Safeguarding the retention of nurses: A systematic review on determinants of nurse's intentions to stay

Why nurses discontinue practice in hospitals? Insights from a qualitative study

AIM

To explore why registered nurses in Italy choose to resign from their positions in hospitals.

BACKGROUND

In recent years, the work environment within hospitals has worsened, with increasing rates of burnout, stress, depression, compassion fatigue, and even suicide among nurses. This has prompted many nurses to either leave their current positions or exit the profession entirely. Previous research has indicated that nurse turnover, especially in hospital settings, poses a significant challenge for society and global healthcare, with insufficient nurse staffing associated with negative patient outcomes.

METHODS

The study used a descriptive phenomenology design, conducting 30 semi-structured interviews with nurses. The Consolidated Criteria for Reporting Qualitative Research have been followed in reporting the methods and findings.

RESULTS

The average age of the participants was 32.8 years, the average length of hospital work experience was 5.7 years, and the majority of the participants were female (n = 22). Thematic analysis revealed two main themes: individual factors, encompassing "quality-of-life threats" and "personal drive and ambitions", and organizational factors, including "unsustainable working conditions" and "lack of support from employers."

IMPLICATION FOR HEALTH POLICY

There is an urgent need for an evidence-based approach to quality improvement to increase nurses' well-being in the workplace. Organizations aiming to retain nursing staff should prioritize strategies such as promoting work flexibility and addressing concerns related to work-life balance. Effective management engagement and implementation of flexible working arrangements are essential, along with the promotion of organizational values aligned with professionalism to combat negative perceptions of the nursing profession.

The Impact of Israel's 1995 National Health Insurance Law and Health Reforms on Nursing: A Historical Overview

This article examines the trends and trajectories of the nursing profession and healthcare practices in Israel from a historical perspective, following the enactment of the 1995 National Insurance Health (NHI) Law, which entitled every Israeli resident to healthcare services. Since then, Israel's health funds have become more competitive and services to patients have improved. Nurses in Israel have taken on new roles in the healthcare system, including working with professional colleagues to develop efficient teamwork that serves patients' needs. Nursing in Israel has also become increasingly academized, with all nursing training taking place in universities or academic colleges as of 2024. These changes mirror global trends in nursing and demand new thinking about the role of nurses, including how nursing can best serve patients and the wider healthcare system.

Predictors of Croatian nurses' turnover intention: A cross-sectional study

The turnover intention rate among nurses is very high both worldwide, and in Europe. It is related to personal and professional factors that contribute to the decision to leave or stay. This descriptive cross-sectional study aimed to identify the personal and professional predictors that contribute to nurses' turnover intention in Croatia. A convenient sample of 448 nurses employed in public general hospitals was used. The Practice Environment Scale of the Nursing Work Index questionnaire and the Turnover Intention Scale were applied. A logistic regression model was used to determine the associations between nurses' turnover intention and their personal and professional factors. The results indicate that both types of factors can influence nurses' turnover intention. The associations between turnover intention and personal factors such as age (p = 0.033), gender (p = 0.023), job satisfaction (p < 0.001), and social satisfaction (p = 0.006), were recorded. Nurse participation in hospital affairs (p = 0.026), and the nurse manager ability, leadership, and support of nurses (p = 0.002), which are professional factors were also associated with turnover intention. In order to prevent turnover intention, continuous measures need to be planned and implemented to increase nurses' satisfaction and improve their working environment.

Comparison of student nurses' expectations and newly qualified nurses' experiences regarding clinical practice: A secondary analysis of a cross-sectional survey

AIM

To compare student nurses' expectations and newly qualified nurses' experiences regarding clinical practice in Switzerland 1 year after graduation.

DESIGN

A secondary explorative analysis of a cross-sectional survey.

METHODS

The data were sourced from the Swiss National Graduate Survey of Health Professionals covering six universities of applied sciences between 2016 and 2019, with information on three cohorts of bachelor student nurses, with a 1-year follow-up between each year. The participants were 533 bachelor-prepared nursing graduates.

RESULTS

The student nurses' overall expectations included the following top two prioritized aspects: 'contributing to something important' and 'adequate time to spend with patients'. Newly graduated nurses' clinical practice experiences demonstrated that not all expectations were met 1 year after graduation. The largest gaps were found in 'adequate time to spend with patients', 'work-life balance' and experiencing 'good management'.

CONCLUSION

The most crucial expectation gaps are related to having sufficient time to spend with patients and a good work-life balance. The most important result is whether there is a shortage of places for nurses to work rather than the oft-cited shortage of nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The expectations of Swiss newly qualified nurses can be better met by an assessment in the first year about which individual perceptions of workplace characteristics cause them to make choices to change something about their work, affect their job satisfaction or influence their intention to stay.

