Keeping nurses at work: a duration analysis

Analyzing nurses' decisions to leave their profession-a duration analysis

Many countries suffer from skilled labor shortages in nursing. One way to increase the nurse labor supply is to raise their retention rates. Yet, though several studies exist on factors associated with the nurse labor supply at different levels, literature on factors associated with nurses' decisions to leave their occupation is relatively scarce. Based on German administrative data, I analyze the determinants of nurses' decisions to leave their profession. My results suggest that younger nurses, nurses in the social sector, and nurses working with smaller employers leave their occupation more often than their counterparts, irrespective of their specific nursing occupations and care settings. Nurses leave more often where more alternative occupational options are available. Nurses who have been unemployed and nurses who have been employed in a different field have a higher probability of leaving the occupation, whereas nurses who just finished vocational training only have a moderate propensity to leave. Female nurses leave less often if employed part time. Female nurses in part time leave even more seldom if they have children. A change in the hospital reimbursement system and introducing a nursing minimum wage during the first decade of the century did not change nurses' occupation durations.

Workplace violence and intention to quit in the English NHS

NHS job vacancies remain at record levels and an increasing number of staff are leaving the NHS. Work-related violence is an aspect that has received little attention as a possible driving force in dropout rates among NHS workforce. Recent figures indicate that approximately 15% of NHS staff had experienced physical violence while at work (NHS Staff Survey, 2022). Given the prevalence of abuse and the consequences it may have on staff wellbeing, we examine the impact of workplace violence on intention to quit the organisation. We employ data from the NHS Staff Survey, a rich dataset that records the experience and views of staff working in the NHS. We use data from 2018 to 2022 of NHS employees surveyed in all NHS acute hospitals, with a sample size of 1,814,120 observations. We study the impact of experiencing physical or verbal violence in the workplace on the intention to quit the organization, examining differences according to perpetrator type. Our analysis also sheds light on any aggravated effect the pandemic had on intention to leave for those exposed to violence. The results suggest that experiencing physical violence increases the intention to leave by 10 percentage points. The effect of verbal violence is quantitatively greater in magnitude, increasing intention to leave by 21 percentage points. Violence from managers has the largest detrimental effect, followed by exposure to violence from multiple perpetrators and violence from colleagues. Heterogeneous effects exist according to occupational group, gender, age and ethnicity. The pandemic only had a marginal contribution to these effects. Staff health, trust in management and quality of patient care are some of the possible mechanisms through which violence influences the intention to quit. Overall, the results suggest that targeted interventions are needed to improve retention after exposure to violence.

The attractiveness of jobs in the German care sector: results of a factorial survey

The skilled labour shortage in nursing is an issue not unique to Germany. Unattractive characteristics of nursing jobs are one reason for the low supply in nursing personnel. In our study, we analyse the influence of job characteristics on the attractiveness of nursing jobs. We address this issue via factorial survey analysis, an experimental method particularly suited to assessing personal opinions and less prone to social desirability bias than standard interview methods. Around 1300 (current and former) nurses in a distinct region in Germany were asked to rate a set of synthetic job postings, each of which contained information on 9 systematically varied job characteristics. We find that, first, attractiveness of care jobs is most strongly affected by rather "soft" characteristics such as atmosphere within the team and time for patients. "Hard" factors play a considerably smaller role. Second, one hard factor, contract duration, is estimated to be among the most important job factors, however. This is a remarkable finding given that nursing occupations suffer from severe skill shortages. Third, though wage has a statistically significant influence on attractiveness, enormous wage raises would be needed to yield higher attractiveness gains than the top-rated soft factors, or to compensate for less pleasant job characteristics with respect to those factors. Last, even after controlling for other job characteristics, hospital nursing is still rated as more attractive than geriatric nursing.

Exploring the Results of the Ontario Home Care Minimum Wage Change

Background

:In 2014, Ontario increased its "minimum wage" for personal support workers (PSWs) in publicly funded home care.

Objective

The objective of this article is to determine the short-term results of this policy for home care PSWs' wages, hours and job stability.

Methods

This study uses descriptive graphs and ordinary least squares and unconditional quantile regressions, using PSWs across Canada as comparison groups.

Results

Pre-policy nominal wages for Ontario home care PSWs stagnated, whereas real wages declined. The policy increased home care PSWs' wages without noticeably affecting hours or job stability. However, wages were already increasing for low-wage home care workers in the rest of Canada.

