Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover

Assessing the Job Satisfaction of Registered Nurses Using Sentiment Analysis and Clustering Analysis

Job satisfaction is a critical component of the professional work environment and is often ascertained through surveys that include structured or open-ended questions. Using data from 24,543 respondents to California Board of Registered Nursing biennial surveys, this study examines the job satisfaction of registered nurses (RNs) by applying clustering analysis to structured job satisfaction items and sentiment analysis to free-text comments. The clustering analysis identified three job satisfaction groups (low, medium, and high satisfaction). Sentiment analysis scores were significantly associated with the job satisfaction groups in both bivariate and multivariate analyses. Differences between the job satisfaction clusters were mostly driven by satisfaction with workload, adequacy of the clerical support services, adequacy of the number of RN staff, and skills of RN colleagues. In addition, there was dispersion in satisfaction related to involvement in management and policy decisions, recognition for a job well done, and opportunities for professional development.

Factors associated with difficulty in adapting and intent to leave among new graduate nurses in South Korea

BACKGROUND

New graduate nurses experience difficulty in adapting to a new environment, which affects intent to leave. However, data on the factors contributing to difficulty in adapting and intent to leave among new graduate nurses are insufficient.

PURPOSE

The aim of the study was to explore and compare factors associated with difficulty in adapting and the intent to leave among new graduate nurses in South Korea.

METHODOLOGY

This cross-sectional study used secondary data analysis. Primary data were obtained from the 2015-2016 Korean National Graduates Occupational Mobility Survey. Descriptive statistics, independent t tests, and chi-square statistics with weighted samples besides multivariate logistic regression analyses were conducted (N = 467).

RESULTS

Roughly 46% of nurses reported difficulty adapting, and 16% expressed their intent to leave. The factors linked to difficulty in adapting were working at large hospitals with rotating shifts, low person-job fit, and low satisfaction with personal competency; intent to leave was associated with high monthly salary and low satisfaction with the workplace (all ps < .05). Difficulty in adapting did not equate to their intent to leave.

CONCLUSIONS

There were high rates of difficulty in adapting and intent to leave among new graduate nurses. Although different factors were associated with difficulty adapting and intent to leave, workplace condition is a common factor.

PRACTICE IMPLICATIONS

Different strategies are needed to improve adaptation and intention of leaving among new graduate nurses. For better adaptation, developing training programs enhancing professional competency with a sufficient training period is required. In addition, providing staff and resources to reduce the intent to leave is crucial.

Nurses' rest breaks and organizational leaving intentions

Improving nurses' staff retention is highly needed since risks of turnover are high in this profession. Prior research uncovered job demands as important driver and job resources as protective factor for the development of nurses' organizational leaving intentions. However, research on beneficial effects of rest break design as an important job resource on nurses' leaving intentions is sparse and their interactions with present job demands have been widely neglected. Therefore, we aimed to examine if different rest break characteristics (i.e. break length, break disturbances, and social breaks) predict nurses' organizational leaving intentions while also considering job demands (i.e. quantitative, cognitive, and emotional demands, and social conflicts) and other well-known person-related and work-related turnover antecedents. We conducted a cross-sectional paper-pencil survey study with 167 nurses from Germany. We found a positive relation between rest break disturbances and organizational leaving intentions even after adjusting for person-related and work-related confounders. Rest break length and the frequency of social breaks were no significant predictors when considering all rest break characteristics in combination. Moreover, high quantitative demands and high social conflicts at work related to higher leaving intentions. Fewer rest break disturbances increased the negative relation between cognitive demands and leaving intentions. In order to reduce nurses' organizational leaving intentions and to improve staff retention, nursing management should prevent disturbances of nurses' rest breaks in addition to other work design interventions such as reducing quantitative demands and social conflicts and especially when implementing cognitive challenging tasks.

Nurses and the acceptance of innovations in technology-intensive contexts: the need for tailored management strategies

Background

Several technological innovations have been introduced in healthcare over the years, and their implementation proved crucial in addressing challenges of modern health. Healthcare workers have frequently been called upon to become familiar with technological innovations that pervade every aspect of their profession, changing their working schedule, habits, and daily actions.

Purpose

An in-depth analysis of the paths towards the acceptance and use of technology may facilitate the crafting and adoption of specific personnel policies taking into consideration definite levers, which appear to be different in relation to the age of nurses.

Approach

The strength of this study is the application of UTAUT model to analyse the acceptance of innovations by nurses in technology-intensive healthcare contexts. Multidimensional Item Response Theory is applied to identify the main dimensions characterizing the UTAUT model. Paths are tested through two stage regression models and validated using a SEM covariance analysis.

Results

The age is a moderator for the social influence: social influence, or peer opinion, matters more for young nurse.

Conclusion

The use of MIRT to identify the most important items for each construct of UTAUT model and an in-depth path analysis helps to identify which factors should be considered a leverage to foster nurses’ acceptance and intention to use new technologies (o technology-intensive devices).

Practical implications

Young nurses may benefit from the structuring of shifts with the most passionate colleagues (thus exploiting the social influence), the participation in ad hoc training courses (thus exploiting the facilitating conditions), while other nurses could benefit from policies that rely on the stressing of the perception of their expectations or the downsizing of their expectancy of the effort in using new technologies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06628-5.

Job demands, work engagement and job turnover intentions among registered nurses: Explained by work-family private life inference

BACKGROUND

The job demands on nurses have increased. Conflict between work life and family life may lead to stress and lower work engagement. Consequently, nurses may choose a different career path or leave the profession.

OBJECTIVE

Examine the extent to which perceived job demands (interpersonal conflicts at work and workload), work engagement, work-family conflict and family-work conflict are associated with turnover intentions, and examine a possible moderating effect of work-family conflict on the relationship between the intention to leave the nursing profession, job demands and work engagement.

METHODS

Cross-sectional study using Hobfoll's Conservation of Resources theory. Data were collected from a sample of 807 registered nurses (RNs) from western Sweden. Tests of moderation were conducted using the PROCESS software macro developed by Andrew F. Hayes.

RESULTS

Work-family conflict was a significant moderator in the relationship between the intentions to leave the nursing profession and work engagement as well as interpersonal conflicts at work. Low work engagement, high work-family conflict and high job demands intensify turnover intentions in well-educated and well-experienced nurses.

CONCLUSIONS

The results imply that work-family conflict has a greater impact when RNs experience lower work engagement. In other words, higher motivation implies a lower moderation effect of work-family conflict. Managers should promote a positive working climate by listening to and providing nurses with opportunities to develop their skills. By so doing, managers can gain better understanding of nurses' resources, knowledge and work situation, thus strengthening nurses' confidence and ability to practice their profession.

Nurse turnover: A longitudinal survival analysis of the Korea Nurses' Health Study

AIMS

To identify factors influencing turnover among Korean female nurses from a longitudinal perspective.

DESIGN

A national cohort study called the Korea Nurses' Health Study (2013-2020) was used.

