Intention to response, emergency preparedness and intention to leave among nurses during COVID-19

Determinants of intention to leave among nurses and physicians in a hospital setting during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The global outbreak of COVID-19 has brought to light the profound impact that large-scale disease outbreaks can have on healthcare systems and the dedicated professionals who serve within them. It becomes increasingly important to explore strategies for retaining nurses and physicians within hospital settings during such challenging times. This paper aims to investigate the determinants of retention among nurses and physicians during the COVID-19 pandemic.

METHOD

A systematic review of other potential determinants impacting retention rates during the pandemic was carried out. Secondly, a meta-analysis on the prevalence of intention to leave for nurses and physicians during the COVID-19 pandemic.

FINDINGS

A comprehensive search was performed within four electronic databases on March 17 2023. Fifty-five papers were included in the systematic review, whereas thirty-three papers fulfilled the eligibility criteria for the meta-analysis. The systematic review resulted in six themes of determinants impacting intention to leave: personal characteristics, job demands, employment services, working conditions, work relationships, and organisational culture. The main determinants impacting the intention to leave are the fear of COVID-19, age, experience, burnout symptoms and support. Meta-analysis showed a prevalence of intent to leave the current job of 38% for nurses (95% CI: 26%-51%) and 29% for physicians (95% CI: 21%-39%), whereas intention to leave the profession for nurses 28% (95% CI: 21%-34%) and 24% for physicians (95% CI: 23%-25%).

CONCLUSION

The findings of this paper showed the critical need for hospital managers to address the concerning increase in nurses' and physicians' intentions to leave during the COVID-19 pandemic. This intention to leave is affected by a complex conjunction of multiple determinants, including the fear of COVID-19 and the confidence in and availability of personal protective equipment. Moreover, individual factors like age, experience, burnout symptoms, and support are maintained in this review. Understanding the influence of determinants on retention during the COVID-19 pandemic offers an opportunity to formulate prospective strategies for retaining nurses and physicians within hospital settings.

The evolution of professional identity in intensive care nurses during COVID-19 - An interpretive phenomenological study

OBJECTIVES

This study explored the meaning behind professional identity in intensive care nurses who cared for patients with COVID-19.

RESEARCH METHODOLOGY/DESIGN

The exploration was conducted using a qualitative interpretive phenomenological approach with guidance from hermeneutics.

SETTING

Semi-structured audiovisual interviews were conducted with intensive care unit nurses (n = 20) throughout the United States of America, spanning nurse experiences of caring for patients with COVID-19 between 2019 and 2022.

OUTCOME MEASURE

Outcome measures were codes and themes which emerged from data using Benner's interpretive phenomenology method for nursing and Heidegger's hermeneutic circle.

FINDINGS

Four critical findings of this study were the themes a) Keep Them Alive, b) We Are Survivors, c) I Am An Intensive Care Unit Nurse, and d) I Was Meant For This.

CONCLUSION

Findings suggest that professional identity is evolving for nurses as they care for patients in the intensive care and that evolution affects nursing professionals' quality of life.

IMPLICATIONS FOR CLINICAL PRACTICE

The findings of this study have important implications for nursing practice. These themes highlight intensive care nurses' deep commitment and strong professional identity, which can positively impact nurse retention and foster a sense of purpose and fulfillment. Understanding the meaning attached to nurses' experiences can allow nurse leaders and mentors to enhance their roles and aid in the preparation of future intensive care nurses, helping future nurses find focus and satisfaction in their professional identities. Recognizing and nurturing nurses' strong professional identity may positively impact nurse retention and fulfillment. To achieve this, nurse leaders must comprehend and support nurses' experiences, cultivating an environment that empowers these caregivers to thrive and make a lasting impact on patient care.

Quality of life and emergency preparedness of MHO staff: role of psychological capital and perceived organizational support

PURPOSE

Enhancing the initiative and enthusiasm of emergency preparedness behaviors among Medical and Health Organization (MHO) staff is an effective measure to prevent and reduce losses from emergencies. In this study, emergency preparedness behavioral intentions were divided into noncooperative behavioral intentions (EPNCBI) and cooperative behavioral intentions (EPCBI) to discuss the impact brought by quality of life (QoL). The mediating effects of psychological capital (PsyCap) and perceived organizational support (POS) were also considered.

DESIGN/METHODOLOGY/APPROACH

A web-based questionnaire was used for MHO staff in China, and a structural equation analysis of the data collected from 243 participants was conducted to test the hypotheses.

