Satisfaction, Burnout, and Turnover Among Nurse Practitioners and Physician Assistants: A Review of the Empirical Literature

Examining the work-related psychological states of nurse practitioners and physician assistants is important, given their increased role expansion. The current PRISMA-guided review examined studies published between 2000 and 2016 for both these groups. The review also examined features of the research to draw conclusions about overall quality. Applying theories in job enrichment and job demands, 32 articles were identified that contained analyses of satisfaction, burnout, stress, and turnover. Key findings include the lack of robust research designs, overemphasis on job satisfaction, lower levels of satisfaction across both groups, and higher intrinsic versus extrinsic satisfaction levels generally. The literature can develop by using larger, more representative samples, including subgroup analyses that incorporate everyday work contexts, and more predictive modeling. The results suggest that both occupations experience role expansion in both positive and negative ways that may require additional policy or managerial interventions.

Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study

BACKGROUND

Health care systems globally are facing challenges of meeting the growing demand for primary care services due to a shortage of primary care physicians. Policy makers and administrators are searching for solutions to increase the primary care capacity. The effective utilization of nurse practitioners (NPs) has been proposed as a solution. However, organizations utilize NPs in variable capacities. In some settings, NPs serve as primary care providers delivering ongoing continuous care to their patients, referred to as patient panels, whereas in other settings they deliver episodic care. Little is known about why organizations deploy NPs differently.

OBJECTIVES

Investigate the NP role in care delivery-primary care providers with the own patient panels or delivering episodic care-within their organizations and understand how work environments affect their role.

DESIGN

A cross-sectional survey design was used to collect data from primary care NPs.

SETTINGS

The study was conducted in one state in the United States (Massachusetts). Data from 163 primary care organizations was obtained, which employed between one to 12 NPs.

PARTICIPANTS

807 NPs recruited from the Massachusetts Provider Database received mail surveys; 314 completed and returned the survey, yielding a response rate of 40%.

METHODS

The survey contained measures of NP role in care delivery and work environment. NP role was measured by an item asking NPs to report if they deliver ongoing continuous care to their patient panel or if they do not have patient panel. The work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). The multilevel Cox regression models investigated the influence of organization-level work environment on NP role in care delivery.

RESULTS

About 45% of NPs served as primary care providers with their own patient panel. Organization-level Independent Practice and Support subscale, an NP-PCOCQ subscale, had a significant positive effect on NP role (risk ratio=2.33; 95% CI: 1.06-5.13); with a one unit increase on this subscale, the incidence of the NPs serving as primary care providers with their own patient panel doubled.

CONCLUSIONS

NPs can help meet the increasing demand for primary care by taking responsibilities as primary care providers, and organizations can assign NPs their own patient panels. Supporting NP independent practice within organizations promotes NP role as primary care providers. Policy and organizational change focused on promoting NP work environments so NPs can practice as primary care providers can be an effective strategy to increase the primary care capacity.

The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities

The growing nurse practitioner (NP) workforce represents a significant supply of primary care providers, who if optimally utilized, are well-positioned to improve access to health care for racial and ethnic minorities. However, many barriers affect the optimal utilization of NPs in primary care delivery. These barriers may also prevent NPs from maximally contributing to efforts to reduce racial and ethnic health disparities. Our review of the empirical and health policy literature sought to elucidate factors that affect NPs' potential and ability to narrow or eliminate health disparities. We found that restrictive state scope of practice regulations, disparate reimbursement policies, lack of NP workforce diversity, and poor organizational structures in NP practices may limit NPs' contributions to current efforts to reduce disparities. Our results led to the development of the nurse practitioner health disparities model which identifies barriers to and opportunities for optimal use of NPs in reducing racial and ethnic disparities. State and federal policymakers and administrators in health-care settings should take actions to remove legislative and organizational barriers to enable NPs to deliver high-quality care to racial and ethnic minorities. Researchers can use the nurse practitioner health disparities model to produce empirical evidence to reduce health disparities and improve population health.