METHODS

A national sample of female nurses from module 1 (N = 20,613, 2013-2014), module 5 (N = 11,527, 2016-2017), module 7 (N = 8,658, 2018-2019) and module 8 (N = 10,253, 2019-2020) was used. Based on a nurse turnover model, individual, health-related, social work environment and work organizational factors were considered explainable variables for nurse turnover. Kaplan-Meier survival analysis and multivariate Cox regression analysis were used to identify the factors influencing female nurse turnover in South Korea.

RESULTS

Female nurses who had less education, were unmarried, were pregnant, and had higher stress levels and an increased probability of experiencing turnover as they aged. Those who perceived moderate health rather than good/very good health, had depressive symptoms, had a higher salary, were charge nurses/unit managers/supervisors or advanced practice nurses, were advanced practice nurses rather than registered nurses, worked shifts, worked in special care units or outpatient wards/administration as opposed to general wards, and worked in larger hospitals had a decreased probability of experiencing turnover as they aged. A two-way interaction analysis revealed that those who had depressive symptoms and increased perceived stress were more likely to experience turnover as they aged.

CONCLUSION

Multiple factors influenced female nurse turnover, including individual, health-related, social work environment and work organizational factors. A multidimensional approach is needed to reduce nurse turnover.

IMPACT

Various factors predict nurse turnover as nurses age, implying that a multifaceted approach is needed to manage nurse turnover. The influence of depressive symptoms on turnover should be evaluated by considering the perceived stress level. Nursing managers and policy makers could use our results to develop programs/policies to reduce nurse turnover.

Retaining nurses in a changing health care environment: The role of job embeddedness and self-efficacy

BACKGROUND

Because nurses are on the front lines of care delivery, they are subject to frequent changes to their work practices. This change-laden environment puts nurses at higher risk for turnover. Given the frequent disruption to the way nurses perform their jobs, change-related self-efficacy (CSE), or confidence that one can handle change, may be vital to their retention.

PURPOSE

The purpose of this article is to examine the roles of CSE and job embeddedness in reducing turnover intentions among nurses. Specifically, this article tests a model in which CSE is the intervening mechanism through which job embeddedness influences turnover intentions.

METHODS

Drawing on a sample of 207 nurses working in the medical/surgical unit of a major metropolitan hospital in the United States, this study employs OLS regression to test for direct effects of job embeddedness and CSE on turnover intentions and bias-corrected bootstrapping to test for the indirect effects of job embeddedness on turnover intentions through CSE.

FINDINGS

Results show that CSE is directly linked to turnover intentions, and the effects of job embeddedness on turnover intentions become fully manifest through CSE.

PRACTICE IMPLICATIONS

Improved nurse retention may lead to stable patient care and less disruption in service delivery. Improved retention also benefits health care organizations financially, as costs of replacing a nurse can exceed 100% of the salary for the position. Given the shortage of nurses in some geographic areas, retention remains an important goal.

Comparing the Impact of COVID-19 on Nurses' Turnover Intentions before and during the Pandemic in Qatar

Background: Although several studies examining nurses’ turnover intentions have been conducted, few studies have been conducted to explore how COVID-19 contributes to nurses’ turnover intentions. This study aims to compare nurses’ turnover (TO) intentions before and during COVID-19. Methods: The cross-sectional study was conducted using the Turnover Intention Scale (TIS-6) and a convenience sample of participants from the largest healthcare provider in Qatar between August and September 2020. Results: A total of 512 nurses were included in the final analysis. The majority were between 31 and 40 years of age (61.5%), 67.6% were females, 76.4% were married, 79.7% had a BSN, 43% had less than 5 years of experience, and 60.4% had worked in COVID-19 designated facilities. The turnover intentions were higher compared with before COVID-19 (p < 0.01). Conclusion: Nurses in Qatar have higher TO intentions during COVID-19. The participants’ characteristics and stress levels are playing a major role in nurses’ decision to leave during COVID-19. Understanding the factors that contribute to turnover intentions is crucial for workforce planning, especially during pandemics.

Determinants of healthcare worker turnover in intensive care units: A micro-macro multilevel analysis

BACKGROUND

High turnover among healthcare workers is an increasingly common phenomenon in hospitals worldwide, especially in intensive care units (ICUs). In addition to the serious financial consequences, this is a major concern for patient care (disrupted continuity of care, decreased quality and safety of care, increased rates of medication errors, …).

OBJECTIVE

The goal of this article was to understand how the ICU-level nurse turnover rate may be explained from multiple covariates at individual and ICU-level, using data from 526 French registered and auxiliary nurses (RANs).

METHODS

A cross-sectional study was conducted in ICUs of Paris-area hospitals in 2013. First, we developed a small extension of a multi-level modeling method proposed in 2007 by Croon and van Veldhoven and validated its properties using a comprehensive simulation study. Second, we applied this approach to explain RAN turnover in French ICUs.

RESULTS

Based on the simulation study, the approach we proposed allows to estimate the regression coefficients with a relative bias below 7% for group-level factors and below 12% for individual-level factors. In our data, the mean observed RAN turnover rate was 0.19 per year (SD = 0.09). Based on our results, social support from colleagues and supervisors as well as long durations of experience in the profession were negatively associated with turnover. Conversely, number of children and impossibility to skip a break due to workload were significantly associated with higher rates of turnover. At ICU-level, number of beds, presence of intermediate care beds (continuous care unit) in the ICU and staff-to-patient ratio emerged as significant predictors.

CONCLUSIONS

The findings of this research may help decision makers within hospitals by highlighting major determinants of turnover among RANs. In addition, the new approach proposed here could prove useful to researchers faced with similar micro-macro data.

Can high workplace social capital buffer the negative effect of high workload on patient-initiated violence? Prospective cohort study

BACKGROUND

High workload seems to increase the risk of patient-initiated workplace violence (patient-initiated violence). However, the temporal association between workload and violence remains uncertain. Understanding the interplay of factors in the psychosocial working environment and patient-initiated violence is important to future preventive initiatives.

AIM

To assess whether a high workload increases the risk of patient-initiated violence, and whether intraorganizational relationships based on trust, reciprocity, justice and collaboration, known as workplace social capital, moderate this risk.

METHOD

Baseline survey data on 1823 social educators was collected followed by 12 monthly surveys on patient-initiated violence exposure. Poisson regressions, in mixed models, were conducted to assess the risk of violence at four levels of workload. Further, moderation analyses were conducted to assess the moderating effects of three sub-types of workplace social capital.

RESULTS

High and very high workload increased the risk of patient-initiated violence: RR = 1.5 [1.4-1.6], p < .001 and RR = 1.4 [1.3-1.4], p < .001. All three levels of workplace social capital had a moderating effect on the workload-violence association: Workload*Workplace social capital_(co-worker): F (3, 16,712) = 3.4, p = .017, Workload*Workplace social capital_{(local management)}: F (3, 16,748) = 11.9, p < .001, Workload*Workplace social capital_{(general management)}: F (3, 16,556) = 5.5, p < .001. Only high Workplace social capital _(co-workers) reduced the risk of violence at all levels of workload. Workplace social capital _{(general management)} reduced the risk of violence at high, medium and low workload, and Workplace social capital _{(local management)} reduced the risk of violence at medium and low workload.

