Job Demand and Job Satisfaction in Latent Groups of Turnover Intention Among Licensed Nurses in Taiwan Nursing Homes

Moderating role of relationships between workloads, job burnout, turnover intention, and healthcare quality among nurses

BACKGROUND

In Jordan, nurses consider a primary providers of direct patient care, and play a multifaceted role in ensuring healthcare quality. The study aimed to examines the moderating effect of job satisfaction in the relationship between workload and healthcare quality, job burnout and healthcare quality, and turnover intention and healthcare quality.

METHODS

A cross-sectional research approach was adopted among 311 from Registered Nurses (RN) across Jordanian hospitals. Job satisfaction, workload scale and job burnout scale were shared between March and April 2023.

RESULTS

The overall findings indicate that workload, job burnout, and turnover intention are negatively and significantly related to healthcare quality, and that job satisfaction moderates the relationship between workload and healthcare quality, job burnout and healthcare quality, and turnover intention and healthcare quality. These findings have broad implications for healthcare organizations, emphasizing the pivotal role of job satisfaction in mitigating the negative effects of workload, burnout, and turnover intentions among nurses.

CONSULSION

Strategies to enhance job satisfaction, such as reducing work-related stress and fostering supportive work environments, should be prioritized by healthcare policymakers and institutions to ensure the delivery of high-quality patient care.

Patterns of occupational commitment among nurses: a latent profile analysis

Background

Occupational commitment (OC) is a multidimensional construct that predicts turnover intentions. The interindividual variability of nurses' OC merits further exploration. Therefore, this study aims to examine patterns of OC and its relationship with psychological empowerment and job crafting in nurses.

Methods

A sample of 1,061 nurses was recruited from February 2022 to April 2022 by using a stratified four-stage cluster sampling procedure. A self-report survey included the Psychological Empowerment Scale, Job Crafting Scale, and Occupational Commitment Scale. Latent profile analysis (LPA) was used to examine the patterns of OC. Associations of the latent class membership with individual characteristics, psychological empowerment and job crafting were examined using multinomial logistic regression.

Results

Three patterns of OC were identified: (1) "Low OC group" (n = 224, 21.1%); (2) "Moderate OC group" (n = 665, 62.7%); (3) "High OC group" (n = 172, 16.2%). Nurses with higher education, fewer years of service, working in medicine, lower psychological empowerment and lower job crafting had a higher likelihood of belonging to Class 1 (Low OC group). In contrast, nurses working in emergency and with higher psychological empowerment and job crafting were more likely to belong to Class 3 (High OC group).

Conclusion

The findings revealed the heterogeneity of occupational commitment among nurses in China and could guide the identification and early intervention of nurses with low level of occupational commitment.

Personal care workers' intention to stay in residential aged care: An integrative review

AIM

To identify key factors that influence personal care workers' (PCW) intention to stay in residential aged care (RAC).

BACKGROUND

PCWs are the 'backbone' of providing direct care in RAC settings. The well-being of older people hinges upon their dedication and commitment; thus, enhancing their intention to stay is a priority to reduce turnover and ensure continuity of care.

METHODS

Six databases were searched for articles focusing on factors influencing PCWs' intention to stay in RAC. Studies were independently assessed for quality using the Joanna Briggs Institute Methodology for systematic review tools. Reporting of the results followed the PRISMA guidelines.

FINDINGS

Eight articles published between 2010 and 2022 were included. The key issues were categorized as: (a) sociodemographic characteristics; (b) psychological factors; (c) workplace factors and (d) job satisfaction. Older age, being married and immigration status were positively associated with intention to stay. Work stress and burnout contributed towards demotivation, while a supportive and engaging organizational culture that recognized workers' contributions and provided appropriate remuneration and benefits, enhanced job satisfaction and retention.

CONCLUSION

This review affirms the complexity of the decision-making process influencing workers' intention to stay. A comprehensive understanding of the interplay of these factors and the personal and sociocultural challenges faced by PCWs is essential to design strategies to provide support and enhance job satisfaction and retention.

IMPLICATIONS FOR AGED CARE

This review showed that support from the organization is critical in improving PCWs' intention to stay in aged care. Given the interconnectedness of a range of key factors, decision-makers need to address modifiable factors holistically. Including PCWs in planning retention strategies could be the missing link in tailoring interventions towards workforce retention.