[Opinions and nurse' satisfaction with INICIARE 2.0 scale: A qualitative study in a hospital setting]

OBJECTIVE

To know the opinions and satisfaction of nurses with the use of INICIARE, an instrument developed for assessment of nursing care needs in hospitalized patients. INICIARE is based on Virginia Henderson's conceptual model, and built up with indicators of Nursing Outcomes Classification (NOC) taxonomy.

METHOD

Exploratory qualitative study, using focus group technique for data collection. The sessions were recorded until saturation of information. A content analysis of syntactic, semantic and pragmatic levels of transcripts was performed. Participants' informed consent was obtained.

RESULTS

Three focus groups were developed; 24 nurses from two Public Hospitals in Andalusia (Southern Spain) participated; and four thematic categories were created to measure satisfaction with the instrument. INICIARE helped the nursing process. Its closed format, and items in NOC taxonomy streamline evaluation, facilitates its inclusion in Electronic Information Systems, and strengthens effective communication at all levels.

CONCLUSIONS

Nurses are satisfied with the use of INICIARE scale as a tool to enhance quality of care. It also has potential to be used as a tool for decision making in management of nursing care.

Establishment of Pediatric Cardiac Intensive Care Advanced Practice Provider Services

The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs.

Leadership, job satisfaction and intention to leave among registered nurses in the North West and Free State provinces of South Africa

Background

The nurse leadership of a hospital is identified as the single most important aspect of the practice environment that impacts nurse outcomes. When nurses are satisfied with their jobs, they tend to remain with their employers and become more productive in their workplaces.

Objectives

This study aimed to investigate the relationship between leadership, job satisfaction and intentions to leave among registered nurses (RNs) working in hospitals in the North West and Free State provinces of South Africa.

Methods

A cross-sectional survey design was adopted. The population (N = 680) with the sample (n = 204) included RNs in medical–surgical units in both private and public hospitals in the two provinces. Data were collected using the RN4CAST questionnaire.

Results

RNs were satisfied with the items pertaining to leadership except for praise and recognition (55.7%). They also indicated high levels of overall job satisfaction (70.5%) but were dissatisfied with wages (50%), study leave (40.9%) and opportunities for advancement (40.1%). Furthermore, 46.1% of the RNs intended to leave their current hospitals. The results indicated a relationship between leadership and job satisfaction (r = 0.47; p = 0.00) and between intention to leave and job satisfaction (d = 0.50).

Conclusion

The nurse managers played a significant role influencing RN’s level of job satisfaction, while job satisfaction was highly correlated with intention to leave. The nurse leadership can improve job satisfaction by giving praise and recognition to the RNs for jobs well done, and RNs should be afforded the opportunity to advance their careers through further studies.

Novice Nurse Practitioner Workforce Transition Into Primary Care

The purpose of this integrative review was to analyze the current state of the science related to the novice nurse practitioner (NP) transition into primary care. A systematic review of the literature was conducted using the databases Pubmed, MEDLINE, Ovid, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) with the terms nurse practitioner, role, and transition to search articles published after 1997. Three major themes emerged from the literature related to the novice NP transition into primary care. These themes were categorized as “experiencing role ambiguity,” “quality of professional and interpersonal relationships,” and “facing intrinsic and extrinsic obstacles.” Strategies to reduce role ambiguity, improve the quality of professional relationships, and mitigate extrinsic obstacles faced by novice NPs may improve their transition into the primary care workforce. Educational institutions, employers, and novice NPs all have a stake in the successful transition from student to primary care practitioner and should be engaged in developing effective NP transition-to-practice programs.

Novice nurse practitioner workforce transition and turnover intention in primary care

PURPOSE

Little is known about the workforce transition and turnover intention of novice nurse practitioners (NPs) in primary care (PC). This research aimed to describe the individual characteristics, role acquisition and job satisfaction of novice NPs, and identify factors associated with their successful transition and turnover intention in the first year of PC practice.

DATA SOURCES

A descriptive, cross-sectional study was conducted via online survey administered to a national sample of 177 NPs who graduated from an accredited NP program and were practicing in a PC setting for 3-12 months.