CONCLUSION

High workload clearly increases the risk of patient-initiated violence. A high workplace social capital appears to be a viable protective factor and should be investigated further in studies of patient-initiated violence prevention.

Job satisfaction and intention to quit: A bibliometric review of work-family conflict and research agenda

This paper, for the first time, performs a bibliometric review on work-family conflict focusing on job satisfaction and intention to quit since the inception of this concept in 1994. For analysis and graphical presentation, bibliometrix package in R software and VOSviewer software are used. Total 146 documents from Scopus database are examined in this study. The results from the analysis reveal that the number of publications on work-family conflict is recently in an ascending growth that can be characterized by low productivity, low average citations per document and rising collaboration among authors. The growth of work-family conflict literature began to increase from 2003 and the International Journal of Human Resource Management and Journal of Vocational Behaviour played significant roles. Future research areas have been identified from the results of thematic map, trend topics, bibliometric coupling, three-fields plot and co-occurrence network. It is revealed from development of topics in this literature that pay satisfaction, occupational differences, effects of burnout and organizational politics has potential literature gaps. In addition, the examination of highlighted theories and methods used in previous literature contributing in different industries shall be the propitious areas of future research apart from other research agenda as identified in this study.

Meaningful moves: A meaning-based view of nurses' turnover

Nurses’ turnover is a major global problem with significant service and cost implications. Although sizeable research inquiries have been made into the antecedents, the dynamics, and the consequences of nurses’ turnover, there is still a lack of fine-grained understanding of the psychological states that reflect the cumulative impact of different antecedents and immediately precede nurses’ intentions to quit either from their unit/organization and/or their profession. This paper introduces and develops a meaning-based view of nurses’ turnover. This perspective distinguishes between meaning in work (based on the nurses’ relationship with their work) and meaning at work (based on the nurses’ relationship with their work environment) and explain the implications of high/low meaning in and at work on nurses’ turnover. This meaning-based view of nurses’ turnover offers nurses, administrators and policy makers a deeper and a more nuanced understanding of turnover and promises more tailored remedies for the turnover problem.

Model of Organizational Commitment Applied to Health Management Systems

In this paper, we try to build on the problems surrounding the management of human resources in health care organizations worldwide. After the analysis of the reviewed literature, we detected that the scientific community considers several recurring themes that need attention: stress, burnout, and turnover intention. Based on this, we developed a model of organizational commitment that aims to achieve performance and health quality, its main result the establishment of the appropriate management policies in order to avoid the abandonment of the organization through the search for commitment and job satisfaction. Amongst our main conclusions, we highlight the need to implement a human resources model for hospital administrators based on the relationships with "patients" not "clients" through the maintenance of a positive and strong atmosphere of staff participation. It is important to develop innovative practices related to clear job design that eliminate reasons for ambiguity and stress in executing the tasks of the healthcare system. Finally, we urge training programs in transformational leadership to promote the well-being and organizational commitment of employees.

Cluster analysis of self-concept and job satisfaction in Chinese nurses with master's degree to identify their turnover intention: A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to implement cluster analysis of self-concept and job satisfaction to identify subgroups in nurses with master's degree and explore the associations of turnover intention with characteristics among these clusters.

DESIGN

A cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

METHODS

A convenience sample of 408 nurses with master's degree in China filled out the survey from 19 November 2019 to 30 December 2019. A sociodemographic questionnaire, the Nurses' Self-Concept Questionnaire (NSCQ), Job Satisfaction Scale (JSS) and Turnover Intention Questionnaire (TIQ) were adopted to collect the data. K-means cluster analysis was implemented on the R software, and data were analysed using SPSS 24.0.

RESULTS

Three subgroups were identified based on cluster analysis of NSCQ and JSS subscales in 405 nurses (99.3%) available for statistical analysis, among whom 30.9%, 17% and 48.1% were allocated to these clusters respectively. Turnover intention significantly differed among the three clusters, with cluster 2 having the highest turnover intention and cluster 1 having the lowest turnover intention. Working department, position, professional title, clinical nurse specialist and annual income were factors differentiating TIQ scores in each cluster.

CONCLUSIONS

This study identified three clusters of nurses with master's degree and showed that each cluster was associated with the level of turnover intention. The unique characteristics of the three clusters may be also helpful in identifying and providing specific managerial or social support to reduce turnover rates in nurses with master's degree.

RELEVANCE TO CLINICAL PRACTICE

Cluster analysis is s an unsupervised machine learning method to identify meaningful subgroups within heterogeneous population based on variables distributions and patterns underlying in the data set. Through clustering, nurses with multi-dimensional characteristics could be allocated into subgroups associated with turnover intention. As a result, nursing managers could provide approaches for each subgroup to reduce turnover intention.

Competitive employer positioning through career path analysis: the case of the Swiss nursing sector

BACKGROUND

The global shortage of nurses has caused strategic employer positioning and strengthened employer branding to become progressively relevant addressing the increased competition in the recruitment of nurses. This study provides competition-oriented strengths-and-weaknesses profiles for nurse attraction and attrition for the major types of healthcare institutions to advise on competitive employer positioning.

METHODS

We applied bivariate weighted logistic regressions with cluster-adjusted standard errors to evaluate 4844 employer changes of 3011 nurses participating in the nurses at work study, whereby the reasons to quit (RQs) acted as both predictors of the former and the follow-up type of employer. For each employer type, we introduce a coordination system allocating each workplace criterion along its push and implicit pull characteristics, given through the specific odds ratios, to derive different strategic implications for an organisation's competitive nurse recruitment.

RESULTS

Depending on the employer type, workplace criteria were variously acting as push or pull factors in nurses' career decisions.

CONCLUSIONS

Nurses' career choices are affected by experienced and presumed workplace characteristics associated with specific employer types. Becoming aware of these associations and experiences, employers should leverage workplace criteria with relatively strong pull or/and weak push characteristics by intensified communication measurements and criteria with relatively weak pull or/and strong push characteristics should be enhanced to a competitive level.

The mediating role of resilience between work-family conflict and career development among Chinese nurses: A cross-sectional study

AIM

To investigate the association between work-family conflicts and career development with resilience among nurses.

BACKGROUND

Nurses tend to have high levels of work-family conflict. Resilience may affect their individual career development, the stability of the nursing team and the quality of nursing care.

METHODS

A cross-sectional survey using correlational design was conducted in mainland China. Data were collected using demographic and career development questionnaire, work-family conflict and resilience scale.

RESULTS

A total of 70,932 nurses were included. The total score for work-family conflict was relatively high (38.37 ± 12.82). Work-family conflict of nurses had a significant negative correlation with career development (r = -0.35, p < .001) and with resilience (r = -0.23, p < .001), while resilience had a significant positive correlation with career development (r = 0.62, p < .001). Resilience plays a mediating role between work-family conflict and career development.

