Intention to stay of nurses in current posts in difficult-to-staff areas of Yemen, Jordan, Lebanon and Qatar: a cross-sectional study

The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals

The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.

Growth and challenges of China's nursing workforce from 1998 to 2018: A retrospective data analysis

BACKGROUND

Nurses play a vitally important role in promoting equitable and essential care. China undertook bold reforms in its education and healthcare systems since 1990s. The effect of these reforms on the nursing workforce has not been assessed systematically.

OBJECTIVE

This study aims to assess the changing trends and the underlying challenges of the nursing workforce in Mainland China in the period of 1998-2018.

DESIGN

Retrospective data analysis.

METHODS

Data were acquired from the National Health Statistics Yearbook from 1999 to 2019. Descriptive statistics were used to analyze the nature of the nursing workforce in terms of quantity, quality, and structure. Non-parametric tests were used to compare doctors and nurses in terms of number and work experiences. Global Moran's I index and hotspot analysis were applied to compare the equity in distribution of nurses at national and provincial levels.

RESULTS

From 1998 to 2018, the number of nurses increased from 1.22 to 4.10 million with an average rate of increase of 6.3% per annum. The ratio of doctors to nurses changed from 1: 0.61 to 1: 1.14, reaching 1: 1 in 2013. The main educational level of registered nurses elevated to associated degree (48.9%), and nurses with advanced titles increased at the most rapid rate. In 2018, 60.3% of nurses were younger than 35 years old. The Global Moran's I index ranged from 0.211 to 0.198 (Z > 1.96, P < 0.05). Hotspot analysis showed the distribution of nurses was unequally concentrated in the northern region and with the highest distribution in Beijing.

CONCLUSIONS

Great improvement on the scale and the quality of nursing workforce over the past 20 years has been witnessed in China. However, the shortage of nurses, outflow of younger nurses and the imbalance distribution of nursing workforce among the country are emerging challenges. Plans should not be ignored on continuously cultivating more qualified nurses, retaining younger nurses, attracting nurses to work in rural areas and the northeast region. Tweetable abstract: Numbers of Chinese nurses finally outstrip the number of doctors but do limited educational opportunities limits their contribution to the nation's health? New article in @ijnsjournal.

Recruitment and retention strategies, policies, and their barriers: A narrative review in the Eastern Mediterranean Region

BACKGROUND

Understanding factors affecting recruitment and retention of health workers in rural and remote communities is necessary for proper policy development and the equitable achievement of Universal Health Coverage.

AIM

Review and synthesize the literature on interventions used to retain health workforce in rural and remote areas by low- and middle-income countries (LMICs) in the Eastern Mediterranean Region (EMR).

METHOD

We carried out a narrative review of literature (peer-reviewed and gray) on the distribution and retention of health workers in rural and remote areas in the LMICs of the EMR. Out of the 130 retrieved articles, 21 met the inclusion criteria and were studied using WHO's Global Recommendations For Increasing Access To Health Workers In Remote And Rural Areas Through Improved Retention (education, regulation, financial, and personal/professional) as the analytical framework for extractions.

RESULTS

There is a dearth of literature on retention in rural areas in the EMR and a complete absence of evaluation studies for implemented intervention. Various LMICs in the EMR have implemented interventions across one or more of the WHO four categories, especially educational and regulatory interventions. Limitations in the number and quality of published studies, fragmented data, over-representation of certain cadres in research and policies, and poor governance were chief barriers to the design, implementation, and evaluation of health workforce retention policies in rural and remote areas. The main challenges for EMR countries are in policy implementation and evaluation. Strengthening data governance and health information systems would improve evidence-based policies and enhance retention in rural and remote areas.

CONCLUSIONS

There is a need for a focused research agenda supported by regional collaboration to guide policymakers on factors, challenges, and best practices that need to be considered for improving the distribution and retention of the health workforce by cadre, gender, and region.

Nurses' willingness to work with COVID-19 patients: The role of knowledge and attitude

Aim

This study aims to assess the role of nurses’ knowledge and attitude in relation to their willingness to work with patients diagnosed with COVID‐19 in Qatar.

Design

A cross‐sectional study.

Methods

A self‐administered, 35‐item online survey was circulated to the Registered Nurses working in Hamad Medical Corporation, the principal healthcare provider in Qatar.

Results

A total of 580 attempts to complete the survey. Of them, 377 completed surveys with a response rate of 65%. Logistic regression was used to predict nurses’ willingness to work with patients with COVID‐19. Nurses’ knowledge level and monetary compensation that is associated with the work‐environment risk category were found to have a significant positive relationship with the nurses’ willingness to care for patients with COVID‐19 (p < .05). The findings of this study may help nursing leaders design educational programmes and remuneration models that may help boost nurses’ willingness to work with high‐risk patient groups, especially during a pandemic.

Understanding International Immobility through Internal Migration: “Left behind” Nurses in the Philippines

Migration scholars have tended to portray internal mobility as a step toward broader cross-border movement, reinforcing the notion of ongoing progress toward international migration. This article argues for a need to recognize how internal mobility can also explain international immobility, or why people do not move across national borders. Using the case of Filipino nurses, we argue that while internal migration does allow aspiring migrants to build the potential ability to emigrate, individual trajectories are much more diverse and multi-directional, often prolonging or reinforcing their international immobility. As a result, and in our case study, the costs and burdens of constant internal movement can also alter nurses’ migration aspirations, prompting them to either alter their original goals or acquiesce to their inability to leave their origin countries. This article calls for migration scholarship to address not only a “mobility bias” within the field but also the over-focus on international migration, rather than internal mobility, as a subject of study.