IMPACT

Personal, psychological and workplace factors alone and in combination influence personal care workers' intention to stay in residential aged care (RAC). The interrelationships among the factors impacting PCWs' intention to stay are complex, wherein a change in one often influences other factors. Addressing the causes of psychological stress, improving workplace culture and understanding their interrelationships provide a foundation for co-designing strategies to promote intention to stay among PCWs in RAC.

REPORTING METHOD

The authors have adhered to relevant EQUATOR guidelines PRISMA.

NO PATIENT OR PUBLIC CONTRIBUTION

This integrative review is conducted with no involvement or contribution from patients or the public.

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.

Relationship between Experience of Client Violence and Turnover Intention among Workers in Long-Term Care Facilities for Older Adults: Focusing on Nurses, Social Workers, and Care Workers

To prevent discontinuity of long-term care service and guarantee the quality of care, it is important to clarify the determinants of turnover intentions of long-term care workers. They are at a higher risk of experiencing violence—including physical, emotional, and sexual—from patients or their families, possibly leading to high turnover intention. This study aims to verify how having experienced client violence affect turnover intention of long-term care workers and to suggest implications to prevent frequent turnover in long-term care field. Logistic regression analysis was conducted between groups who have experienced client violence and who have not, using 2019 Korean LTC Survey data. Results revealed that, first, there were differences in determinants of turnover intention depending on groups. Second, having experienced client violence had a different effect on turnover intention based on personal characteristics. Third, gender and occupational differences were found. Based on our results, we highlighted the need for discussions on interventions to address client violence exposure among long-term care workers.

Psychosocial Work Environment and Well-Being of Direct-Care Staff Under Different Nursing Home Ownership Types: A Systematic Review

This systematic review investigated the psychosocial work environment and well-being of direct-care staff under different nursing home ownership types. Databases searched: Scopus, Web of Science, Cinahl, and PubMed, 1990-2020. Inclusion criteria: quantitative or mixed-method studies; population: direct-care staff in nursing homes; exposure: for-profit and non-profit ownership; and outcomes: psychosocial work environment and well-being. In total, 3896 articles were screened and 17(n = 12,843 participants) were assessed using the Joanna Briggs Institute Critical Appraisal tools and included in the narrative synthesis. The results were inconsistent, but findings favored non-profit over for-profit settings, for example, regarding leaving intentions, organizational commitment, and stress-related outcomes. There were no clear differences concerning job satisfaction. Job demands were higher in non-profit nursing homes but alleviated by better job resources in one study. The result highlights work environment issues, with regulations concerning for-profit incentives being discussed in terms of staff benefits.

Job satisfaction and wellbeing among migrant care workers in nursing homes: An integrative review

AIM

To systematically analyse and synthesize studies investigating job satisfaction (including turnover and turnover intention) and wellbeing (physical, social and psychological including work stress, acculturation stress and sick leave) among migrant care workers in nursing homes.

DESIGN

An integrated review was conducted.

METHODS

Joanna Briggs Institute's manual guided the analysis of qualitative data (n = 31). Quantitative data (n = 17) were summarized and integrated with the qualitative findings.

RESULTS

Migrants described high job demands, limited control and social support, and stress possibly related to acculturation. Although, compared to natives (born in the country), inconsistent results were reported about wellbeing and job satisfaction, migrant care workers reported enjoying the relational aspects of work and feeling pride when providing care. A satisfying work environment for migrant care workers enables them enjoying working in elderly care with pride.

PUBLIC CONTRIBUTION

Help managers to promote an inclusive working life in line with the United Nations Sustainable Development Goal number 8.

The adaptation of the Nurse Turnover Intention Scale into Turkish: A validity and reliability study

AIM

The aim of this study was to adapt the Nurse Turnover Intention Scale to Turkish and test its validity and reliability.

METHODS

This methodological study was conducted with 200 nurses. The Personal Information Form and the Nurse Turnover Intention Scale were used for data collection between November and December 2021. Language and content validity, explanatory and confirmatory factor analysis, criterion validity, Cronbach's alpha coefficient, item-total score correlation and test-retest reliability methods were used for the validity and reliability analysis of the scale.

RESULTS

Exploratory factor analysis showed that the Nurse Turnover Intention Scale had a single factor. Its single factor structure was confirmed using confirmatory factor analysis. Cronbach's alpha coefficient of the scale was 0.902, and factor loading was between 0.60 and 0.78. Statistical analyses indicated that each item in the Turkish version of the scale had a high internal consistency. The test-retest correlation value was found as p < 0.05.