CONCLUSIONS

The work-family conflict had a significant negative correlation with career development among nurses. Resilience has a mediating role between work-family conflict and career development. Nursing managers could reduce the level of work-family conflict by enhancing nurses' resilience.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should prioritize the improvement of resilience through training and education, enhancing nurses' ability to address work-family conflicts.

Implementing a Mentorship Program for New Nurses During a Pandemic

This article describes the implementation of an evidence-based mentoring program for new registered nurses (RNs) hired into medical-surgical units in a small community-based hospital during the unfolding of the SARS-Cov2 (COVID-19) pandemic. The hospital's nursing leadership supported the program implementation during the COVID-19 pandemic to provide a broader support system to new RNs to improve nurse retention. During a response to the pandemic, the medical-surgical units faced numerous process changes in a short time, which further reinforced the urgency of an additional support system for the newly hired RNs.

A Hybrid MADM Model for Newly Graduated Nurse's Competence Evaluation and Improvement

Nursing departments in hospitals must evaluate the practical competency of newly graduated nurses and assist them to increase their competence. Competency assessments often consider multiple qualitative attributes and use expert knowledge as the basis for decision-making. This study proposes a hybrid multiple attribute decision-making (MADM) model that determines practical competency of the newly graduated nurse as an evaluation framework. A causal influence-network diagram (CIND) and influential weights are obtained from nursing experts' clinical experience using the decision-making trial and evaluation laboratory (DEMATEL)-based analytical network process analysis (DANP). The MOORA-AS method is then used to evaluate the ability expectation ratio-gap for newly graduated nurses in practice. The CIND is used to allow each newly graduated nurse to reduce the performance ratio-gaps between the current level and the aspirational level from a systematic perspective. The empirical data applies to a third-class and a first-class hospital in China. The results show that the proposed hybrid MADM model has reliable results and allows nursing department decision-makers/managers to easily evaluate and systematically improve competencies for newly graduated nurses.

Exploring the relationships among professional quality of life, personal quality of life and resignation in the nursing profession

AIM

To explore the relationships between nurses' quality of life, personal quality of life, intention to stay (ITS) and resign and factors related to resignation.

DESIGN

Prospective cohort design.

METHODS

The participants were recruited from three different levels of hospital in central Taiwan. The survey instruments were structured questionnaires including demographics, Professional Quality of Life Scale, Short Form Health Survey (SF-36) and the Scale of ITS. The survey data were collected from December 2017-August 2018. Data on nurses' resignation were collected from the hospital systems 3 months after the survey. Descriptive analysis and multiple logistic regression were used to analyse the factors predicting participants' resignation.

RESULTS

Five hundred and fifty-three participants were recruited. Forty-nine out of 553 participants resigned (8.9%). Higher scores in compassion satisfaction were related to a greater ITS (p < .05). Employment units, burnout and ITS were the predictors for resignation (p < .05). We also found that compassion satisfaction moderated the relationship between ITS and resignation.

CONCLUSION

Compassion satisfaction of nursing professionals strengthened the effect of ITS on resignation. Programmes to reinforce satisfaction and stress management could be strategies for increasing nurses' professional quality of life and retention in clinical practice.

IMPACT

The study was the first to explore the relationships between professionals' quality of life, personal quality of life, ITS and resign. The study showed that compassion satisfaction increased the effect between ITS and resignation. Sense of achievement and satisfaction were the most important factors influencing nurses to stay in clinical practice. It is important to enhance nurse compassion satisfaction in nursing career, their job identity and gratification. The effective supportive environment and self-reflection may enhance compassion satisfaction, ameliorate nurse retention and improve the quality of care.

A New Perspective for Improving the Human Resource Development of Primary Medical and Health Care Institutions: A Structural Equation Model Study

In some countries, including China, primary health care is rarely utilized because of medical personnel shortages at primary medical and health care institutions (PMHCIs). Several studies suggest that the most effective solution is to guide qualified doctors and medical graduates to work in PMHCIs, but the studies and measures have been formulated only from the perspective of the government and PMHCIs; few have considered the subjective willingness of medical personnel. Therefore, it is necessary to explore the measures to develop human resources of PMHCIs from the guiding object. This research was divided into two parts based on implicit theory and a lexical approach. The first part collected the factors affecting their choosing PMHCIs for employment, and the second part used exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM) to explore the dimensions and paths of the influencing factors. At last, seven factors were obtained from the EFA, and the SEM hypothesis fit the data well. Internal Organization Development, Patient Factor, Remuneration and Development, and Family Support had a significantly positive effect on the Sense of Gain of medical personnel seeking employment at PMHCIs, whereas both Job Responsibilities and Condition of the City Where the PMHCI Is Located had no significant effect. In addition, the indirect effects of Internal Organization Development and Condition of the City Where the PMHCI Is Located on the Sense of Gain were significant. The Patient Factor, Family Support, and Remuneration and Development significantly mediated the relationship between the internal and external environment of the institution and the Sense of Gain, whereas the mediating effect of Job Responsibilities was not significant. The improvement of family support, remuneration and development, and patient factors increase the willingness of medical personnel to seek employment at PMHCIs. In addition, the internal and external environments of a PMHCI play a vital role in guiding medical personnel to PMHCIs for employment. This research provides theoretical support for improving the development of human resources, guiding medical personnel to work in PMHCIs, and promoting the use of primary care services.

Relationships among sex, empowerment, workplace bullying and job turnover intention of new graduate nurses

AIMS AND OBJECTIVES

The purpose of this study was twofold: examine the relationships among new graduate nurses' (NGNs) structural empowerment, experience of workplace bullying, and their job turnover intention and assess the relationships between sex, workplace bullying, and job turnover intention.

BACKGROUND

Nursing research has highlighted the issue of workplace bullying and its negative impacts. Despite increased awareness, male nurses and their responses to bullying have not been a significant focus of study.

DESIGN

A secondary analysis of data collected from a random sample of 1008 Canadian NGNs from the following: Starting Out: A time-lagged Study of New Graduate Nurses' Transition to Practice.

METHODS

All data were analysed using SPSS, and the study model was tested using the SPSS PROCESS macro, specifically Model 4 (for simple mediation). This paper is compliant with the STROBE reporting guideline for cross-sectional studies.

RESULTS

Structural empowerment significantly predicted workplace bullying and job turnover intention. Workplace bullying significantly predicted job turnover intention. Structural empowerment mediated job turnover intention through workplace bullying. Male new graduate nurses reported significantly higher workplace bullying than female NGNs yet lower job turnover intention.

CONCLUSIONS

The findings demonstrate the positive effects of structural empowerment on both decreasing workplace bullying and job turnover intention. Furthermore, findings showed the influence of sex on workplace bullying and job turnover intention. The findings contribute to literature on male NGNs and suggest that they experience significantly higher rates of workplace bullying than their female counterparts. The findings suggest differences exist in the workplace experience for male and female NGNs that future research may help reveal.