IMPACT

Few of the student nurses' expectations were met 1 year after graduation, therefore Swiss healthcare institutions should improve needs assessments to strengthen the nurse workforce starting early in employment. The results underscore the importance of a constructive management culture, such as that in magnet hospitals in the United States which underpins the philosophy of changing in nursing. The results can be used internationally as a benchmark and as a basis for introducing potential interventions for nurse retention.

REPORTING METHOD

This study was reported following the Standardized Reporting of Secondary Data Analyses Checklist.

PATIENT OR PUBLIC CONTRIBUTION

There were no patient or public contributions.

TRIAL AND PROTOCOL REGISTRATION

This study has not been registered.

The Influence of Burnout, Resilience, and Resources to Support Clinical Practice Among Newly Licensed Nurses Intended Job Plans

OBJECTIVE

Survey newly licensed nurses (NLNs) with respect to burnout, resilience, perception of the work environment, and intended short- and long-term job plans.

BACKGROUND

NLN retention is a significant contributing factor to the nursing shortage.

METHODS

A 126-item survey measuring demographics, burnout, resilience, work environment, and job plans distributed via email, using Listservs to recruit nurses licensed for 5 years or less.

RESULTS

Participants (N = 547) reported moderate burnout, specifically emotional exhaustion, and resilience. Overall scores on perception of the work environment were positive. Multiple logistic regression suggests odds of 1-year intended job flight are positively associated with emotional exhaustion (odds ratio [OR], 1.77; P < 0.001), resilience (OR, 1.07; P = 0.003) and non-White racial identity (OR, 2.99; P < 0.001) and negatively associated with staffing and resource adequacy (OR, 0.63; P = 0.038).

CONCLUSIONS

Retaining NLNs requires mitigating burnout, addressing the experience of non-White NLNs in clinical practice, and improving support and resources for NLNs.

Effects of grit, calling, and resilience on the retention intention of general hospital nurses

AIM

This study aimed to determine the influence of personal factors such as grit, calling, and resilience on nurses' retention intention in South Korean general hospitals.

BACKGROUND

The global shortage and high turnover rate of nurses have become significant concerns with no clear solutions for increasing retention.

INTRODUCTION

Determining the factors related to the f general hospital nurses and retention intention is important for solving the problem of inadequate nursing personnel and improving the quality of nursing services.

METHODS

This study was a descriptive survey of 221 nurses working at a general hospital in South Korea from July 2021 to February 2022. Data were collected using self-reported online questionnaires, with measurement tools focusing on grit, calling, resilience, and retention intention. The STROBE checklist was used for reporting this study.

RESULTS

The average retention intention score was 5.35 ± 1.52 out of 8 points. Significant correlations were found between retention intention and grit, calling, and resilience. The factors influencing retention intention were job satisfaction, calling, marital status, and total career length, explaining 31.9% of the variance.

CONCLUSIONS

To enhance nurses' intention to remain at general hospitals, their job satisfaction and sense of a calling should be improved. Further research should be conducted to identify factors that influence retention intention, particularly among groups with low job retention, with consideration of individual characteristics that might affect retention intention.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Increasing nurses' retention intention would alleviate the nursing shortage, help hospitals retain competent nurses, reduce turnover-related costs, and improve organizational efficiency. Resolving the nursing shortage is critical for improving patient safety and nursing service quality at general hospitals.

Relationship between organizational commitment, working environment, and burnout in clinical nurses

BACKGROUND

Burnout is a mental condition caused by chronic emotional or psychological stress. Organizational commitment is always an important issue in the field of organizational development of clinical nurses. The study aimed to assess the association between organizational commitment, work environment, and burnout in clinical nurses.

MATERIALS AND METHODS

This is a correlational descriptive study that was conducted from November 2021 to January 2021 on 456 clinical nurses at the Hazrat Rasul Akram University Hospital in Iran. The convenience sampling method was used. Data were collected using socio-demographic and work-related data collection sheet, the Working Environment Scale (WES-10), the Organizational Commitment Questionnaire (OCQ), and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Data were analyzed by the Statistical Package for the Social Sciences (SPSS) version 23.

RESULTS

The overall results showed that the mean score of organizational commitment was 29.87 ± 8.19, the mean score of burnout was 91.98 ± 17.40, and the mean score of work environment satisfaction was 24.62 ± 7.53. There were negative and significant relationships between organizational commitment with burnout (r = -0.324, P < 0.001) and work environment satisfaction (r = -0.440, P < 0.001). Also, there was a positive and significant relationship between work environment satisfaction with burnout (r = 0.386, P < 0.001).

CONCLUSION

The nursing profession is widely recognized as one of the most stressful professions, often characterized by high rates of staff turnover, absenteeism, and burnout. The result of this study highlights the importance of positive work conditions for ensuring the commitment and well-being of clinical nurses.