CONCLUSION

The Nurse Turnover Intention Scale has been confirmed to be a suitable, valid and reliable measurement tool for Turkish society. Nurse turnover intention is the most powerful predictor of actual turnover within the nursing profession. This scale will help to easily attain valid and reliable outcomes.

Nurses’ Work Environment during the COVID-19 Pandemic in a Person-Centred Practice—A Systematic Review

The work environment and especially the psychosocial work environment influence the mental and physical well-being of employees. The aim of this study was to identify and analyse the state of knowledge regarding nurses’ work situation, health, and person-centred work during the COVID-19 pandemic through a systematic review. Methods: Systematic Review, nine included articles. The theoretical swAge model was used as the framework in a deductive content analysis. Results: The result was presented in the nine determinate areas from the swAge model and showed that all nine determinate areas of the swAge model were of importance to both the nurses’ sustainable work situation during the COVID-19 pandemic and to person-centred care. The COVID-19 pandemic has had a negative effect on nurses’ health, both physically but especially psychologically, with high levels of depression, anxiety, and burnout. Nurses experienced a lack of control and support from organizations. They had to work with limited resources and sometimes care for patients beyond their expertise. Conclusion: There is a further need for more studies that address person-centredness from an organisational perspective with the intention to develop strategies and measure activities on how to make the nurses’ work situation more sustainable, and to increase their ability to give more person-centred care.

Nursing home nurses' turnover intention: A systematic review

Aim

This review aimed to examine and describe the published research on nursing home (NH) nurses' turnover intentions in their workplace.

Design

This study is a systematic review following PRISMA guidelines.

Methods

An electronic search was conducted for English and Korean articles to identify research studies published between 2009–2019 using CINAHL, PubMed, Cochrane Library, PsycINFO, RISS, and DBpia.

Results

A total of six studies met the inclusion criteria and revealed NH nurses' turnover intentions. The factors influencing NH nurses' turnover intentions were identified and classified as individual and organizational factors. Among the various factors above, this study found that job satisfaction was the most influential factor in nurses' turnover intentions. Therefore, further efforts are required to increase NH nurses' job satisfaction to decrease turnover intention.

Individual and organizational factors of nurses' job satisfaction in long-term care: A systematic review

BACKGROUND

In long-term care facilities, nurses' job satisfaction predicts staff turnover, which adversely affects resident outcomes. Thus, it is important to develop a comprehensive understanding of factors affecting nurses' job satisfaction in long-term care facilities.

OBJECTIVES

To analyze factors associated with job satisfaction among nurses in nursing homes from individual and organizational perspectives utilizing a deductive approach.

DESIGN

Systematic literature review SETTING: Nursing homes.

PARTICIPANTS

Registered nurses and licensed practical nurses in nursing homes.

METHODS

A systematic literature review of seven online databases (EMBASE, CINAHL, PsychINFO, MEDLINE, PubMed, Scopus, and Web of Science) to July 23, 2020 was conducted. Studies were included if they examined factors associated job satisfaction in the target population and setting. Decision rules on how to determine factors important to nurse job satisfaction were developed a priori. Two team members independently screened the publications for inclusion, extracted data, and assessed included publications for methodological quality; conflicts were resolved through a consensus process and consultation of the third senior team member when needed.

RESULTS

Twenty-eight studies were included. Of these, 20 studies were quantitative, 6 were qualitative, and 2 were mixed methods. Factors associated with job satisfaction were grouped into two categories: individual and organizational. Individual factors significantly associated with job satisfaction were age, health status, self-determination/autonomy, psychological empowerment, job involvement, work exhaustion, and work stress. Individual factors identified as not important or equivocal were gender and experience as a nurse/in aged care. No organizational factors were identified as important for nurses' job satisfaction. Facility ownership, supervisor/manager support, resources, staffing level, and social relationships were identified as equivocal or not important. Findings from qualitative studies identified relationship with residents as an important factor for job satisfaction.

CONCLUSIONS/IMPLICATIONS

Factors identified as important to nurses' job satisfaction differ from those reported among care aides in nursing homes and nurses employed in acute care settings, suggesting that there is a need for unique approaches to enhance nurses' job satisfaction in nursing homes.