CONCLUSIONS

This study demonstrated that greater professional autonomy in the workplace is a critical factor in turnover intention in novice NPs in the PC setting.

IMPLICATIONS FOR PRACTICE

Further research is needed regarding the novice NP workforce transition to provide adequate professional autonomy and support during this critical period.

Nurse practitioners' job satisfaction in rural versus nonrural areas

PURPOSE

The purpose of this study is to examine the nature of nurse practitioners' (NPs) job satisfaction and its relationship to work conditions in rural versus nonrural areas.

DATA SOURCES

A secondary analysis of data extracted from the 2012 National Sample Survey of Nurse Practitioners. NPs in active practice in clinical settings were included in this study. The final analytic sample consisted of 9010 NPs.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Overall, NPs were satisfied with their positions (satisfied to very satisfied). Both rural and nonrural NPs were most satisfied with the proportion of their time spent in patient care, their level of autonomy, and the respect that they received from other colleagues. Nonrural NPs who said or stated that they performed to the fullest extent of their states' legal scope of practice were more satisfied than nonrural NPs who did not. When nonrural NPs fully utilized their NP skills, their job satisfaction increased. For rural NPs, a similar pattern was found regarding full use of their NP skills. The evidence found in this study reminds us that given the increasing demands for NPs' healthcare services, continuous effort should be made to recruit and retain rural NPs.

Academic-correctional health partnerships: preparing the correctional health workforce for the changing landscape-focus group research results

Providing health care in corrections is challenging. Attracting clinicians can be equally challenging. The future holds a shortage of nurses and primary care physicians. We have a unique opportunity, now, to develop and stabilize our workforce, create a positive image, and enhance quality before the health care landscape changes even more dramatically. Focus groups were conducted with 22 correctional health care professionals divided into three groups: physicians (6), nurses (4), and nurse practitioners/physician assistants (12). Content focused on curricular themes, but additional themes emerged related to recruitment and retention. This article describes recruitment challenges, strategic themes identified, and the proposed initiatives to support a stable, high-quality correctional health workforce.

Using focus groups to identify characteristics of an ideal work environment for Advanced Practice Clinicians

Advanced Practice Clinicians (APCs) in collaborative practice represent a diverse and valuable group of health care professionals, including nurse practitioners, physician assistants, nurse anesthetists, and nurse midwives. Because these healthcare professionals have been identified as part of the solution to physician shortages, it is critical for health networks to examine and address issues affecting collaborative relationships. We invited our network APCs to participate in focus group sessions to determine both attributes and barriers to an ideal work environment. Four major themes emerged: (1) compensation, (2) network representation, (3) employment structure, and (4) workplace culture. While issues relating to compensation and representation were prevalent, discussions also revealed the importance of relationships and communication. To ensure successful collaboration and, thereby, reduce clinician turnover, leaders must address gaps between the existing and ideal states in structural factors affecting job satisfaction (Themes 1-3) as well as the behavioral factors represented in workplace culture (Theme 4).

Boredom in the Workplace: Reasons, Impact, and Solutions

Boredom in the workplace is not uncommon, and has been discussed widely in the academic literature in relation to the associated costs to individuals and organizations. Boredom can give rise to errors, adverse patient events, and decreased productivity-costly and unnecessary outcomes for consumers, employees, and organizations alike. As a function of boredom, individuals may feel over-worked or under-employed, and become distracted, stressed, or disillusioned. Staff who are bored also are less likely to engage with or focus on their work. In this article, we consider the nature of boredom and also the reasons why employees, including mental health nurses, become bored in the workplace. We also discuss the role that can be taken by employees and employers to recognise and address the problem of boredom and we consider how best to develop sustainable workplaces that are characterised by engaged employees who provide the best possible service in healthcare settings.

Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model

BACKGROUND

Nurse practitioners (NPs), if utilized to their optimal potential, could play a key role in meeting the growing demand for primary care.

PURPOSE

The purpose of this study was to propose a comprehensive model for maximizing NP contributions to primary care which includes the factors affecting NP care and patient outcomes and explains their interrelated impact.