FINDINGS

The empirical results reveal that: (1) QoL had a positive effect on EPNCBI, PsyCap and POS; (2) PsyCap had a positive effect on EPNCBI and EPCBI; (3) POS had a positive effect on PsyCap and EPCBI; (4) PsyCap mediated the relationship between QoL and EPNCBI, and the relationship between POS and EPNCBI; (5) PsyCap and POS mediated the relationship between QoL and EPCBI.

PRACTICAL IMPLICATIONS

Improving MHO staff's QoL is an effective way to enhance positive behavioral outcomes. Furthermore, these findings could provide managers with valuable insight focusing their limited resources on enhancing the emergency preparedness of MHO staff by reinforcing the level of PsyCap and POS.

ORIGINALITY/VALUE

This study provides important updated considerations for the application of positive psychology in the field of emergency preparedness.

Factors affecting Iranian nurses' intention to leave or stay in the profession during the COVID-19 pandemic

AIM

This study was conducted to explore the factors affecting nurses' intentions to leave or stay in their profession during the coronavirus pandemic in Iran.

INTRODUCTION

Because the effectiveness of a healthcare response to a disaster depends on an available, skilled, and motivated healthcare workforce, it is essential to understand and address potential barriers to and reasons for the intentions of medical staff to leave or stay in their profession.

METHODS

A qualitative study with a conventional content analysis approach was conducted. The participants included nurses working in hospitals during the COVID-19 pandemic, and nurses who had previously left their job or had been absent from work for a period of time. The participants were selected using a purposeful sampling strategy. Data were collected through 19 in-depth, individual semi-structured interviews with 16 nurses. The COnsolidated criteria for REporting Qualitative research checklist was used to report the study.

FINDINGS

Three categories; commitment and work conscience (with a subcategory of risk-taking), fear (with two subcategories of fear of family infection and fear of protective equipment shortages), and organizational factors (with two subcategories of organizational atmosphere of the hospital and motivational factors), emerged from the analysis.

CONCLUSION

The reasons for quitting a nursing job or to keep working as a nurse during the pandemic include both personal and organizational factors. Commitment and work conscience in pandemic conditions is one of the main factors for keeping nurses in their profession.

IMPLICATION FOR NURSING PRACTICE AND POLICY

Gaining insight into nurses' understanding of the situation and perspectives is the key to being able to provide appropriate support and keep them in the workforce. Peer support can play an important role in supporting novice nurses in facing challenges posed by a pandemic and should be improved. Also, programs and strategies need to be planned to improve resilience among nurses and to help them to manage their stress and fear.

Do Contextual and Demographic Factors Help Malaysian Nurses Prepare in Dealing with the COVID-19 Pandemic?

As of 11 October 2020, Sabah comprised a quarter of all COVID19 cases reported in Malaysia since the start of the pandemic last January 2020. In this pandemic, nurses serve in vital roles to mitigate the effects of COVID-19. This study aims to explore the nurses’ preparedness in managing the COVID-19 outbreak situation in Sabah, Malaysia, examining the contextual (e.g., participated in an actual major disaster event) and demographic factors (e.g., age and working experience that may influence nurses’ preparedness for managing the COVID-19 pandemic). A total of 317 nurses in Sabah, Malaysia were involved in this study. The Emergency Preparedness Information Questionnaire (EPIQ) contained 41 items and was used to assess civilian nurses’ perceived familiarity with 9 competency dimensions of preparedness. The mean scores of nurses’ preparedness indicated a moderate level of nurses’ preparedness in managing the COVID-19 pandemic (mean ranging from 2.89 to 3.79). The results indicated that there was a significant difference between the nurses who actively participate in an actual major disaster event and who were not active in a total of preparedness and all dimensions (t = 2.79, df = 285, p = 0.006) (except in familiarity with decontamination and familiarity with special populations), across working experience (F(2,291) = 5.09, p = 0.007) (except familiarity with Incident Command System and role), and age among nurses ((F(3,290) = 2.68, p = 0.047)) (total of preparedness, familiarity with ethical issues in triage, epidemiology, and surveillance, and psychological issues). Overall, this study has made a significant theoretical contribution, as well as in clinical implications in the field of nursing practice, by addressing the impact of contextual and demographic factors on nurses’ preparedness in managing the COVID-19 outbreak situation. This study will help nurses to understand the skills, abilities, knowledge, and actions needed to respond, mitigate, and prepare for emergencies during pandemics and disasters.