Factors affecting nurses retention during the COVID-19 pandemic: a systematic review

BACKGROUND

The global nursing shortage was a well-known issue before the Covid-19 pandemic, but the Covid-19 pandemic has exacerbated the current nursing workforce shortage and reduced nursing retention. This systematic review aimed to explore factors affecting retention of nurses.

METHODS

The PubMed, Web of Science, Scopus and Proquest databases were searched for relevant primary studies published on nurses retention during Covid-19 pandemic. Finally, Google Scholar was searched for retrieving more related documents that may not be indexed in other searched databases. Inclusion criteria were research articles and gray literature related to nursing retention in Covid-19 pandemic, articles published in English, access to the full-texts, and without time limitation. Both qualitative and quantitative studies focusing on factors affecting the nurses retention were included. The Joanna Briggs Institute checklists were used for assessing quality of quantitative and qualitative studies. Qualitative and thematic content analysis methods based on Braun and Clark's model were used to analyze the data.

RESULTS

Eighteen studies were identified through a systematic search of the literature. The results showed that seven factors include personal, interpersonal, organizational, social media, educational, emotional, and protective factors are the factors affect the nurses retention.

CONCLUSION

The findings of this study showed that retention of nurse is complex and multi-factorial issue that factors from micro to macro-level affect it. Managers and health policy-makers based on the results obtained from this study can plan appropriate measures to increase the retention of nurses.

Turnover intention and its influencing factors among male nurses in China: a national-scale descriptive study

BACKGROUND

The number of registered male nurses has increased in China, yet research specifically addressing their turnover intentions remains limited. While high turnover intention is known to exacerbate the workforce shortage of nurses, the national level and unique factors contributing to turnover intention among registered male nurses in China are unclear and underexplored.

AIM

This study aimed to investigate the turnover intention of registered male nurses in China and its unique influencing factors, with focus on variables that have received limited attention in previous research.

METHODS

In this cross-sectional study, 13,088 registered male nurses were recruited from over 1,000 hospitals across China between May and August 2023. Data collection was conducted through an online questionnaire. Univariate analysis and multinomial logistics regression were performed to analyze the data.

CLINICAL TRIAL NUMBER

Not applicable.

RESULTS

Our analysis revealed that 71.6% of registered male nurses in China exhibited medium to high turnover intentions. Male nurses with no children, lower occupational prestige, and lower work values were more likely to exhibit a higher turnover intention. Other significant factors contributing to a high turnover intention included low income satisfaction, limited career development opportunities, and minimal support from hospitals.

CONCLUSIONS

A substantial proportion of registered male nurses in China express moderate to high turnover intentions, driven by factors that extend beyond traditional occupational concerns. This study highlights the importance of addressing less explored variables such as work value, occupational prestige and marital pressures in developing targeted interventions to enhance job satisfaction and reduce turnover within this essential workforce segment.

Motivations for Enrolment and Dropout of First-Year Undergraduate Nursing Students: A Pilot Multimethod Study

BACKGROUND/OBJECTIVES

Higher education institutions must improve the attractiveness and retention of the nursing profession to address the widespread shortage. This pilot multimethod study aimed to preliminarily understand the relationship between motivations for enrolment and dropout among first-year undergraduate nursing students.

METHODS

A two-step approach was conducted among first-year nursing students from five Italian universities involving: (a) a baseline quantitative online survey collecting their characteristics and motivations for enrolment; (b) a follow-up semi-structured interview qualitative data collection among students who dropped out. Descriptive and inferential statistics were used to describe the motivations for enrolment and differences between universities. Dropout motivations emerged from inductive content analysis, with data categorisation according to Urwin's framework.

RESULTS

A total of 759 students completed the online survey. Primary motivations for enrolment included the desire to be useful (88.8%), help suffering people (84.3%), and find employment (74.2%); 22.3% cited unsuccessful admission to another university as motivation for enrolment. Of the 141 students who discontinued, 31 were interviewed (22%). Eleven categories and three themes were identified. More than half of the participants dropped out due to interest in other courses and lack of aptitude, while a smaller number cited personal circumstances. Other motivations for dropout were related to negative learning environments or feelings and difficulties related to course characteristics.

CONCLUSIONS

This study provides an initial insight into these complex phenomena that will be instrumental in understanding data from an Italian multicenter cohort study. The findings can inform recommendations and strategies to strengthen the future nursing workforce.

Exploring the Influencing Factors of Experienced Nurses' Retention Behaviour: A Qualitative Study Based on the COM-B Model

AIM

The aim of this study was to explore the factors influencing the retention behaviour of experienced nurses in China, using the capability, opportunity, motivation and behaviour (COM-B) model as a conceptual framework.

DESIGN

A qualitative descriptive study based on the COM-B model.