RELEVANCE TO CLINICAL PRACTICE

The findings suggest structural empowerment may be used to reduce bullying prevalence and reduce job turnover intention consequently. The findings also suggest that some measures are needed to address the higher frequency of bullying experienced by male NGNs.

[A Meta-Analytic Path Analysis on the Outcome Variables of Nursing Unit Managers' Transformational Leadership: Systemic Review and Meta-Analysis]

PURPOSE

The purpose of this study was to identify the outcome variables of nursing unit managers' transformational leadership and to test a hypothetical model using meta-analytic path analysis.

METHODS

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Data analysis, conducted using R version 3.6.2 software, included 49 studies for the meta-analysis and 119 studies for meta-analytic path analysis.

RESULTS

In the meta-analysis, four out of 32 outcome variables were selected. These four variables were empowerment, nursing performance, job satisfaction, and organizational commitment, which showed larger effect sizes than the median and more than five k. The hypothetical model for the meta-analytic path analysis was established by using these four variables and transformational leadership. A total of 22 hypothetical paths including nine direct effects and 13 indirect effects were set and tested. The meta-analytic path analysis showed that transformational leadership had direct effects on the four variables. Finally, eight direct effects, 12 indirect effects, and six mediating effects were statistically significant, and the hypothetical model was verified.

CONCLUSION

Nursing unit managers can use the transformational leadership to improve empowerment, nursing performance, job satisfaction, and organizational commitment of nurses. This study empirically showed the importance of transformational leadership of nursing managers. This finding will be used as evidence to develop strategies for enhancing transformational leadership, empowerment, nursing performance, job satisfaction, and organizational commitment in nursing science and practice.

Job Satisfaction Among Home Healthcare Nurses

Understanding the experiences of home healthcare nurses and exploring the factors that influence job satisfaction is important in reducing costly staff turnover. The purpose of the qualitative case study was to describe experiences related to job satisfaction among home healthcare nurses. Herzberg's Two Factor theory was used to frame the study. Twelve home healthcare nurses from an agency in South Texas volunteered to participate in in-depth interviews. Four themes emerged from the data: 1) patients contribute to job satisfaction, 2) autonomy promotes job satisfaction, 3) occupational stressors negatively influenced job satisfaction, and 4) leadership impacts job satisfaction. Home healthcare leadership should take safety concerns seriously and explore innovative ways to promote communication between field nurses and physicians. Further research is needed with a larger and more diverse sample of home healthcare nurses in order to be able to generalize findings.

The mediating effect of exhaustion in the relationship between effort-reward imbalance and turnover intentions: A 4-year longitudinal study from Sweden

OBJECTIVES

Earlier studies suggest that imbalance between effort and reward at work associates with exhaustion. Others have found that exhaustion increases turnover intentions; an important precursor of actual turnover that also associates with counterproductive work behaviors. Few, however, have studied the associations between effort-reward imbalance (ERI) and employees' intentions to leave their current employment, and whether exhaustion is underpinning that relationship. Here, we investigate the mediating role of exhaustion in the effort-reward imbalance - turnover intentions relationship.

METHODS

Data from three waves covering a time span of four years from the Swedish Longitudinal Occupational Survey of Health (SLOSH) were analysed using structural equation modeling. Cross-lagged mediation analyses were conducted to estimate if associations from ERI to subsequent turnover intentions were mediated by exhaustion. Other causal directions (direct and reversed direct effects, reversed mediation) were also examined.

RESULTS

A direct path from ERI T1 to turnover intentions T2 was found, but not from ERI T2 to turnover intentions T3. Additionally, results showed that ERI at time points T1/T2 associated significantly with exhaustion two years later (T2/T3). Also, exhaustion at T1 showed a small but statistically significant direct association with turnover intentions at T2 (no association was found between exhaustion T2 and turnover intentions T3). A small, but statistically significant indirect effect from ERI to turnover intentions was found (estimate 0.005; 95% CI 0.002-0.010).

CONCLUSIONS

Providing a good balance between effort and reward for workers is essential to protect employee health and help retain employees in the organization.

Homecare nurses' length of conversation and intention to remain at the workplace: A multilevel analysis

AIMS

To examine the relationship between homecare nurses' length of conversation with nurse managers and colleagues and intention to remain at the workplace.

BACKGROUND

Nurse turnover is an important issue. Previous studies focused on the perceived function of communication. However, we do not know the contribution of homecare nurses' actual conversations to nurse turnover prevention.

METHODS

We conducted a cross-sectional study in 330 homecare nurse organisations in Japan. We recruited 2,315 homecare nurses and analysed the data of 608 nurses. We used a questionnaire to investigate participants' intention to remain.

RESULTS

Nearly 68% had the intention to remain. The mean length of conversation was 34 min/day with the manager and 68 min/day with colleagues. Multilevel logistic regression analysis showed that long conversations with the nurse manager (20 min and more) and colleagues (40 min and more) were significantly related to the intention to remain.

CONCLUSIONS

Ensuring the time of conversation with a manager and colleagues may contribute to preventing potentially avoidable nurse turnover.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should encourage homecare nurses to have daily conversations of 20 min or more with the nurse manager and 40 min or more with colleagues to continue working at their current workplace.

The home care work environment's relationships with work engagement and burnout: A cross-sectional multi-centre study in Switzerland

This study aimed to investigate the levels of burnout and work engagement among home care workers in Switzerland and to test their association with job demands and job resources. We conducted a multi-centre, cross-sectional survey in the German-speaking part of Switzerland with a convenience sample of seven home care agencies. Data were collected between September 2017 and January 2018. We assessed burnout with the Maslach Burnout Inventory (MBI) and work engagement with the Utrecht Work Engagement Scale (UWES) as well as job demands (overtime, work-family conflicts, experienced aggression and work stressors) and job resources (predictability, staffing, teamwork, leadership, collaboration, social support, sense of community, feedback). To investigate the levels of burnout and work engagement, we applied descriptive statistics. Based on Bakker and colleagues' Job Demands-Resources model, we used a path analysis to test the associations of job demands and job resources with burnout and work engagement. We analysed data from 448 home care workers (response rate 61.8%, mean age 44 years (SD 13.2), 96% female). The frequency of burnout in our sample was low, while that of work engagement was high. Job demands correlated positively with emotional exhaustion (β = .54, p < .001) and negatively with work engagement (β = -.25, p < .001). Job resources correlated negatively with emotional exhaustion (β = -.28, p < .001) and positively with work engagement (β = .41, p < .001). Work-family conflicts and work stressors correlated strongest with emotional exhaustion, whereas social support and feedback were found to correlate strongest with work engagement. Improvements to the home care work environment might enhance work engagement and reduce burnout. Corrective interventions could focus on reducing specific aspects of job demands, such as work-family conflicts and work stressors, as well as on increasing aspects of job resources, especially social support and feedback.

Sanctification of work and hospital nurse employment outcomes: An observational study

Aim

To explore nurse ascriptions of sacredness to work and measure its association with the employment outcomes of job satisfaction, burnout, organisational commitment, employee engagement and turnover intention.