Factors Influencing Turnover Intention among Male Nurses in Korea

The study examined predictors of male nurse turnover intention in Korea using data collected from Korean hospitals. The results were obtained based on a secondary analysis of data previously collected from 306 male nurses in 16 regions of Korea from December 2014 to February 2015. Our findings suggest that male nurse turnover intention is predicted by (1) individual factors: single (B = 0.93, p = 0.008); (2) organizational factors: organizational commitment (B = -0.36, p < 0.001), job satisfaction (B = -0.27, p = 0.001), and job stress (B = 0.24, p < 0.001); and (3) social factors: hospital location in medium-categorized cities (B = 0.70, p = 0.012) and kinship responsibility (B = 0.13, p = 0.026). These factors accounted for 56.9% of the total variance. To lower the rate of turnover intention among male nurses, strategic interventions should be implemented based on the factors identified in this study.

Nurses Working in Nursing Homes: A Mediation Model for Work Engagement Based on Job Demands-Resources Theory

This study examined the impact that the attractiveness of working in nursing homes and autonomous clinical judgment have on affective occupational commitment, and whether work engagement mediates these relationships. This analysis was based on the job demands-resources theory. The study setting was 1200 nursing homes (including long-term care welfare facilities and long-term care health facilities) in eastern Japan. An anonymous, self-report questionnaire survey was administered to two nurses from each facility, resulting in a prospective sample of 2400 participants. Overall, 552 questionnaires were analyzed, in which structural equation modeling and mediation analysis using the bootstrap method were performed. The results showed that the attractiveness of working in nursing homes does not directly affect affective occupational commitment; work engagement fully mediates the impact of attractiveness of working in nursing homes on affective occupational commitment. Additionally, autonomous clinical judgment showed a direct impact on both work engagement and affective occupational commitment, indicating that work engagement partially mediates the impact on affective occupational commitment. To increase the affective occupational commitment of nurses working in nursing homes, managers should help nurses recognize the attractiveness of working in nursing homes, and then provide appropriate support to help such nurses work in a motivated manner.

Quality of care in Hunan Province nursing homes: relationship to staffing and organizational climate

Our objective was to examine the quality of care perceived by nursing staff and its relationship with the staffing and organizational climate in nursing homes. The participants in this cross-sectional study included 358 nursing staff from 26 nursing homes in Hunan Province, China. This study found that the interaction effect between nursing staff to resident ratio and physician to resident ratio exerted a significant effect on quality of care (p < 0.05). Higher scores on the relationships and communication scale (OR = 4.771, p = 0.002) and lower scores on the work stress scale (OR = 0.980, p = 0.050) were also associated with better quality of care. More work experience was related to lower quality of care (OR = 0.944, p = 0.048), and work experience was associated with relationships and communication (Beta = 0.172, p = 0.002) and work stress (Beta= = 0.259, p = 0.000). Staffing level, work experience, work stress, relationships and communication are key factors in providing higher quality of care in nursing homes.

Relationships Between Job Satisfaction and Job Demand, Job Control, Social Support, and Depression in Iranian Nurses

BACKGROUND

Nurses often experience a wide variety of stressful situations. Excessive work stress influences the physical and mental health of nurses and decreases their life quality and professional efficacy. In addition, high levels of psychological stress may cause job dissatisfaction and job strain.

PURPOSE

The objective of this study was to explore the relationship between several work-related risk factors and job satisfaction in Iranian nurses.

METHODS

A cross-sectional study was conducted on 730 nurses from four public hospitals in, respectively, northern, southern, eastern, and western Iran. Variables in the job demand-control-support (JDCS) model were measured using the Job Content Questionnaire, and job satisfaction was measured using the Minnesota Satisfaction Questionnaire.

RESULTS

The mean score for job satisfaction was 62.94 ± 14.24, which is considered moderate. Nurses with a low level of job satisfaction had significantly higher psychological and physical job demands (p < .05). Significant relationships were found between job satisfaction and several dimensions of the JDCS model, including psychological job demands (β = -0.11, p < .001), physical job demands (β = -0.86, p = .004), skill discretion (β = 0.48, p = .033), decision authority (β = 0.43, p = .028), and supervisor support (β = 1.85, p = .004). The sociodemographic and JDCS model variables used in this study explained 42% of the variation in job satisfaction (R2 = .42).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Enhancing the job satisfaction of nurses is possible by creating a balance between job demands, job control, and social support.