METHODS

In this qualitative descriptive study, semi-structured interviews were conducted with 22 nurses across 11 cities in the Guangdong-Hong Kong-Macao Great Bay Area of China between March and May 2024. The interviews followed a predefined topic guide derived from the COM-B model. The transcriptions of the interviews were then subjected to deductive thematic analysis.

RESULTS

Eleven key themes emerged, which were embedded in three categories of the COM-B model, including capability (physical and mental health, professional knowledge and skills), motivation (increasing income, sense of fulfilment in nursing work, positive colleague relationships and job stability) and opportunity (management, career development opportunities, work-life balance, prejudice against nursing and workload).

CONCLUSIONS

The study provides new perspectives on factors influencing the retention of experienced nurses in Mainland China, Hong Kong and Macao. The study identified 11 factors that influence nurse retention behaviour, emphasising three distinctive perceptions: the 'iron rice bowl', the concept of filial piety and public prejudice towards nursing in Chinese society, which are unique to China compared to other nations. Additionally, it revealed similarities in nurse retention factors across Mainland China, Hong Kong and Macao.

IMPLICATIONS FOR THE PROFESSION

To strengthen nurse retention, it is essential to develop tailored strategies for experienced nurses. Future research should also take social culture into account to enhance retention efforts.

REPORTING METHOD

This study's reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Generational Differences in Moral Injury, Resilience, and Well-Being Among Nurses: Predictors of Intention to Leave Position and Profession

BACKGROUND

The COVID-19 pandemic highlighted the negative impact of moral injury on nurses' well-being. However, there is a lack of research about generational differences among nurses, particularly on newer nurses who have been identified as having a higher rate of intention to leave.

OBJECTIVE

This study examines generational differences among nurses on moral injury, well-being, resilience, and intention to leave their nursing position and profession.

METHODS

This is a secondary analysis of cross-sectional data from registered nurses in clinical practice in Ohio between July and August 2021. Data on demographics, moral injury, resilience, and well-being were collected using an online survey. Participants were categorized into 4 generational groups based on their age in 2021: Baby Boomers (57-75 years old), Generation X (42-56 years old), Generation Y (27-41 years old), and Generation Z (12-26 years old). Descriptive and inferential statistics, including logistic regression and analysis of variance, were employed for analysis.

RESULTS

Significant generational differences were found in years of clinical experience, moral injury, resilience, and well-being. Baby Boomers reported higher well-being and resilience and lower moral injury. Notably, the intention to leave the profession was more strongly associated with well-being and moral injury levels than with the years of experience or generational group.

CONCLUSIONS

The findings suggest that interventions to improve nurse retention should prioritize enhancing well-being and addressing the root causes of moral injury. Tailored strategies addressing the needs of different generations are necessary for mitigating the adverse effects of current healthcare challenges on nurse attrition.

International Nurse Migration Experience of the First Two Years: A Mixed Methods Study

AIM

The aim of this study was to explore experiences of internationally educated nurses' first 2 years working and living in England in an age of contemporary migration.

DESIGN

Exploratory mixed method design.

METHODS

An online survey collected responses from August 2022 to October 2022. A mixed-methods approach was applied to gain a breadth of understanding through quantitative outcomes integrated with depth of qualitative analysis.

RESULTS

Data findings from 773 international nurses identified the recognition of prior professional skills and experiences, induction processes, career development systems and the role of line managers are integral to professional integration and could be improved. Communication barriers were frequently transient and time limited, and participants often had incomplete insight of human resource policies. Personal factors affecting life outside of work revealed compromise and sacrifice with accommodation choices, and participants were often not satisfied with their economic status, housing, cost of living in England, and social support. Mental well-being scores varied by country of origin and participants happier with decision to migrate to England had significantly higher mental well-being scores.

CONCLUSION

International nurses have divergent professional and personal motivations for migration unique to individual circumstances. Recognition for transferable skills and experience, receipt of a comprehensive and warm welcome from organisations, safe and well-maintained suitable accommodation and living conveniently located to shops, work and transportation, improve experience. International nurses must have sufficient financial gains from salaries and opportunity to unite with children and families.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Progressing migration experience of international nurses can improve retention and augment improving patient care and outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No patient or members of public contributed to this research.

Factors Influencing Job Satisfaction among Mental Health Nurses: A Systematic Review

BACKGROUND/OBJECTIVES

Job satisfaction is crucial for healthcare professionals, and understanding its influencing factors is essential for fostering a positive work environment, reducing turnover rates, and improving the overall quality of patient care. This systematic review examined the factors linked to nurse job satisfaction in psychiatric hospitals and diverse psychiatric settings, analyzing the findings through the lens of Herzberg's theory. Despite existing evidence, gaps remain in understanding the differences in factors affecting job satisfaction across various settings.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a comprehensive systematic review by searching six databases, namely PubMed, CINAHL, Cochrane Library, PsycINFO, Scopus, and APA PsycNet. Our search yielded an initial 567 studies published between January 2014 and February 2024, which were subsequently screened and evaluated based on predetermined inclusion criteria. Following this process, a total of 16 studies were deemed eligible for final analysis. Each of these selected studies underwent an independent review by two authors, utilizing the Joanna Briggs Institute checklist tool to ensure rigorous assessment.