TURNOVER INTENTION AND CORONAPHOBIA AMONG FRONTLINE NURSES DURING THE SECOND SURGE OF COVID-19: THE MEDIATING ROLE OF SOCIAL SUPPORT AND COPING SKILLS

BACKGROUND

Turnover among frontline healthcare workers, particularly nurses, reached an alarming rate during the COVID-19 pandemic. This turnover has been attributed, in part, to excessive fear of the virus (a condition called coronaphobia). Studies have not yet been conducted examining whether social support and coping skills could act as buffers between coronaphobia and the intention to leave.

AIM

To examine the relationship between coronaphobia and frontline nurses' organizational and professional turnover intention and to assess whether social support and coping skills can buffer this relationship.

METHODS

A correlational research design was used to collect responses through an online questionnaire from a convenience sample of 687 frontline nurses from the Central Philippines. Data was analysed using descriptive (mean, standard deviation, percentages) and inferential statistics (t - test, Pearson r correlation coefficient, ANOVA, and multiple linear regression).

RESULTS

More than half of the frontline nurses experienced coronaphobia, while 25.8% reported a desire to leave their job and 20.7% reported a desire to leave their profession. Coronaphobia had direct significant effects on nurses' organizational (β=.424, p<.001) and professional turnover intention (β=.316, p<.001). Social support and coping skills partially mediated the relationship between organizational (β=.365, p<.001; β=.362, p<.001) and professional turnover intention (β=.279, p<.001; β=.289, p<.001).

CONCLUSION

Frontline nurses who experienced coronaphobia were more likely to quit their job and the nursing profession. Increasing nurses' social support and enhancing their coping skills reduced the negative effects of coronaphobia, resulting in improved nurse retention.

IMPLICATIONS FOR NURSING MANAGEMENT

Institutional approaches to reduce coronaphobia and turnover intention during the pandemic can be facilitated by improving social support through innovative approaches (e.g., use of technology, social media) and equipping nurses with positive coping skills through coping skills training and other empirically based coping skill-building interventions.

Impact of COVID-19 in nursing professionals: systematic review and meta-analysis

Abstract Nursing work is in increasing demand, becoming strenuous especially during the COVID-19 pandemic. Thus, the objective of the study was to assess the impacts of the COVID-19 pandemic on the health of nursing professionals through a systematic review of the literature with meta-analysis, including studies published in 2020 in Web of Science, PubMed and SciELO. Regarding the systematic review, we included 25 studies with a cross-sectional design, from 12 countries. The participants were mostly nurses or nursing teams. Mental impacts such as anxiety, depression, discouragement and a feeling of obligation to work were frequently reported by study participants. The meta-analyses included psychological distress variables, and no association was found between psychological distress and being a frontline healthcare professional (OR 0.94; 95% CI 0.33-2.67). The mental health of nursing professionals has been negatively impacted by the Covid-19 pandemic. The main symptoms presented were anxiety, depression and discouragement, and many nurses felt obliged to work on the front lines of the fight against the pandemic; although they suffer emotional impacts and work overload in health services.

Appetite loss, death anxiety and medical coping modes in COVID-19 patients: a cross-sectional study

AIM

This study aims to explore the current level and associated factors of appetite and death anxiety amongst COVID-19 patients and also to identify correlation between the two variables.

DESIGN

A cross-sectional study.

METHODS

Demographic and characteristic questionnaires, templer death anxiety scale, council on nutrition of appetite questionnaire and medical coping modes questionnaire were utilized.

RESULTS

The average scores of appetite and death anxiety were 19.46 (4.09) and 6.58, (3.21) respectively. 76 patients (100%) suffered from appetite loss, whilst 27 (35.50%) patients suffered from severe death anxiety. Marital status, COVID-19 disease condition ranks, educational level and death anxiety were explained 55.20% of the total variance in the appetite regression model (F = 31.83, p < .001), whilst the gender, avoidance coping strategy and appetite level were explained 49.80% of the total variance in death anxiety model (F = 17.80, p < .001). A moderate negative correlation between appetite and death anxiety was also confirmed (r=-.55, p < .001).

Frontline nurses' willingness to work during the COVID-19 pandemic: A mixed-methods study

AIM

Frontline nurses' willingness to work has significant implications for maintaining workforce stability and quality of care during the COVID-19 pandemic; however, few studies have investigated their willingness and the corresponding reasons. This study aims to examine frontline nurses' willingness to work, identify its predictors and explore its corresponding reasons.

DESIGN

A mixed-methods design was conducted.