Background

High portions of hospital nurses experience burnout. Many factors contributing to burnout also contribute to job dissatisfaction and other negative employment outcomes. Personal factors, such as religiosity, help nurses to cope with work.

Methods

Questionnaires measuring study variables were distributed to all nursing personnel at a faith‐based hospital in Los Angeles; 463 responded. Regression analyses allowed measurement of how sacredness ascribed to work (measured by Sanctification of Work Scale) and religiosity (measured by Duke Religiosity Index) were associated with the various employment outcomes.

Results

Sanctification of work consistently was found to be associated with less burnout and intention to leave, and more job satisfaction, employee engagement and organisational commitment.

Conclusion

The sacredness with which a nurse views work explains, in part, positive employment outcomes.

Implications for Nursing Management

Nurturing a sense of sacredness for work in nurses may provide them with an internal buffer against negative employment outcomes. Suggestions for creating rituals and educating nurses are offered.

Reliability and validity of the Multidimensional Measure of Leader-Member Exchange Japanese version for staff nurses

AIM

To verify the reliability and validity of Multidimensional Measure of Leader-Member Exchange Japanese version (LMX-MDM-J) for staff nurses.

BACKGROUND

Staff nurses who have a high-quality relationship with nurse managers tend to have low turnover intention. However, the validity and reliability of LMX-MDM Japanese version have not been confirmed.

METHODS

Staff nurses (n = 870) working in wards of four Japanese hospitals were surveyed using self-administered questionnaires. Reliability was tested by internal consistency. Validity was tested by the confirmatory factor analysis for construct validity and relationships with external criteria for criterion-related validity.

RESULTS

There were 450 valid responses. Cronbach's α coefficients of the overall scale and each dimension were 0.97 and 0.86-0.95, respectively. The goodness-of-fit indices of the confirmatory factor analysis showed CFI = 0.981 and RMSEA = 0.076. Correlation coefficients with external criteria were 0.57 for job satisfaction, 0.80 for relationship satisfaction with the nurse manager and -0.36 for turnover intention (all p < .001).

CONCLUSION

The reliability and validity of LMX-MDM-J were determined to be adequate for staff nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

LMX-MDM-J can accurately measure the quality of the dyadic relationship between nurse managers and staff nurses. This measurement indicates whether nurse managers are providing leadership.

A pilot study on the possibility of human-centred participative redesign of work organization at psychiatric wards

WHAT IS KNOWN ON THE SUBJECT?: Rationalization and an increasing shortage of nurses in psychiatric care require the improvement of working conditions. Work organization of hospital wards determines nurses' well-being on the job. In somatic care, observation-based assessments and participative improvements of work organization in the wards by involved nurses can reduce workload. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: In psychiatric nursing, observation-based assessment as well as nurses' self-reports may identify characteristics of ward organization that determine nurses' well-being. This study suggests a system of characteristics of work organization at psychiatric wards that may guide participative analyses and improvement measures. This may contribute to the research on prevention of conflicts and aggressive behaviour in psychiatric wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Participative analysis and, if necessary, participative redesign of work organization at psychiatric wards may reduce nurses' perceived work load. An approach to address the above is suggested for psychiatric nursing, which, in another version, is proven effective in somatic care. ABSTRACT: Introduction The study was based on an approach for participative improvement of work organization at somatic hospital wards related to characteristics that determine nurses' health. It differed from research seeking to adjust the environment to prevent aggressive behaviour at psychiatric wards. The focus was on the ergonomic principles of the whole work system and its impact on the nurses' health. Aim/Question We analysed the prerequisites for a transfer of this approach to psychiatric nursing. Method This study employed a cross-sectional design examining 11 wards of a hospital for psychiatry and neurology; 109 nurses participated. We used a multi-method design with observation-based assessments and nurses' self-reports of ward organization. Results Two clusters with wards of different work organization were identified. One cluster consisted of better-organized wards. The other included wards with a worse organization. We found substantial convergence between the observation-based assessments and nurses' self-reports. Discussion This study results indicated that observation-based assessments were an acceptable alternative to nurses' self-reports, enabling the evaluation of ward organization in a feasible and reliable way. Implications for practice This study showed an approach with a specific view on the structural quality of psychiatric wards; this may support work improvement processes in a more systematic way.

Leader empowering behaviour: relationships with nurse and patient outcomes

PURPOSE

This study aims to test a model examining the impact of leader empowering behaviour on experienced nurses' self-efficacy, interprofessional collaboration, job turnover intentions and adverse patient outcomes.

DESIGN/METHODOLOGY/APPROACH

Structural equation modelling in Mplus was used to analyse cross-sectional survey data from experienced nurses in Alberta, Ontario, and Nova Scotia, Canada (n = 478).

FINDINGS

The results supported the hypothesized model: (164) = 333.021, p = 0.000; RMSEA = 0.047; CFI = 0.965; TLI = 0.959; SRMR = 0.051. Indirect effects were observed between leader empowering behaviour and nurses' assessment of adverse events and leader empowering behaviour and nurses' job turnover intentions through interprofessional collaboration.

RESEARCH LIMITATIONS/IMPLICATIONS

Leader empowering behaviour plays a role in creating collaborative conditions that support quality patient care and the retention of experienced nurses.

PRACTICAL IMPLICATIONS

The findings will be of interest to academic and hospital leaders as they consider strategies to retain experienced nurses, such as nurse manager selection, development and performance management systems.

ORIGINALITY/VALUE

The influx of new graduate nurses to the nursing profession and changing models of care requires the retention of experienced nurses in the workforce. The findings suggest that leader empowering behaviour and interprofessional collaboration are important factors in supporting quality patient care and stabilizing the nursing workforce.

Turnover Rates and Factors Influencing Turnover of Korean Acute Care Hospital Nurses: A Retrospective Study Based on Survival Analysis

PURPOSE

This study aimed to explore turnover rates for Korean acute care hospital nurses and identify factors influencing their turnover.

METHODS

The study was retrospective in nature. Nurse cohort data were obtained from hospital status data from Korea's Health Insurance Review Assessment Service. The observation period was from January 1, 2012 to December 31, 2016, and data for 96,158 nurses were analyzed. Independent variables included nurses' age and sex and hospital setting, type, ownership, and nurse staffing level. Kaplan-Meier analysis was performed to estimate survival curves, and factors influencing turnover were analyzed using Cox's proportional hazard regression.

RESULTS

The cumulative turnover probability for all nurses was .17, .29, .38, .45, and .50 for the first, second, third, fourth, and fifth years, respectively. The results showed that the longer the career duration, the lower the turnover rates. According to the factors influencing nurse turnover, both nurses' (i.e., sex and career duration) and hospitals' (i.e., hospital setting, type, ownership, and nurse staffing level) characteristics were statistically significant.