Conclusions

Ontario exercises monopsony power in the home care market and, before the wage increase, kept nominal wages stable compared to rising real and nominal wages in the rest of Canada. This PSW-specific wage increase did not represent a drastic change relative to market conditions.

Mandatory Overtime Work in the United States: Who, Where, and What?

Who works mandatory overtime? Descriptive analysis of a module in the 2002 General Social Survey finds that 28 percent of full-timers face and 21 percent actually worked extra hours because it was required by their employer—a slight increase since overtime work was last measured twenty-five years ago. Mandatory overtime is more frequent among men, the foreign born, those employed in non-profits, blue-collar occupations, and industries such as public administration and manu facturing. Relative to workers who have no overtime, workers who face mandatory overtime are found more frequently among workers who have inflexible work schedules, seniority, difficulty finding alternative jobs, bonus compensation, and poor relationships with management. Relative to those with non-mandatory overtime, those who work man datory overtime show less job satisfaction, job security, and say about their jobs. Thus, understanding the effects of mandatory overtime has implications for organizations that aim for high-performance workplace structures and smooth labor relations and for labor organizers who seek to attract members by addressing the negative consequences of mandatory overtime, such as heightened work-family interference. While some collective bargaining provisions seek to curb mandatory overtime, their limited effect may be why at least seven U.S. states have passed some form of legal ban and/or right to refuse.

Psychosocial work environment and intention to leave the nursing profession: a cross-national prospective study of eight countries

Many countries throughout the world are facing a serious nursing shortage, and retention of nurses also is a challenge. The aim of this study was to compare the predictive contribution of a broad spectrum of psychosocial work factors, including job strain, effort-reward imbalance, and alternative employment opportunity, to the probability of intention to leave the nursing profession. A total of 7,990 registered female nurses working in hospitals in eight countries (Germany, Italy, France, The Netherlands, Belgium, Poland, Slovakia, and China) were included in the one-year prospective study. A standardized questionnaire on job strain, effort-reward imbalance, employment opportunity, and intention to leave the nursing profession was used in the survey. Multilevel logistic regression modeling was used to analyze the data. Results showed that an imbalance between high effort and low reward (in particular, poor promotion prospects) and good employment opportunity at baseline were independently associated with a new intention to leave the nursing profession at follow-up. However, job strain appeared to have relatively less explanatory power. Findings suggest that interventions to improve the psychosocial work environment, especially the reciprocity experienced between effort and reward, may be effective in improving retention of nurses and tackling the international nursing shortage.

Should I stay or should I go? Career change and labor force separation among registered nurses in the U.S

Efforts to retain nurses within the profession are critical for resolving the global nursing shortage, but very little research explores the phenomenon of nursing workforce attrition in the U.S. This study is the first to simultaneously investigate the timing of attrition through survival analysis, the exit path taken (career change vs. labor force separation), and the major socioeconomic, family structure, and demographic variables predicting attrition in this country. Using nationally representative U.S. data from the 2004 National Sample Survey of Registered Nurses (N=29,472), we find that the rate of labor force separation is highest after the age of 60, a typical pattern for retirement. However, a non-trivial proportion of career change also occurs at older ages (50+ years old), and the rate of labor force separation begins to climb at relatively young ages (30-40 years old). Particularly strong predictors of early labor force separation include being married and providing care to dependents in the home (young children or elderly parents). Career change is predicted strongly by higher levels of education, male gender, and current enrollment in a non-nursing degree program. Having an Advanced Practice credential reduced the hazards of attrition for both exit paths. The results suggest a fruitful path for future research and a number of policy approaches to curbing nurse workforce attrition.

Exploring Factors Associated With Turnover Among Registered Nurse (RN) Supervisors in Nursing Homes

Because most turnover studies focus on certified nursing assistants (CNAs), licensed vocational nurses (LVNs), and administrators, little is known about registered nurses’ (RNs) higher turnover. This study builds on the current body of knowledge about turnover among RN supervisors in nursing homes. The article discusses a survey of RN nurse supervisors administered in more than 1,000 nursing homes that was merged with the 2003 Texas Medicaid cost report and the area resource file. Two 2-stage models are developed to predict RN turnover rates. RNs’ intent to leave predicts RN turnover through job satisfaction, perceived empowerment, and education level. High LVN and CNA turnover and high Medicare census are associated with higher turnover. Implications are that participation in management decisions and perceived wage competitiveness are an important determinant of RN retention in nursing homes. Future research should focus why RN supervisors with higher levels of education leave nursing homes.