METHOD

We synthesized the results of the published literature to develop a model, which emphasizes NP scope of practice regulations, institutional policies, NP practice environment, and NP workforce outcomes as determinants of NP care and patient outcomes.

DISCUSSION

Our model provides a framework to help explain how variations in scope of practice regulations at the state-level and institutional policies within organizations directly and indirectly influence the practice environment of NPs, NP workforce outcomes, and patient care and outcomes.

CONCLUSION

Aligning policy change, organizational innovations, and future research are critical to NP optimal utilization and patient care and outcomes.

How important are autonomy and work setting to nurse practitioners' job satisfaction?

PURPOSE

Nurse practitioners (NPs) have reported aspects of their jobs that they are more and less satisfied with. However, few studies have examined the factors that predict overall job satisfaction. This study uses a large national sample to examine the extent to which autonomy and work setting predict job satisfaction.

DATA SOURCES

The 2012 National Sample Survey of Nurse Practitioners (n = 8311) was used to examine bivariate and multivariate relationships between work setting and three autonomy variables (independent billing practices, having one's NP skills fully utilized, and relationship with physician), and job satisfaction.

CONCLUSIONS

NPs working in primary care reported the highest levels of autonomy across all three autonomy measures, while those working in hospital surgical settings reported the lowest levels. Autonomy, specifically feeling one's NP skills were fully utilized, was the factor most predictive of satisfaction. In multivariate analyses, those who strongly agreed their skills were being fully utilized had satisfaction scores almost one point higher than those who strongly disagreed. Work setting was only marginally related to job satisfaction.

IMPLICATIONS FOR PRACTICE

In order to attract and retain NPs in the future, healthcare organizations should ensure that NPs' skills are being fully utilized.

Relationships among moral distress, level of practice independence, and intent to leave of nurse practitioners in emergency departments: results from a national survey

The aims of this research study were to investigate moral distress among emergency department (ED) nurse practitioners (NPs) and examine relationships between moral distress and level of practice independence as well as intent to leave a position. Moral distress has been studied regarding registered nurses and physicians (MDs) but less so in NPs. It is important to explore moral distress in NPs because they tread a unique path between nursing and physician roles. Moral distress may play a significant role in staff nurses' intention to leave practice, and level of practice independence is found to have a relationship with NPs' intention to leave. A convenience sample of ED NPs was obtained from a mailing list of a national nursing specialty organization, the Emergency Nurses Association. Using a correlational design, survey methods assessed moral distress with the Moral Distress Scale-Revised (MDS-R), level of practice independence with the Dempster Practice Behavior Scale, and intent to leave with self-report. Correlational and regression analyses of data were conducted to characterize moral distress among ED NPs and associations between moral distress, level of practice independence, and intent to leave. Results found ED NPs do experience moral distress with poor patient care results from inadequate staff communication and working with incompetent coworkers in their practice. The MDS-R was a significant predictor of intention to leave among respondents. This study is the first of its kind to explore moral distress in ED NPs. Results suggest moral distress influences ED NPs' intent to leave their position. Further studies are needed to explore the findings from this research and to formulate interventions to alleviate moral distress in ED NPs and improve retention in the clinical setting.

Nurse practitioners' role perception, stress, satisfaction, and intent to stay at a Midwestern academic medical center

PURPOSE

There is a growing demand for nurse practitioners (NPs) within academic medical centers (AMCs) because of physician shortages and increased need for access to care. In order to retain these NPs, it is important to assess their role perception and satisfaction. The purpose of this study was to evaluate these concepts and their relationships to stress and intent to stay.

DATA SOURCES

A 90-item descriptive survey, including a new role perception scale and the Misener Nurse Practitioner Job Satisfaction Scale, was administered to all NPs at a Midwestern AMC.