CONCLUSION

It should be noted that the turnover rate of nurses with less than three year of career duration and of those with less than one year has been shown to be quite high. Therefore, target populations for acute care hospital nurse turnover should be expanded from new graduate nurses to experienced nurses with less than 3 years of career. Further studies are required to examine the causes of high turnover rates in hospitals that are small and/or have low nurse staffing levels.

"The hardest job you will ever love": Nurse recruitment, retention, and turnover in the Nurse-Family Partnership program in British Columbia, Canada

Background

Nurse turnover is a significant issue and complex challenge for all healthcare sectors and is exacerbated by a global nursing shortage. Nurse-Family Partnership is a community health program for first-time pregnant and parenting girls and young women living in situations of social and economic disadvantage. In Canada, this program is delivered exclusively by public health nurses and only within a research context. The aim of this article is to explore and describe factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada between 2013 and 2018.

Methods

Interpretive description was used to guide sampling, data collection and analytic decisions in this qualitative component drawn from the British Columbia Healthy Connections Project mixed methods process evaluation. Semi-structured, individual interviews were conducted with 28 public health nurses who practiced in and then exited Nurse-Family Partnership.

Results

Nurses were motivated to join this program because they wanted to deliver an evidence-based program for vulnerable young mothers that fit with their personal and professional philosophies and offered nurse autonomy. Access to program resources attracted nursing staff, while delivering a program that prioritizes maintaining relationships and emphasizes client successes was a positive work experience. Opportunities for ongoing professional development/ education, strong team connections, and working at full-scope of nursing practice were significant reasons for nurses to remain in Nurse-Family Partnership. Personal circumstances (retirement, family/health needs, relocation, career advancement) were the most frequently cited reasons leading to turnover. Other factors included: involuntary reasons, organizational and program factors, and geographical factors.

Conclusions

Public health organizations that deliver Nurse-Family Partnership may find aspects of job embeddedness theory useful for developing strategies for supporting recruitment and retention and reducing nurse turnover. Hiring nurses who are the right fit for this type of program may be a useful approach to increasing nurse retention. Fostering a culture of connectivity through team development along with supportive and communicative supervision are important factors associated with retention and may decrease turnover. Many involuntary/external factors were specific to being in a study environment. Program, organizational, and geographical factors affecting nurse turnover are modifiable.

Professional characteristics and work attitudes of hospital nurses who leave compared with those who stay

AIM

To compare characteristics and attitudes of nurses who resigned and those who remained in two Israeli hospitals and assess the reasons for leaving.

BACKGROUND

Nurse turnover is a current global problem in health care system, especially given the severe nurse shortages. Retention of nurses requires an understanding of the characteristics of the resigning nurses, their attitudes and their reasons for leaving.

METHODS

A matching case-control study was conducted among 100 resigning nurses and 200 matched remaining nurses. Questionnaires were used to survey the professional characteristics and attitudes of the participating nurses. In addition, exit interviews were used to assess the reasons to leave of resigning nurses.

RESULTS

Resigning nurses had higher education, less seniority and fewer managerial positions compared with remaining nurses. In addition, resigning nurses had lower professional autonomy and higher aspirations for professional advancement. The reasons to leave cited by the resigning nurses were distance of the workplace from home and working conditions as well as aspiring for professional advancement.

CONCLUSIONS

The interface between high education and having few opportunities for advanced positions may lead to resignation.

IMPLICATIONS FOR NURSING MANAGEMENT

We recommend organisational interventions for training new hospital nurses through professional career path development, such as mentoring programme.

Evidence-Based Practice Guideline: Nurse Retention for Nurse Managers

Nursing retention and turnover impacts health care on many facets; pressures are increasing to provide quality care in a cost-effective manner to a satisfied patient with an engaged staff as defined by the Quadruple Aim. Retention of experienced staff nurses is paramount as the nursing profession enters another shortage era, which leads to impact on patient safety and quality of care. The purpose of this nurse retention evidence-based practice guideline is to provide strategies for first line nurse managers in various health care settings to use in enhancing job satisfaction and decreasing turnover of staff nurses. Interventions are focused on three areas that are beyond compensation issues and are within the purview of nurse managers: (a) autonomy; (b) recognition; and (c) communication. Retaining expert nurses will have a positive effect on quality patient care. [Journal of Gerontological Nursing, 45(11), 11-19.].

Challenging and redesigning a new model to explain intention to leave nursing

BACKGROUND

It is important to have a full and detailed understanding of the factors that influence intention to leave nursing. It has been shown to be the best predictor of actual turnover, and turnover has a significant financial impact and also on the provision of care.

AIMS

The aim is to examine the impact of predictive work environment factors on nurses' intention to leave their position and to explore contributing factors.

METHODS

Cross-sectional survey using a convenience sample (n = 605) of Finnish nurses drawn from five clinical settings. The Nursing Context Index, an internationally used and psychometrically validated tool, was used to measure workplace practice environment, work stress, job satisfaction and intention to leave. A response rate of 29.4% was achieved, exceeding power calculation estimates.

RESULTS

Personal satisfaction and satisfaction with profession and resources, and organisational commitment were significantly related to intention to leave. Younger nurses reported higher levels of intention to leave and there was variability among clinical specialties. Measures of stress and practice environment had no significant relationship with intention to leave.

DISCUSSION

This study provides a new theoretical model for understanding intention to leave. Having a better understanding of the factors that may help reduce intention to leave allows for targeted interventions to be developed and implemented. This would help reduce the personal and financial implications associated with turnover.

IMPLICATIONS FOR PRACTICE, POLICY, MANAGEMENT AND EDUCATION

The findings have significant implications for all aspects of nursing. Educators need to prepare new nursing staff for the working environment; policymakers must ensure that nursing satisfaction is promoted to strengthen organisational commitment and nurse managers and leaders respond accordingly in implementing effective interventions.

Effects of organizational commitment, job satisfaction and workplace violence on turnover intention of emergency nurses: A cross-sectional study

AIMS

To describe turnover intention of emergency nurses and clarify the effects of organizational commitment, job satisfaction and workplace violence on turnover intention.

BACKGROUND

Research has showed the predictors of turnover intention differed among nurses of different specialties. However, research on turnover intention has mostly focused on general nurses rather than emergency nurses.

DESIGN

A descriptive, cross-sectional study was conducted.

METHODS

A self-administered questionnaire was used to collect data from 415 emergency nurses in Beijing, China, using convenience sampling. Path analysis was used to test the relationships between organizational commitment, job satisfaction, workplace violence and turnover intention.

RESULTS

Most emergency nurses (90.2%) had a high level or very high level of turnover intention. Contrary to previous studies, organizational commitment had a significant direct positive effect on workplace violence. It also had a direct positive effect on job satisfaction and a negative effect on turnover intention. Workplace violence had a negative effect on job satisfaction and a positive effect on turnover intention. Job satisfaction had a direct negative effect on turnover intention.

CONCLUSION

To reduce turnover intention in the emergency department, measures should be taken to reduce workplace violence and increase nurses' job satisfaction, especially those with high organizational commitment.