RESULTS

The findings revealed that interpersonal relationships, working conditions, and recognition were the most frequently reported factors associated with nurse job satisfaction, along with various extrinsic, intrinsic, personal, emotional, and psychosocial factors. Notably, psychiatric hospitals showed a mix of personal, extrinsic, intrinsic, and psychosocial factors influencing job satisfaction, with demographic factors being the most frequently examined. In contrast, diverse psychiatric settings focused more on external aspects impacting job satisfaction.

CONCLUSIONS

The review highlights the importance of both intrinsic and extrinsic factors and suggests that future research should employ more robust methods and consider psychiatric hospitals and other mental health contexts. Herzberg's theory provides a valuable framework for understanding the factors associated with nurse job satisfaction.

Concerns about practice: supporting staff by fostering a climate of psychological safety

The nursing profession is under growing pressure and many nursing staff find it increasingly challenging to maintain standards and provide safe, effective and efficient care that meets the needs of patients. Nurses' job satisfaction is predicated on feeling supported, including when there are concerns about practice - whether their own or that of their colleagues. This article discusses how nurse managers can support staff to challenge suboptimal practice, admit their own errors and learn from these by fostering a climate of psychological safety. This includes adopting a relational model of leadership; cultivating open communication; providing clarity on roles and expectations; ensuring transparency and fairness in performance management; having supportive 'tough conversations' with staff; demonstrating objectivity when investigating concerns; and promoting a 'just culture'.

Adaptation of the Nursing Activities Score in Latvia

This study focuses on the adaptation and validation of the Nursing Activities Score (NAS) for use in Latvian intensive care units (ICUs) to measure nursing workload. The NAS, widely used internationally, was selected for its comprehensive ability to reflect 81% of ICU nursing activities, making it a suitable tool for assessing nursing workload in the Latvian healthcare context. The study followed a two-phase methodology: (1) expert validation using the Content Validity Index (CVI) and (2) a pilot study to assess the psychometric properties of the adapted tool. In the first phase, 10 ICU nursing experts assessed the translated NAS items, resulting in revisions to three specific paragraphs (4a, 14, and 20) based on low CVI scores. After refinement, CVIs improved from 0.6 to 0.8 for paragraphs 4a and 14, and from 0.5 to 0.9 for paragraph 20. The final CVI for all items reached 0.909. In the second phase, a pilot study was conducted in a Latvian ICU with 42 patients and 226 NAS assessments. The psychometric evaluation showed strong reliability and validity, confirming the NAS's suitability for measuring nursing workload in this context. Cronbach's alpha for the scale was 0.973. The adapted NAS provides a standardised method for workload assessment in Latvian ICUs, offering potential improvements in nurse resource management and patient care.

Personal and Workplace Characteristics as Predictors of Intent-To-Stay Among Registered Nurses: An Exploratory Quantitative Multicentre Study

AIM

This study aims to describe and examine the factors associated with registered nurses' intent-to-stay and subsequently identify predictors of nurses' intent-to-stay.

DESIGN

A quantitative, cross-sectional correlational design was used.

METHODS

A convenience sample of 270 registered nurses completed the questionnaire and was included in this study. Descriptive statistics were used to present the sociodemographic characteristics and scores of outcome measures. Pearson's correlation coefficient and multiple linear regression with backward selection were conducted to examine how nurses' characteristics and workplace factors influence nurses' intent-to-stay.

RESULTS

The mean age of the participants was 29.2 years. The mean scores for the outcomes were intent-to-stay (mean = 2.96), resilience (mean = 3.34), occupational self-efficacy (mean = 4.34), sleep quality (mean = 9.73) and workplace environment scores (mean = 3.15). The correlation analysis showed that resilience, occupational self-efficacy, self-realisation and workload were positively correlated to intent-to-stay while sleep quality was negatively correlated to intent-to-stay. Multiple linear regression analysis found occupational self-efficacy, sleep quality, workload, nervousness, nurses' designation and specialisation status to be significant factors associated with intent-to-stay.

CONCLUSION

Intent-to-stay is a complex and multidimensional construct influenced by a variety of personal and workplace factors. Hospital administrators should endeavour to develop measures to improve occupational self-efficacy, workload, nervousness and push for specialisation training to bolster nurses' intent-to-stay.

