurse, and other factors? I understand that this is not the main focus of the study, but I feel that taking into account potential moderating, or even mediating, factors between the variables of interest is crucial for understanding potential (causal) relationships. Please provide more information about this in the results (by attuning the analyses used), and the discussion. At the very least, I feel that it should be acknowledged more explicitly in the discussion that such factors might play an important role, and provide directions as to study these in future research. I was much impressed with the sample size, so I feel that the sample size would be sufficiently robust to conduct such analyses. 

As to the discussion, please make the implications for practice a little bit more concrete. 

I wish the authors well in revising their manuscript and look forward to reading the revised version. 

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

The abstract should be completed because there is some important information missed, for examen, number of sample. It should explain better the objective of the study. The abstract should be a total of about 200 words maximum.

No hypothesis title should appear, either study objetive. At the end of the introduction, the authors should explain the objective at the end of the introduction.

Figure 1 does not explain more the text and it is irrelevant, it should be improve to explain positive and negative relationships.

If variables explained has been revealed in the previous research, what this study is important for? The authors should explain better why it is important to study it.

Table 1 is not relevant. It is too large for his relevancy.

Table 2 and 3 are the same and should be in one table, showing only important data. Other results can be explaining in the text.

The same happen with next three tables.

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

El artículo se ha mejorado con respecto a la versión anterior.