Frontline nurse managers' visions for their units: A qualitative study

AIMS

To elucidate frontline nurse managers' visions of their units.

BACKGROUND

Managers have the opportunity to imagine and share their visions for effective unit management.

METHODS

Semi-structured interviews were conducted with 12 frontline nurse managers working at inpatient units in two hospitals between 2016 and 2017. Data were qualitatively analysed using an inductive approach, focusing on participants' intents.

RESULTS

Although participants showed four types of difficulties in verbalizing visions, five categories and 18 subcategories were extracted through analysis of their descriptions about actual cases reflecting their visions. The categories were (a) provide excellent care to ensure patient recovery based on reliable knowledge and skills, (b) make efforts to broaden patients' futures, (c) create a climate for pursuing better practice, (d) all staff continuously pursue professional development and (e) provide nursing care that responds to external changes. All categories were common to all participants' images of the future and linked together to form each manager's vision.

CONCLUSION

Frontline managers experienced difficulty in articulating their visions. However, through episodes, they represented images of visions. The managers' visions comprised five categories reflecting various perspectives.

IMPLICATIONS FOR NURSING MANAGEMENT

Using a conceptualized vision framework, and identifying difficulties in verbalizing their images, can help managers articulate their visions.

Nurses' job involvement and association with continuing current position-A descriptive comparative study

AIMS AND OBJECTIVES

The aim of the study is to examine nurses' job involvement and intentions to continue in their current position.

BACKGROUND

Globally, the supply of nurses fails to meet the labour markets' high demand. Compared to specialist health service, the community health service has the greatest challenge when it comes to nursing shortage. There is a lack of studies comparing nurses working in different parts of the healthcare system in research focusing on nurses' intentions to continue in their current position. Similarly, there has been relatively little research on nurses' job involvement, even less how it is associated with retaining the nurses, despite indications that job involvement may be the key to job-related motivated behaviour.

DESIGN

A descriptive comparative study with a cross-sectional design.

METHODS

The study comprises 297 nurses from the community health service and specialist health service, respectively. The relationships between nurses' intention to continue and participant characteristics were examined using binary logistic regression. Reporting followed the STROBE guidelines.

RESULTS

Nurses in the community health service are older, have more children under the age of 18 and hold more permanent positions than nurses in the specialist health service. Job involvement is the only variable associated with nurses' intention to continue in their current position regardless of whether the nurse works in the community health service or specialist health service.

CONCLUSIONS

The results indicate that the community health service has the same possibilities as the specialist health service to retain nurses in their current jobs.

RELEVANCE TO CLINICAL PRACTICE

The results indicate that nursing leaders/employers with a goal to retaining nurses are recommended to focus on improving the nurses' job involvement.

Operating Room Culture and Interprofessional Relations: Impact on Nurse's Retention

The purpose of this article is to describe interprofessional relations in order to better understand their impact on nurse retention, while considering the operating room culture and its specific context. A focused ethnography was performed between September and October 2017 at a university hospital in an urban center in the province of Quebec, Canada. This was a secondary analysis of 11 nurses' semistructured one-on-one interviews. Additional data were collected through 6 days of observations, informal conversations, field notes, and a journal. A thematic analysis followed. Interprofessional relations and the need for recognition are important for nurse retention. In addition, a nurse's personality appears to be an important aspect in the complex and specific context of the operating room. Nurse retention in the operating room is multifactoral, and like the need for recognition, interprofessional relations are important issues. Interventions to improve working relationships, recognition of nurses, and consideration of a nurse's personality during hiring appear to be promising avenues for improving retention in the operating room.

The Association Between Unit-Level Workplace Social Capital and Intention to Leave Among Employees in Health Care Settings: A Cross-Sectional Multilevel Study

OBJECTIVE

The aim of this study was to investigate the multilevel association between workplace social capital and intention to leave among employees in health care settings in Japan.

METHODS

This study was a secondary data analysis of the cross-sectional data. A sample of 658 Japanese employees in health care settings with 17 facilities were recruited using a self-administered questionnaire. Multilevel linear regression analysis of intention to leave on unit-level workplace social capital (average score for each unit) was conducted.

RESULTS

Among 317 respondents from 49 units, after adjusting for demographic and work-related variables, both unit-level and individual-level workplace social capital were significantly negatively associated with intention to leave (P < 0.001).

CONCLUSIONS

The current study found that there was a significant negative association between unit-level workplace social capital and intention to leave in the health care field.

Nurses' intention to stay: The impact of perceived organizational support, job control and job satisfaction

AIM

To propose a theoretical model of intention to stay (ITS) and examine the effects of perceived organizational support, job control and job satisfaction on ITS.

DESIGN

Cross-sectional multicentre survey.

METHODS

The survey was conducted from January 2017-July 2017 and comprised 3,240 clinical nurses from nine tertiary hospitals in eastern, central and western China, with 2,352 effective responses. Structural equation modelling was used to analyse the relationship between ITS and its correlative factors.

RESULTS

The hypothesized model was supported. Job control, perceived organizational support and job satisfaction significantly and directly affected nurses' ITS. Furthermore, job control and perceived organizational support showed indirect effects on ITS, which was mediated by job satisfaction. Perceived organizational support could positively influence job control to have a further impact on job satisfaction and ITS.

CONCLUSION

Based on a large sample of Chinese tertiary hospital nurses, this study proposed and verified a theoretical model of nurses' ITS, revealing that organization characteristics, work characteristics and affective response to work can have an impact on ITS.

IMPACT

This study was the first to examine the relationships among perceived organizational support, job control, job satisfaction and ITS, enriching the theoretical model of ITS. Nurse managers can improve nurses' ITS by enhancing their perceived organizational support, job control and job satisfaction.

Development and evaluation of a prospective staffing model to improve retention

AIMS

To improve predictability and accuracy of hiring using historical staffing data, quality improvement and workforce engagement.

BACKGROUND

Twenty-three per cent of newly licensed nurses leave their first job within one year, costing employers $52,100 per nurse replacement. Tools for anticipatory hiring strategies are not available in the literature.

METHODS

We used retrospective, secondary data analysis to develop a Prospective Staffing Model and conduct a five-year longitudinal evaluation of the implementation of the model in a convenience sample at a quaternary academic Cardiothoracic Intensive Care Unit. We used a team-based, quality improvement approach to restructure recruitment and hiring strategies, standardize new graduate nurse orientation and implement AACN Healthy Work Environment standards.

RESULTS

Over the five-year prospective evaluation period (2014-2018), 388 nurses were hired and included in the evaluation cohort. Retention increased (n = 286 days) and turnover decreased (17.6%) between 2014 and 2018. Improvements in workforce stability were sustained at five years.

CONCLUSIONS

Use of a Prospective Staffing Model is associated with improved nurse retention and decreased turnover, and may improve workforce stability.

IMPLICATIONS FOR NURSING MANAGEMENT

Results suggest that an innovative tool can mitigate the deleterious effects of turnover, adding to current knowledge and providing a method for anticipatory assessment of local turnover.