IMPACT

Against an everchanging healthcare landscape following the COVID-19 pandemic, the findings of this study contribute to a deeper understanding of the factors of registered nurses' intent-to-stay. The findings of this study alluded to the importance of professional development and workload as factors that can influence registered nurses' intent-to-stay. Hospital administrators can prioritise workforce retention policies by introducing strategies such as opportunities for upskilling, flexible working hours and streamlining work processes to promote nurses' intent-to-stay.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Organisational factors associated with healthcare workforce development, recruitment, and retention in the United Kingdom: a systematic review

AIMS

To synthesise evidence regarding organisational practice environment factors affecting healthcare workforce development, recruitment, and retention in the UK.

METHODS/DATA SOURCES

A systematic search of PubMed, Web of Science, EMBASE, and PsycINFO yielded ten relevant studies published between 2018 and 2023 and conducted in the UK (the last search was conducted in March 2023). Adhering to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent reviewers conducted screening, sifting, and data extraction, applying the quality assessment tool for risk of bias.

RESULTS

Results highlight key factors associated with staff intention to leave/turnover/retention: workplace challenges, aggression, moral distress, on-the-job embeddedness, leadership involvement, organisational support, and flexible shift patterns. Notably, aggression from colleagues, including clinical staff but not interdisciplinary personnel, has a more detrimental impact on staff intention to leave than aggression from patients.

CONCLUSION

The complex and context-dependent impacts of these organisational factors on the UK healthcare workforce underscore the need for tailored interventions. The review acknowledges limitations, including bias from excluding qualitative studies, a small pool of included studies, and nurse overrepresentation.

Fostering belonging and social connectedness in nursing: Evidence-based strategies: A discussion paper for nurse students, faculty, leaders, and clinical nurses

BACKGROUND

The phenomenon of loneliness among healthcare providers, particularly nurses, has garnered increasing attention due to its detrimental effects on individual well-being and professional retention. The isolation experienced by nurses has been linked to heightened turnover rates and intentions to leave the profession, posing significant challenges to healthcare systems globally. Recognizing loneliness as an epidemic in 2023, the U.S. Surgeon General highlighted the urgency of addressing this issue within the healthcare workforce.

PURPOSE

This paper explores evidence-based strategies to mitigate loneliness and promote social connectedness among nurses, drawing insights from various stakeholders. It aims to offer actionable recommendations to enhance the nursing experience and retain professionals in the field.

DISCUSSION

Strategies include peer support programs, mentorship initiatives, wellness activities, and fostering open communication. Leveraging technology for virtual connections is also highlighted, especially in remote work scenarios.

CONCLUSION

A holistic approach is vital, combining individual, interpersonal, and systemic interventions to combat nurse loneliness. Prioritizing social connectedness fosters a supportive work environment, benefiting both nurses and patient care quality.

Effects of Nurse Staffing on Missed Breastfeeding Support in Maternity Units With Different Nurse Work Environments

PURPOSE

To examine the effect of nurse staffing in varying work environments on missed breastfeeding teaching and support in inpatient maternity units in the United States.

BACKGROUND

Breast milk is the optimal food for newborns. Teaching and supporting women in breastfeeding are primarily a nurse's responsibility. Better maternity nurse staffing (fewer patients per nurse) is associated with less missed breastfeeding teaching and support and increased rates of breastfeeding. We examined the extent to which the nursing work environment, staffing, and nurse education were associated with missed breastfeeding care and how the work environment and staffing interacted to impact missed breastfeeding care.

METHODS

In this cross-sectional study using the 2015 National Database of Nursing Quality Indicator survey, maternity nurses in hospitals in 48 states and the District of Columbia responded about their workplace and breastfeeding care. Clustered logistic regression models with interactions were used to estimate the effects of the nursing work environment and staffing on missed breastfeeding care.

RESULTS

There were 19 486 registered nurses in 444 hospitals. Nearly 3 in 10 (28.2%) nurses reported missing breastfeeding care. In adjusted models, an additional patient per nurse was associated with a 39% increased odds of missed breastfeeding care. Furthermore, 1 standard deviation decrease in the work environment was associated with a 65% increased odds of missed breastfeeding care. In an interaction model, staffing only had a significant impact on missed breastfeeding care in poor work environments.

CONCLUSIONS

We found that the work environment is more fundamental than staffing for ensuring that not only breastfeeding care is not missed but also breastfeeding care is sensitive to nurse staffing. Improvements to the work environment support the provision of breastfeeding care.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Both nurse staffing and the work environment are important for improving breastfeeding rates, but the work environment is foundational.

Associations between paramedics' salutogenic health experience and the intention to stay in the profession: A cross-sectional survey

AIM

To investigate the association between paramedics' salutogenic health and their intentions to stay in their profession.

DESIGN

A cross-sectional survey.

METHODS

Paramedics from eight purposively selected organizations participated in this study (n = 433). The data were collected in 2022 with the Salutogenic Health Indicator Scale and validated single questions that assessed work ability, recovery and self-rated stress. Intention to stay was measured using two questions about the intention to leave prehospital emergency medical service work and leave the nursing sector completely during the next 2 years. Data were analysed using logistic regression and statistical significance tests.