CONCLUSIONS

The response rate was 62.4% (n = 181). Overall, the NPs had moderate role perception (M = 4.30, SD = 1.23) and were somewhat satisfied (M = 4.23, SD = 0.74). Over a third (39.4%) reported they were unsure about staying or did not intend to stay in their position. Intent to stay and stress were moderately correlated with overall satisfaction and weakly correlated with role perception. There were significant differences in the intrapractice and professional aspects of job satisfaction based on their supervisor.

IMPLICATIONS FOR PRACTICE

With increased NP needs, it is crucial for AMCs and NP supervisors to assess role perception, satisfaction, and stress among NPs in order to ensure a stable, satisfied, and productive workforce.

A descriptive study of employment patterns and work environment outcomes of specialist nurses in Canada

PURPOSE/OBJECTIVES

The purpose was to describe the number, demographic characteristics, work patterns, exit rates, and work perceptions of nurses in Ontario, Canada, in 4 specialty classifications: advanced practice nurse (APN)-clinical nurse specialist (CNS), APN-other, primary healthcare nurse practitioner [RN(extended class [EC])], and registered nurse (RN) with specialty certification. The objectives were to (1) describe how many qualified nurses are available by specialty class; (2) create a demographic profile of specialist nurses; (3) determine the proportions of specialist and nonspecialist nurses who leave (a) direct patient care and (b) nursing practice annually; (4) determine whether specialist and nonspecialist nurses differ in their self-ratings of work environment, job satisfaction, and intention to remain in nursing. Employment patterns refer to nurses' employment status (eg, full-time, part-time, casual), work duration (ie, length of employment in nurses and in current role), and work transitions (ie, movement in and out of the nursing workforce, and movement out of current role).

DESIGN

A longitudinal analysis of the Ontario nurses' registration database from 2005 to 2010 and a survey of specialist nurses in Canada was conducted.

SETTING

The setting was Canada.

SAMPLE

The database sample consisted of 3 specialist groups, consisting of RN(EC), CNS, and APN-other, as well as 1 nonspecialist RN staff nurse group. The survey sample involved 359 nurses who were classified into groups based on self-reported job title and RN specialty-certification status.

METHODS

Data sources included College of Nurses of Ontario registration database and survey data. The study measures were the Nursing Work Index, a 4-item measure of job satisfaction, and 1-item measure of intent to leave current job. Nurses registered with the College of Nurses of Ontario were tracked over the study period to identify changes in their employment status with comparisons made between nurses employed in specialist roles and those registered as general staff nurses. Analysis involved descriptive summaries, mean comparisons with independent-samples t test, and χ(2) tests for categorical data.

RESULTS

Exit rates from direct practice were highest for APN-other (7.6%) and CNS (6.2%) and lowest for RN(EC) (1.0%) and staff nurses (1.2%). χ(2) Tests indicated yearly exit rates of both APN-other and CNS nurse groups were significantly higher than those of staff nurses in all years evaluated (α = .025). Every specialist employment group scored significantly higher than staff nurses on measures of work environment and satisfaction outcomes.

CONCLUSIONS

We provided a description of specialist nurses in Ontario and examined the relationship between specialization and employment patterns of nurses to inform nurse retention strategies in the future. Employment in specialist nursing positions is significantly associated with differences in transitions or exits from nursing among the specialist and nonspecialist groups. Registered nurses (EC) displayed improved retention characteristics compared with staff nurses. Advanced practice nurse-other and APN-CNS exit rates from nursing practice in Ontario were comparable to staff nurses, but exit rates from direct clinical practice roles were higher than those of staff nurses.

IMPLICATIONS

Targeted strategies are required to retain CNS and APN-other in direct clinical practice roles.

Retail clinics versus traditional primary care: Employee satisfaction guaranteed?

PURPOSE

To examine if differences exist in the levels of autonomy and job satisfaction among primary care nurse practitioners (NPs) employed in retail clinics versus traditional primary care settings.

DATA SOURCES

Data were collected from 310 primary care NPs who attended the American Association of NP's 28th Annual Conference in June 2013. Participants completed a demographic form, the Misener NP Job Satisfaction Scale, and the Dempster Practice Behavior Scale.