METHODS

Based on a multilevel behavioural-diagnostic model, a questionnaire survey was used to collect quantitative and qualitative data concurrently from 13 February to 24 February 2020 to explore frontline nurses' willingness to work and the corresponding reasons in two hospitals in Wuhan, China. One was a designated hospital which only received COVID-19 patients, and the other was built up temporarily for COVID-19 patients.

RESULTS

Of the 2014 participants, most (n = 1950, 96.8%) indicated their willingness to work, and a few (n = 64, 3.2%) expressed their unwillingness. Binary logistic regression analysis identified five predictors of participants' willingness to work, including monthly family income, average working hours per shift, belief in their colleagues' preparedness, belief in their hospitals' preparedness and levels of depression. These indicators explained 27% of the variance (p < .05). Frontline nurses' willingness to work mainly arose from professional commitment, patriotism and faith, while unwillingness to do so primarily stemmed from safety concerns and family responsibility.

CONCLUSION

Most frontline nurses were willing to work and showed great professional commitment.

IMPACT

Professional commitment and patriotism were two important individual-level factors affecting frontline nurses' willingness to work during a pandemic. Strategies should be implemented, such as appreciating and acknowledging their contribution, rewarding their valuable work, arranging reasonable working hours, enhancing colleagues' and hospitals' preparedness, and providing emotional support. Moreover, adequate personal protective equipment, self-protection training and social support should be ensured to address frontline nurses' safety concerns and family responsibility.

Influence of caring for COVID-19 patients on nurse's turnover, work satisfaction and quality of care

Aim

This study aims to examine, through the lens of the Job Demands‐Resources model, the influence of caring for COVID‐19 patients on nurse's perception of chronic fatigue, quality of care, satisfaction at work and intention to leave their organisation and the profession.

Background

Studies have examined how fear of COVID‐19 contributes to the mental, physical and work adjustment among nurses. To date, few studies have been conducted examining how caring for patients with COVID‐19 contributes to work outcomes among nurses.

Methods

This is a cross‐sectional survey involving 1705 frontline nurses and licensed practical nurses in Quebec, Canada. From these, 782 reported caring for COVID‐19 patients.

Results

High chronic fatigue, poor quality of care, lower work satisfaction and higher intention to leave their organisation were found for nurses caring for COVID‐19 patients. Poorly prepared and overwhelmed nurses showed higher turnover intention than those well prepared and in control.

Conclusions

There is an urgent need to provide support to nurses during the pandemic, with a long‐term strategy to increase their retention.

Implications for Nursing Management

Nurse administrators play an important role in supporting their nurses during a pandemic in the form of education, training and policy development to positively impact quality of care and retention.

Barriers and Facilitators of Nurses' and Physicians' Willingness to Work during a Respiratory Disease Outbreak: A Mixed-Methods Systematic Review

This review was undertaken to identify the perceived barriers and facilitators of nurses’ and physicians’ willingness to work during a respiratory disease outbreak. This mixed-methods systematic review involved the extraction of data from the electronic databases PubMed, Web of Science, CINAHL, and PsycINFO and from a manual search of articles published between 2003 and April 2021. The quality of the included studies was assessed using a mixed-method appraisal tool. A total of 29 studies were eligible for inclusion: 21 quantitative and 8 qualitative. Using the Integrated Behavioral Model, perceived barriers and facilitators were identified under seven categories: demographics, attitude, perceived norm, personal agency, knowledge and skills to perform the behavior, environmental constraints, and habit. The results of this study broaden the understanding of various factors that affect nurses’ and physicians’ willingness to work during a respiratory disease outbreak. These findings will facilitate the modification of current pandemic workplace staffing strategies and practices and will inform preparedness planning for similar situations in the future.

Intention to Care for COVID-19 Patients Among Nurses Working at Health Care Institutions of Debre Tabor Town, North Central Ethiopia

Background

Coronavirus disease 2019 (COVID-19) has caused many challenges for health care providers. Nurses meet patients with coronavirus disease and offer care for newly communicable diseases. Despite global and national efforts to prevent the spread, the outbreak is still on a rise, and studies on the health care behaviors of nurses were scarce in the study setting. Therefore, this study was intended in addressing nurses’ intention to care for coronavirus disease 19 patients and its determinants among nurses working at Debre Tabor town Health Care Institutions, 2020.