Staff nurses' evaluation of care process quality and patient outcomes in long-term care hospitals: A cross-sectional questionnaire survey

AIM

Despite the large and growing body of research on quality care evaluation and improvements in long-term care facilities, issues regarding the quality of care provided prevail worldwide. Further and more diverse research related to this topic is urgently required. To that end, this study examines the association between the subjective care process evaluations of nurses and selected patient outcomes in Japanese long-term care hospitals.

METHOD

To conduct a cross-sectional survey, we approached 2,000 long-term care hospitals in Japan, of which 263 (13.2%) completed and returned the questionnaires. We recruited ward managers and all full/part-time nurses in one ward from each hospital. We questioned managers about six patient outcome indicators: prevalence of physical restraint, urinary tract infections, indwelling catheter use, monthly incidence of new pressure ulcers, falls and recreational activities. We examined the nurses' care process evaluations using nine questions pertaining to daily caregiving activities developed from previous qualitative research. We examined the association between the ward averages of the nurses' evaluations and selected patient outcomes using the generalised linear model with a negative binomial distribution, with the exception of recreational activities for which we used a Poisson distribution, controlling for ward size and patient case mix.

RESULTS

We analysed the responses with complete data for outcome indicators from 199 (10.0%) managers and 2,508 nurses. Some patient outcome indicators were significantly associated with the nurses' care process evaluations, namely, urinary tract infections (B = -1.28, p < .001), indwelling catheter use (B = -0.57, p < .049), pressure ulcers (B = -1.20, p < .001) and recreational activities (B = 1.48, p < .001). These results suggest that better patient outcomes were associated with higher care process evaluations.

CONCLUSION

The nurses' evaluations and certain patient outcome indicators were associated. When considering potential quality improvement programmes, focusing on these evaluations will be beneficial.

Related Factors of Turnover Intention Among Pediatric Nurses in Mainland China: A Structural Equation Modeling Analysis

PURPOSE

Pediatric nurses are at high risk for turnover. Turnover intention strongly predicts the actual voluntary turnover. Currently, no nationwide study has examined turnover intention among pediatric nurses in mainland China since the universal two-child policy implementation. Related factors associated with pediatric nurse turnover intention have not yet been identified. This study aims to understand factors related to turnover intention among pediatric nurses in mainland China.

DESIGN AND METHODS

A cross-sectional on-line questionnaire survey was conducted among 6673 pediatric nurses across mainland China. Structural equation modeling (SEM) was used to examine the relationships between job satisfaction, work stress, job burnout, organizational commitment, work-family support and turnover intention.

RESULTS

Six hundred and sixty-three (9.93%) nurses reported high turnover intention. Work stress and job burnout were directly and indirectly associated with turnover intention positively. Job satisfaction was related to turnover intention negatively with both direct effect and indirect effect through the mediations of job burnout and organizational commitment. Organizational commitment had a negative direct effect on turnover intention. Work-family support had indirect effects on turnover intention through the mediating role of burnout, job satisfaction, and organizational commitment.

CONCLUSION

Turnover intention among pediatric nurses was associated with job satisfaction, work stress, job burnout, organizational commitment and work-family support.

PRACTICE IMPLICATIONS

Attention to pediatric nurses' job burnout and work stress is important to improve job satisfaction and organizational commitment and to provide them with support in order to alleviate the turnover intention.

The impact of perceived workload on nurse satisfaction with work-life balance and intention to leave the occupation

BACKGROUND AND AIM

In the drive to make the health sector more economically efficient and effective, what is potentially being lost is the need to look after the well-being of those who work within this profession. Nurses are the largest group in the health sector workforce and the frontline of patient care. Workload perceptions are known to be impacting nurses' well-being and are becoming a critical concern for the retention of this workforce. In response, this study aims to examine the relationships among perceived workload, satisfaction with work-life balance (an indicator of well-being), and intention to leave the occupation. Additionally, high involvement work practices (HIWPs) are examined as a form of organisational support that may buffer the negative impact of perceived workload on nurses' well-being and intention to leave the occupation.

METHOD

A 2016 online survey of the nursing profession in Australia yielded 2984 responses. We assessed the impact of perceived workload on nurses' well-being and intention to leave the occupation, and the role of HIWPs in ameliorating the negative impact of perceived workload.