CONCLUSIONS

Overall, there were no differences in job satisfaction or autonomy among NPs by practice setting. Retail NPs felt less valued and were less satisfied with social interaction, but more satisfied with benefits compared to NPs in traditional settings. NPs working in retail clinics were less likely to have intentions to leave current position compared to NPs in traditional practice settings.

IMPLICATIONS FOR PRACTICE

The results of this study enhance our current understanding of the linkages between levels of autonomy, job satisfaction, and practice setting among primary care NPs. The findings of this descriptive study offer valuable insights for stakeholders devoted to the development of the primary care workforce and identify modifiable factors that may influence retention and turnover rates among NPs.

Nurse practitioner organizational climate in primary care settings: implications for professional practice

The expansion of the nurse practitioner (NP) workforce in primary care is key to meeting the increased demand for care. Organizational climates in primary care settings affect NP professional practice and the quality of care. This study investigated organizational climate and its domains affecting NP professional practice in primary care settings. A qualitative descriptive design, with purposive sampling, was used to recruit 16 NPs practicing in primary care settings in Massachusetts. An interview guide was developed and pretested with two NPs and in 1 group interview with 7 NPs. Data collection took place in spring of 2011. Individual interviews lasted from 30-70 minutes, were audio recorded, and transcribed. Data were analyzed using Atlas.ti 6.0 software by 3 researchers. Content analysis was applied. Three previously identified themes, NP-physician relations, independent practice and autonomy, and professional visibility, as well as two new themes, organizational support and resources and NP-administration relations emerged from the analyses. NPs reported collegial relations with physicians, challenges in establishing independent practice, suboptimal relationships with administration, and lack of support. NP contributions to patient care were invisible. Favorable organizational climates should be promoted to support the expanding of NP workforce in primary care and to optimize recruitment and retention efforts.

Exploring the Factors that Influence Nurse Practitioner Role Transition

The transition from registered nurse (RN) to nurse practitioner (NP) is often a stressful career change. Data are lacking on the factors affecting NP role transition. This study examined the relationships between NP role transition, prior RN experience, and a formal orientation. From a sample of 352 NPs, only a formal orientation contributed significantly to the regression model indicating a positive relationship with NP role transition (b = 6.24, p < .001). Knowledge of the factors that explain NP role transition is important to inform the discipline how best to support NPs during entry into practice.

Does moonlighting influence South African nurses' intention to leave their primary jobs?

Background

Staff retention and turnover have risen in prominence in the global discourse on the health workforce. Moonlighting, having a second job in addition to a primary job, has not featured in debates on turnover.

Objective

This paper examines whether moonlighting is a determinant of South African nurses’ intention to leave their primary jobs.

Design

During 2010, a one-stage cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information and information on moonlighting, the questionnaire obtained information on the participants’ intention to leave their primary jobs in the 12 months following the survey. A weighted analysis of the survey data was done using STATA^® 13.

Results

Survey participants (n=3,784) were predominantly middle-aged with a mean age of 41.5 (SD±10.4) years. Almost one-third of survey participants (30.9%) indicated that they planned to leave their jobs within 12 months. Intention to leave was higher among the moonlighters (39.5%) compared to non-moonlighters (27.9%; p<0.001). Predictors of intention to leave in a multiple logistic regression were moonlighting in the preceding year, nursing category, sector of primary employment, period working at the primary job, and number of children. The odds of intention to leave was 1.40 (95% CI: 1.16–1.69) times higher for moonlighters than for non-moonlighters. The odds ratio of intention to leave was 0.53 (95% CI: 0.42–0.66) for nursing assistants compared to professional nurses and 2.09 (95% CI: 1.49–2.94) for nurses working for a commercial nursing agency compared to those working in the public sector.

Conclusions

Moonlighting is a predictor of intention to leave. Both individual and organisational strategies are needed to manage moonlighting and to enhance retention among South African nurses.

Relationship between job satisfaction, professional identity and intention to leave the profession among nurses in Turkey

AIMS

The purpose of this study is to investigate the relationship between job satisfaction, professional identity and intention to leave the profession among nurses in Turkey.