Nurses wanted Is the job too harsh or is the wage too low?

When entering the job market, nurses choose among different kind of jobs. Each of these jobs is characterized by wage, sector (primary care or hospital) and shift (daytime work or shift). This paper estimates a multi-sector-job-type random utility model of labor supply on data for Norwegian registered nurses (RNs) in 2000. The empirical model implies that labor supply is rather inelastic; 10% increase in the wage rates for all nurses is estimated to yield 3.3% increase in overall labor supply. This modest response shadows for much stronger inter-job-type responses. Our approach differs from previous studies in two ways: First, to our knowledge, it is the first time that a model of labor supply for nurses is estimated taking explicitly into account the choices that RN's have regarding work place and type of job. Second, it differs from previous studies with respect to the measurement of the compensations for different types of work. So far, it has been focused on wage differentials. But there are more attributes of a job than the wage. Based on the estimated random utility model we therefore calculate the expected value of compensation that makes a utility maximizing agent indifferent between types of jobs, here between shift work and daytime work. It turns out that Norwegian nurses working shifts may be willing to work shift relative to daytime work for a lower wage than the current one.

The prevailing winds of oppression: understanding the new graduate experience in acute care

TOPIC

The experience of new graduates in acute care.

PURPOSE

The majority of newly graduated nurses make their initial professional role transition in acute care. Being socialized into the dynamic culture of today's hospitals creates significant challenges not only for the nurses themselves but also for institutions of higher education, healthcare administrators, and policy makers across this country. Demanding workloads for hospital nurses, an aging nursing workforce, and the high level of stress inherent in workplaces across North America are factors contributing to an exodus of both new and seasoned nurses out of acute care. This article outlines the implicit and explicit factors that may be contributing to the dissatisfaction and distress in nursing graduates entering professional practice through hospital nursing.

SOURCES OF INFORMATION

CINAHL, MEDLINE, Sociolit, and PubMed.

CONCLUSION

Discussion is focused on the oppressive context in which hospital nursing continues to be situated and explores the ideological, structural, and relational aspects of domination that continue to surface in the work experiences of novice as well as seasoned nurses. Suggestions for addressing the issues that plague the acute care environment are integrated throughout the article, and a detailed framework of empowerment for this nursing context is offered.

Explaining young registered Finnish nurses’ intention to leave the profession: A questionnaire survey

BACKGROUND

Regardless of the current global nursing shortage, many nurses are planning to leave their profession. According to previous research, young nurses in particular are the most eager to leave-there is, however, no research available as to why this is.

OBJECTIVES

The aim of this survey study was to discover what proportion of young nurses intends to leave the profession in Finland and what the reasons behind this are.

DESIGN

Quantitative, survey study.

SETTINGS

Six hospital districts in Finland.

PARTICIPANTS

A total of 147 Registered Nurses, under the age of 30, working mainly in hospitals.

METHOD

Data was collected as part of the NEXT (Nurses Early Exit)--Study. A structured postal questionnaire, BQ-12, was used to collect the data in autumn 2003. Quantitative data were analysed using chi(2), the Fisher exact-test and Mann-Whitney U-test, and qualitative data were analysed using quasi-statistics.

RESULTS

During the course of the past year, 26% of young nurses have often thought of giving up nursing. This was associated with personal burnout, poor opportunities for development, lack of affective professional commitment, low job satisfaction, work-family conflicts and higher quantitative work demands. In open-ended question, nurses stated that the main reasons for them considering leaving the profession included dissatisfaction with salary, the demands of nursing work, the inconvenience of shift work/working hours and uncertain work status.

CONCLUSIONS

Findings illustrate that there were several factors influencing the young nurses' intentions. By identifying the factors responsible, it could be possible to retain young nurses in the field.