RESULTS AND CONCLUSION

Our results show that perceived workload is associated with increasing intention to leave the occupation and is mediated by nurses' satisfaction with work-life balance. Where organisational support is provided through HIWPs, this can mitigate such intentions. These aspects are within the control of those who manage this workforce and should be central to human resource management strategies in the health care sector.

Subtypes of overtime work and nurses' fatigue, mental status, and work engagement: A latent class analysis of Japanese hospital nurses

AIMS

To clarify the subgroups of overtime work motivations and to determine how fatigue, mental status, and work engagement differ among the subgroups.

DESIGN

Cross-sectional.

METHODS

Questionnaires were distributed to 1,075 full-time nurses working in four hospitals in Japan from October 2015 - February 2016. Nurses were categorized into subgroups of overtime work motivation by latent class analysis. An analysis of covariance was conducted to examine how fatigue, mental status, and work engagement differ among subgroups.

RESULTS/FINDINGS

We identified five types of overtime workers differing greatly in fatigue, mental status, and work engagement.

CONCLUSIONS

Even when nurses worked approximately the same work hours, the difference in motivation corresponded to different degrees of fatigue, mental status, and work engagement. When introducing policies to reduce overtime work, managers should consider the different groups of overtime workers, as effective measures may differ.

Self-management in liver transplantation

BACKGROUND

Self-management is crucial for liver transplant (LT) recipients to maintain transplants and optimize health outcomes. However, previous literature has been primarily limited to examining medication adherence; there is a knowledge gap regarding self-management in the LT population.

AIM

The aims of this study were to 1) comprehensively describe self-management behaviors and activities in LT recipients, 2) explore levels of overall self-management, and 3) explore the relationships of self-efficacy, cognition, and health information seeking behavior with self-management.

METHODS

Adult LT recipients (n = 113) who had a functioning transplant for at least 6 months participated in this cross-sectional, descriptive study. Participants were asked to identify self-management behaviors and rate their performance of those behaviors, including symptom management and medication adherence. They also completed a cognitive assessment and questionnaires measuring self-efficacy and health information seeking behavior. Descriptive statistics, latent profile analysis, and probit model for path analysis were used for the data analysis.

RESULTS

LT recipients acknowledged engaging in various self-management behaviors including symptom management, physical activity, maintenance of positive attitudes, and communication with healthcare providers. Three levels of self-management (i.e., low, medium, and high) were found; a high level of self-management was related to self-efficacy and health information seeking behavior.

CONCLUSIONS

The findings indicate that self-management may be improved with interventions aimed at increasing self-efficacy and health information seeking behavior. Findings from this study will inform future interventions, to improve self-management and subsequent health outcomes in this population. Future longitudinal studies are necessary to confirm the causality of the identified relationships.

Factors affecting turnover intentions among public hospital doctors in a middle-level city in central China

Objective The aim of the present study was to explore prominent factors affecting turnover intentions among public hospital doctors in urban areas, particularly in Xiangyang City, Hubei Province, a middle-level city in central China. Methods Questionnaires were used to collect data from 284 public hospital doctors. Pearson's Chi-squared was used to assess whether sociodemographic and other factors were related to the turnover intentions of public hospital doctors. Binary logistic regression was performed to determine the significant factors that influence turnover intentions. Results The analysis revealed that 28.2% of public hospital doctors intended to leave the hospital where they were currently employed. Dissatisfaction with working conditions and hospital management processes, as well as work pressures, were significant factors contributing to the turnover intentions of public hospital doctors. Conclusion Research into turnover intentions indicates that public hospital doctors surveyed in urban China give greater weight to their professional environment and career development rather than salary in their employment decisions. What is known about the topic? Turnover of medical staff is a concern to hospital administrators because it is costly and detrimental to organisational performance and quality of care. Most studies have focused on the effects of individual and organisational factors on nurses' intentions to leave their employment. Income dissatisfaction was one of the determining factors of turnover intentions in previous studies. What does this paper add? The satisfaction of public hospital doctors with regard to income is not a determining factor of turnover intentions. In contrast with findings of previous studies, the doctors in public hospitals in urban China in the present study gave greater weight to their professional environment and career development in their employment decisions. What are the implications for practitioners? The findings suggest that health service managers and policy makers should pay greater attention to the factors affecting public hospital doctors' turnover intentions. This study will be useful for optimising public hospital management and minimising the turnover of doctors in China.