RESULTS

Men had higher mean salutogenic health scores than women. No significant differences in salutogenic health were observed across work experience or occupational groups. Paramedics intending to stay in their profession exhibited higher salutogenic health scores than those intending to leave. In the logistic regression models, increasing levels of salutogenic health and work ability were associated with intention to stay in the profession.

Differences in shift and work-related patterns between metropolitan and regional/rural healthcare shift workers and the occupational health and safety risks

OBJECTIVES

To explore if there are differences in shift patterns and work-related factors between metropolitan and regional/rural healthcare shift workers and their risk of poor sleep and mental health. Furthermore, explore whether these factors impact on medical errors, workplace and car/near car accidents.

DESIGN

A cross-sectional study.

SETTING

An anonymous online survey of healthcare shift workers in Australia.

PARTICIPANTS

A total of 403 nurses, midwives and paramedics completed the survey.

MAIN OUTCOME MEASURES

Sample characteristics, employment location, shift work-related features, sleep and mental health measurements, workplace accidents, medical errors and car/near car accident post shift.

RESULTS

Regional/rural healthcare shift workers were significantly older, had more years' experience, worked more nights, on-call and hours per week. Those in metropolitan areas took significantly longer (minutes) to travel to work, had higher levels of anxiety, increased risk of shift work disorder, reported significantly more workplace accidents and were more likely to have a car/near car accident when commuting home post shift. Both groups reported ~25% having a medical error in the past year. Workplace accidents were related to more on-call shifts and poor sleep quality. Medical errors were associated with fewer years' experience, more evening shifts and increased stress. Car accidents were associated with metropolitan location and increased depression.

CONCLUSION

Differences in work-related factors between metropolitan and regional/rural healthcare shift workers were observed. Some of these factors contributed to occupational health and safety risks. Further exploration is needed to understand how to reduce occupational health and safety risks, and improve employee and patient safety both in both regional/rural and metropolitan areas.

Sleep and fatigue management strategies: How nurses, midwives and paramedics cope with their shift work schedules-a qualitative study

AIMS

To understand the benefits and challenges of shift work, and the coping strategies used by nurses, midwives and paramedics to manage the impact of shift work on sleep and fatigue from shift work.

DESIGN

A single case study with embedded units.

METHODS

Twenty-seven participants were interviewed exploring their shift work experiences, coping strategies used to improve sleep, and what their recommendations are for improving shift work management. Interviews were completed between November and December 2022.

RESULTS

Participants enjoyed the lifestyle, flexibility and financial rewards offered by working shift work. However, fatigue and sleep deprivation undermined these benefits, as it impacted their ability to enjoy social and family events. There were also concerns of long-term health consequences of shift work and delivery of care. Changes to rostering practices and sleep and shift work education were common recommendations.

CONCLUSION

This study provides insights on how healthcare professionals manage sleep and fatigue due to shift work and the inadequate support. There is absence of adequate policies, processes and training at an organizational, academic and personal level on how to best manage sleep and fatigue when working shift work. Future research is needed to explore how to equip healthcare shift workers with the skills to successfully manage their schedules to mitigate the negative impact that poor sleep and fatigue has on the health and safety of themselves and their patients.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Understanding the specific challenges of shift work and how workers manage their shift work schedules is critical for improving the health and safety of themselves and their patients. This study identified that there is insufficient training regarding sleep and shift work management strategies, potentially leading to occupational health and safety concerns. Further education and training to equip staff with the necessary information, training and guidance to staff on how to reduce fatigue risk is required.

PATIENT OR PUBLIC CONTRIBUTION

This study involved healthcare shift workers in semi-structured interviews. Data gathered from a previous survey that participants were involved in helped shape the interview topics and the study design.

Turnover intention of nurses in public hospitals and its association with quality of working life: a cross-sectional survey in six provinces in China

Objectives

High turnover intention can exacerbate the workforce shortage of nurses. This study aimed to determine the level of turnover intention of public hospital nurses in China and its associated factors.

Methods

A cross-sectional questionnaire survey of 2,863 nurses was conducted in 48 public hospitals across six provinces in mainland China, measuring the sociodemographic (gender, age, marital status, and monthly basic salary) and work characteristics (professional title, workload, night sleep deprivation, and workplace violence) of respondents, their quality of working life (QWL), and turnover intention. Multivariate logistic regression models were established to determine the association between QWL and turnover intention after adjustment for variations of the sociodemographic and work characteristics.