BACKGROUND

Although there are many studies on job satisfaction among nurses in Turkey, there is a gap in the literature in relation to professional identity, particularly for intentions to leave the profession.

METHOD

This cross-sectional, descriptive and correlational study was conducted with 2122 nurses from Turkey.

RESULTS

A positive and significant correlation was determined between the nurses' job satisfaction and professional identities. It was found that 15.5% of the nurses intended to leave their profession. Intention to leave the profession was greater among the nurses with inadequate professional identity development and low job satisfaction.

CONCLUSION

Professional identity is a factor affecting job satisfaction. Both professional identity and job satisfaction are important factors affecting nurses' intention leaving the profession.

IMPLICATIONS FOR NURSING MANAGEMENT

Given that professional identity and job satisfaction affect intention to leave the profession and professional identity affects job satisfaction, nurse managers who are mainly responsible for the quality of nursing care should develop strategies that support nurses' professional identity and increase their job satisfaction if they are to prevent nurses from leaving the profession.

Relationship between ICU nurses’ moral distress with burnout and anticipated turnover

Background:

Moral distress is one of intensive care unit nurses’ major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses’ personal and professional practice, recognizing moral distress is very important.

Research objective:

The aim of this study was to determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses.

Research design:

This study is a descriptive-correlation research.

Participants and research context:

A total of 159 intensive care unit nurses were selected from medical sciences universities in Iran. Data collection instruments included “demographic questionnaire,” “ICU Nurses’ Moral Distress Scale,” “Copenhagen Burnout Inventory” and “Hinshaw and Atwood Turnover Scale.” Data analysis was done by using SPSS19.

Ethical considerations:

Informed consent from samples and research approval was obtained from Shahid Beheshti Medical Sciences University Research Ethics Board in Tehran.

Findings:

The findings showed intensive care unit nurses’ moral distress and anticipated turnover was high, but burnout was moderate. The results revealed that there was a positive statistical correlation between intensive care unit nurses’ age, their work experience and the fraction of nurses’ number to number of intensive care unit beds with their moral distress and burnout. However, there were no correlation between gender, marriage status, educational degree and work shift and moral distress.

Discussion:

Some of the findings of this research are consistent with other studies and some of them are inconsistent.

Conclusion:

Similarly, moral distress with burnout and anticipated turnover did not have statistical correlation. However, a positive correlation was found between burnout and anticipated turnover. The results showed that increase in the recruitment of young nurses, and nursing personnel, and diminishing intensive care unit nurses’ moral distress, burnout and their turnover intention are essential.

The promise of group medical visits

Innovative group medical visit programs have emerged in an effort to increase efficiency, improve service and quality of healthcare, and better manage high-risk patient populations. A case study program for cancer survivors, adapted from the Centering Healthcare Institute's model, demonstrates how nurse practitioners can lead the implementation and measurement outcomes of group visit models.

Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa

Background

Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies.

Objective

The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa.

Methods

We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave.

Results

There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (χ²=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (χ²=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave.

Conclusions

We have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less standardised and more targeted HRH strategies than has been practised to date.

The contribution of personality and workplace characteristics in predicting turnover intention among sexual assault nurse examiners: a path analytic study

The purpose of this study was to determine how personality characteristics, sense of organizational empowerment, and job satisfaction combine to predict turnover intention among a population of Sexual Assault Nurse Examiners (SANEs). Data were collected from 161 SANEs from 23 SANE organizations across the central and west United States through standardized tools and a demographic questionnaire. Both personality, namely agreeableness and workplace characteristics, particularly perceived empowerment and job satisfaction, combine to predict intention to leave the job of these sampled SANEs. One particularly curious finding was the positive prediction of agreeableness on turnover intention - that is, more agreeable people would be more likely to leave their jobs as SANEs. Professionals can gain insight from the path analysis results that show the need to address both personal and organizational factors in mitigating turnover intention among SANEs. This appears to be particularly true in providing a sense of empowerment and opportunity within the organization.