Methodology

An institutional-based cross-sectional study was conducted among 163 nurses working at health care institutions of Debre Tabor Town, from June 01 to 15/2020. The data were collected using tools with a self-administration questionnaire adapted from the theory of planned behavior and different kinds of literatures. All nurses working at Debre Tabor health care institutions were included. Data were entered using Epi-data 4.2.0.0 statistical software, and analysis was done by Stata version 14 statistical software. Binary logistic regression model was used for analysis. Strength of association was measured using the odds ratio with 95% CI, and the level of significance was estimated at P-value ≤0.05.

Results

Nurses’ intention to care for COVID-19 patient was 59.5% (95% CI; 58.7:60.3). Having better working experience (adjusted odds ratio (AOR) =2.3:95% CI; 1.120, 4.910), caring experience for infectious disease (AOR=2.5; 95% CI: 1.10, 5.50), good perceived behavioral control (AOR=2.33; 95% CI: 1.13, 4.8), and subjective norms (AOR= 2.14; 95% CI: 1.05, 4.36) were significantly associated with intention of caring behavior.

Conclusion

Nurses’ intention to care for COVID-19 patients was low. Working experience, the experience of caring for infectious disease, self-efficacy, and subjective norm were independently related with nurses’ caring intention. The government should work on improving nurse’s confidence in disaster management, design disaster management nursing education, and frequent support of nurses.

Nurses' Preparedness, Readiness, and Anxiety in Managing COVID-19 Pandemic

Nurses' preparedness has been very important for them to treat patients effectively during the COVID-19 pandemic and serve the community. Nurses provide a vital role in mitigating the effects of health crises. In order to help nurses better understand their skills, abilities, and knowledge, as well as the actions that they should take to manage care, the research aims of this study are to (1) investigate the level of preparedness, readiness, and anxiety among nurses during the COVID-19 outbreak in Sabah, Malaysia; (2) examine the effects of various differences in preparedness and readiness among nurses; and (3) examine the effect of COVID-19 preparedness on anxiety among nurses. The results revealed that the nurses were moderately competent in managing the COVID-19 care situation. Each of the 3 differentiating characteristics (age, work experience, and previous disaster experience) did not predict how nurses would manage COVID-19 preparedness significantly. Besides, we also found only 2 dimensions of preparedness (familiarity with epidemiology and surveillance and familiarity with psychological issues) significantly predicted nurses' anxiety levels. Familiarity with epidemiology and surveillance predicted nurses' anxiety positively; in contrast, familiarity with psychological issues negatively influenced nurses' anxiety.

Disaster preparedness among nurses of developing countries: An integrative review

BACKGROUND

Nurse preparedness and prompt response are essential to save lives and reduce the consequences of disasters and emerging pandemics. This paper aimed to synthesize the available evidence that demonstrates the adequacy on disaster preparedness among nurses in developing countries.

METHODS

Five stages of the integrative review approach were employed. Seventeen articles from 2010 to 2019 were selected using different databases after a quality appraisal performed by two researchers independently. The findings were summarized and synthesized based on the themes concerning disaster preparedness among nurses.

RESULTS

The major themes emerged were disaster knowledge and perceived self-preparedness. Nurses were found to have a weak-to-average or a low-to-moderate level of disaster preparedness based on their knowledge and perception. Education and training were discovered to be vital factors, often requiring a variety of strategies, for the enhancement of the nurses' preparedness level.

CONCLUSION

This review concludes that nurses in developing countries remain inadequately prepared on all domains of disaster nursing competencies. Therefore, providing well-designed disaster nursing educational packages, training manuals, and support to attend disaster drills or partake in actual disaster events are essential to the enhancement of disaster preparedness and the retention of relevant skills among nurses in all sectors.

Intention to response, emergency preparedness and intention to leave among nurses during COVID-19

AIM

To comprehensively assess the current level and identify associated factors of intention to response and emergency preparedness of clinical nurses during COVID-19 outbreak.

DESIGN

A cross-sectional study was designed.

METHODS

Demographic and characteristic questionnaire, intention to response scale, emergency preparedness scale and a self-designed questionnaire related to effects of events and intention to leave were used in this study.

RESULTS

The mean scores of intention to response and emergency preparedness were 82.00 (SD = 18.17) and 64.99 (SD = 12.94), respectively. Moral consideration, engaged in COVID-19 protection training, had working experience in SARS, and the other eight factors were explained 34.6% of the total model variance in intention to response model (F = 80.05, p < .001). While, the level of IR, whether the pace of work was affected and above three same factors were explained 21.5% of the total model variance (F = 91.05, p < .001). Pathway analysis revealed that moral consideration, intention to leave and impacts on work and life mediate the relationship between EP and IR.