Results

Overall, 42.8% of respondents reported turnover intention. Higher QWL scores (AOR = 0.824 for job and career satisfaction, p < 0.001; AOR = 0.894 for professional pride, p < 0.001; AOR = 0.911 for balance between work and family, p < 0.05) were associated with lower turnover intention. Workplace violence was the strongest predictor of higher turnover intention (AOR = 3.003-4.767) amongst the sociodemographic and work characteristics, followed by an age between 30 and 40 years (AOR = 1.457 relative to <30 years), and night sleep deprivation (AOR = 1.391-1.808). Senior professional title had a protective effect (AOR = 0.417 relative to no title) on turnover intention.

Conclusion

High levels of turnover intention are evident across China in nurses employed by public hospitals, in particular in those aged between 30 and 40 years. Low QWL and poor work environment are significant predictors of turnover intention.

Internationally recruited nurses and their initial integration into the healthcare workforce: A mixed methods study

Background

Nursing deficits are growing, and healthcare providers in developed countries must address the challenges of ethically building a sustainable workforce without a continued excessive reliance on overseas recruitment. To secure this, a focus on long-term retention of international recruits is paramount.

Objective

To explore the migration motivations and experiences of initial integration for internationally recruited nurses within the healthcare system (England).

Design

A mixed methods survey.

Settings and participants

655 internationally recruited nurses who had recently commenced work in England completed the survey.

Methods

qualitative and quantitative data was gathered to explore internationally recruited nurses' demographics and professional backgrounds, migration motivations, application processes, arrival and settlement and initial experiences of integration into the workforce alongside their support and future aspirations.

Results

The quantitative results revealed a population of international nurses that were highly educated and vastly experienced, with career development and desires to improve quality of life being the primary motivations for migration. Participants indicated a perception of being well supported during initial application and arrival stage, however, did experience some degree of challenge during workplace integration involving fluctuating levels of support and appointments into positions that did not match their years of experience and previous qualifications. This data was reinforced further detailed by the qualitative feedback that illuminated the difficulties nurses can face during initial arrival and integration and the apparent impact on mental well-being.

Conclusion

This paper, contextualised with an international literature base verifying the experiences of internationally recruited nurses, argues that it is the consistent responsibility of employers in developed countries to protect the experiences of international recruits. This can be done by investing in solutions as a key retention strategy.

Emotional intelligence as a predictor of job satisfaction: the mediating role of conflict management in nurses

Background

Emotional Intelligence (EI) has emerged as a pivotal factor in work effectiveness and well-being within the healthcare domain. Specifically, its significance is heightened in the nursing sector, where emotional and social demands are high. Additionally, job satisfaction and conflict management are recognized as vital predictors of patient care service quality. However, there is a dearth of research addressing the mediating role of conflict management in the relationship between EI and job satisfaction within a nursing context.

Objective

This study aims to assess the mediating role of conflict management in the relationship between emotional intelligence and job satisfaction among nurses.

Methods

The STROBE checklist for cross-sectional studies was followed. A cross-sectional and explanatory design was employed. Data were collected using self-reported questionnaires to measure emotional intelligence, conflict management, and job satisfaction. Structural Equation Modeling (SEM) was conducted to test the proposed hypotheses.

Results

A total of 208 nurses aged between 18 and 65 years participated (M = 41.18, SD = 8.942). The findings confirmed a positive relationship between emotional intelligence and conflict management (β = 0.64, p < 0.001). Similarly, a positive relationship between conflict management and job satisfaction was observed (β = 0.37, p < 0.001). Moreover, conflict management was validated as a mediator in the relationship between emotional intelligence and job satisfaction (β = 0.77, p = 0.002).

Conclusion

The study underscores the importance of emotional intelligence and conflict management as predictors of job satisfaction in nurses. The results suggest that interventions aimed at enhancing emotional intelligence might be an effective avenue for increasing job satisfaction, especially when conflict management strategies are integrated.

The Nursing Work Environment, Supervisory Support, Nurse Characteristics, and Burnout as Predictors of Intent to Stay among Hospital Nurses in the Republic of Korea: A Path Analysis

This study aimed to examine the comprehensive impact of five aspects of the nursing work environment as well as supervisory support, nurse characteristics, and burnout on intent to stay (ITS) among Korean hospital nurses. A cross-sectional questionnaire was distributed in seven general hospitals from May to July of 2019. Data were collected from a sample of 631 Korean nurses. The hypothesized model was evaluated using the STATA program for path models. Findings demonstrated that burnout played a mediating role on the relationships between the nursing work environment, supervisory support, nurse characteristics, and ITS. Burnout was the most influential predictor of ITS (β = -0.36, p < 0.001). Nurse participation in hospital affairs (β = 0.10, p = 0.044) and collegial nurse-physician relationships (β = 0.08, p = 0.038) had a direct effect on ITS. Supervisory support had a significant direct effect on ITS (β = 0.19, p < 0.001). Therefore, to increase nurses' ITS, it is necessary to improve their participation in hospital affairs and collegial relationships, as well as strengthen support from supervisors and reduce burnout.