Work attitudes of older RNs

Using data collected from 1,906 RNs from Metropolitan Statistical Areas in 29 states, the purpose of this study was to examine the characteristics and work attitudes of older RNs compared to RNs less than age 50 at two time periods, and compare among the older RNs those who are working in nursing, working outside nursing, and not working. Older RNs reported more distributive justice (fairness of rewards), work group cohesion, and supervisory support and less organizational constraint, and quantitative workload than younger RNs. Overall, older RNs were more satisfied, had greater organizational commitment, and had less desire to quit than younger RNs. There were no significant differences between older and younger RNs for autonomy, mentor support, or variety. Strategic efforts by employers and government could be used to retain older workers, attract RNs working in nonnursing settings back into nursing, and recruit retired RNs into the nursing workforce.

Investigating the quitting decision of nurses: panel data evidence from the British National Health Service

In this paper, we provide a detailed investigation into the quitting behaviour of nurses in the British National Health Service (NHS), using a recently constructed longitudinal survey. We fit both single and competing risks duration models that enable us to establish the characteristics of those nurses who leave the public sector, distinguish the importance of pay in this decision and document the destinations that nurses move to. Contrary to expectations, we find that the hourly wage received by nurses outside of the NHS is around 20% lower than in the NHS, and that hours of work are about the same. However, while the effect of wages is found to be statistically significant, the predicted impact of an increase in nurses' pay on retention rates is small. The current nurse retention problem in the NHS is therefore unlikely to be eliminated through substantially increased pay.

Reasons for leaving nursing care and improvements needed for considering a return: a study among Swedish nursing personnel

Based on two research projects in Sweden during the 1990s, the aim of this study was to identify former nursing personnel's main reasons for leaving nursing care, and to find out under what circumstances they would consider returning. Two open-ended questions in a questionnaire were analysed. The results showed that different aspects of working conditions, mainly working schedule, management and status of profession were the dominating reasons both for leaving and considering a return. The findings indicate that interventions required for retaining personnel in nursing care need to be addressed both at the political and at the local level.

Factors contributing to the decision to leave nursing care: a study among Swedish nursing personnel

BACKGROUND

An ageing nursing workforce raises questions of recruitment strategies and how to prevent nursing personnel from leaving their jobs.

AIM

The aim of this study was to examine factors contributing to the decision to leave nursing care with special reference to work conditions related to nursing care.

METHODS

This paper is based on data from a survey of nursing personnel who were employed at various county hospitals in Sweden from 1992 to 1995 (n = 1507). A self-administered questionnaire was used to identify those who had left nursing care voluntarily (n = 158) and to examine factors contributing to their decision to leave.

RESULTS

Results showed that unsatisfactory salary contributed most to the nursing personnel's decision to leave, followed by lack of professional opportunities and restricted professional autonomy.

CONCLUSION

The fact that nursing personnel leave because of unsatisfactory salary and lack of professional opportunities underpins the importance of making nursing more attractive in terms of financial and professional development. However, the sample size of this study was relatively small and larger studies are thus required to further investigate the importance of these factors in the decision to leave nursing care.

Monitoring and evaluation of human resources for health: an international perspective

BACKGROUND: Despite the undoubted importance of human resources to the functions of health systems, there is little consistency between countries in how human resource strategies are monitored and evaluated. This paper presents an integrated approach for developing an evidence base on human resources for health (HRH) to support decision-making, drawing on a framework for health systems performance assessment. METHODS: Conceptual and methodological issues for selecting indicators for HRH monitoring and evaluation are discussed, and a range of primary and secondary data sources that might be used to generate indicators are reviewed. Descriptive analyses are conducted drawing primarily on one type of source, namely routinely reported data on the numbers of health personnel and medical schools as covered by national reporting systems and compiled by the World Health Organization. Regression techniques are used to triangulate a given HRH indicator calculated from different data sources across multiple countries. RESULTS: Major variations in the supply of health personnel and training opportunities are found to occur by region. However, certain discrepancies are also observed in measuring the same indicator from different sources, possibly related to the occupational classification or to the sources' representation. CONCLUSION: Evidence-based information is needed to better understand trends in HRH. Although a range of sources exist that can potentially be used for HRH assessment, the information that can be derived from many of these individual sources precludes refined analysis. A variety of data sources and analytical approaches, each with its own strengths and limitations, is required to reflect the complexity of HRH issues. In order to enhance cross-national comparability, data collection efforts should be processed through the use of internationally standardized classifications (in particular, for occupation, industry and education) at the greatest level of detail possible.