Content Validation of the Arabic Translation of the Practice Environment Scale of the Nursing Work Index-Revised

BACKGROUND AND PURPOSE

There is no reliable and valid version of the Practice Environment Scale of the Nursing Work Index-Revised (PES-NWI-R) in Arabic. The purpose of this study was to describe the systematic instrument translation and validation of the PES-NWI-R.

METHODS

Using the Content Validity Indexing-based approach, 32 expert nurses from four countries in the Eastern Mediterranean Region (Jordan, Oman, Saudi Arabia, and United Arab Emirates) participated in the validation of this translation.

RESULTS

The content validity index score of the overall scale was excellent (0.87 for the relevancy, and 0.95 for the quality of Arabic translation).

CONCLUSION

Our study supported the content validity of the Arabic version of the instrument which provided the first valid Arabic translation of the instrument.

Intention to leave and associated factors among psychiatric nurses in China: A nationwide cross-sectional study

BACKGROUND

The retention of psychiatric nurses is an important concern for healthcare administrators in China. However, Chinese psychiatric nurses' intention to leave their jobs and the factors associated with it have been scarcely studied.

OBJECTIVE

To investigate Chinese psychiatric nurses' intention to leave their jobs, and to explore the associations between the intention to leave and individual characteristics, job-related factors and job satisfaction.

DESIGN

A cross-sectional, anonymous survey of a nationwide sample was conducted.

SETTINGS

Thirty-two tertiary psychiatric hospitals in 29 provincial capital cities in China.

PARTICIPANTS

All 9907 nurses in 32 hospitals were targeted for this survey conducted in December 2017; 8493 responded (response rate = 85.7%), and 7933 (without logic errors in the data) were included in the analysis.

METHODS

A questionnaire was used to investigate the respondent's intention to leave their job and to collect data on related factors, including individual characteristics (gender, age, marital status, educational background and self-rated health), job-related factors (professional title, working years, income, work hours, history of patient-initiated violence, perceived respect from patients, social recognition as well as physician-nurse coordination and trust) and job satisfaction. The short version of the Minnesota Satisfaction Questionnaire was used to assess job satisfaction. Chi-square tests and multilevel logistic regression analysis were used to examine associations between an intention to leave and other factors.

RESULTS

Among 7933 respondents, 20.2% reported an intention to leave their current jobs. The multiple regression analysis showed that better self-rated health (i.e. OR = 0.373, 95%CI = 0.308-0.452 for good health, reference: poor health), working more than 20 years (OR = 0.479, 95%CI = 0.389-0.590, reference: 20 years or less), higher monthly income (i.e. OR = 0.521, 95%CI = 0.399-0.680 for 6001-8000 RMBs, reference: 4500 RMB or less), perceived patient respect (OR = 0.727, 95%CI = 0.623-0.849), physician-nurse coordination (OR = 0.549, 95%CI = 0.480-0.629) and being satisfied with one's job (OR = 0.373, 95%CI = 0.308-0.452) were negatively associated with an intention to leave; while those who were male (OR = 1.879, 95%CI = 1.605-2.199), working more than 40 hours per week (OR = 1.584, 95%CI = 1.374-1.825) and experienced patient-initiated violence in the past 12 months (OR = 1.566, 95%CI = 1.376-1.781) had a higher odds of reporting an intention to leave.

CONCLUSIONS

Self-rated health, monthly income, work hours, patient-initiated violence, perceived patient respect, physician-nurse coordination and job satisfaction are significant factors associated with a nurse's intention to quit their job. In order to retain nurses in Chinese tertiary psychiatric hospitals, the government and hospital administrators should consider ways to address these factors.

Stress Among Iranian Nurses in Critical Wards

BACKGROUND

Stress has been recognized as a significant psychosocial and physiologic component in educational and practical processes.

OBJECTIVES

The purpose of present study was to survey stress among Iranian nurses in critical wards.

PATIENTS AND METHODS

In this cross-sectional study, 3643 anonymous questionnaires were disseminated among nurses in different hospitals in Tehran, Iran, by utilizing multistage random sampling. The questionnaire consisted of two sections: demographic characteristics and a 22-item list on a five-point Likert scale. The association of variables with stress was evaluated using hierarchical logistic regression.

RESULTS

A total of 3043 completed questionnaires were completed and returned (response rate, 83.53%). Age (> 33 years, 1571 (51.63%); < 33 years old, 1472 (48.37%)), marital status (single, 188 (6.18%); married, 2685 (88.24%); and widow, 170 (5.59%)), working shift (morning, 605 (19.88%); evening, 631 (20.74%); night, 603 (19.82%); and rotation, 1204 (39.57%)), and the years of experience of nurses (1 - 5 years, 413 (13.57%); 6 - 10 years, 589 (19.36%); 11 - 15 years, 832 (27.34%); 16 - 20 years, 758 (24.91%); and 21-25 years, 451 (14.82%)) had significant association with the level of stress (P < 0.05 for all parameters). However, sex (male, 937 (30.79%); and female, 2106 (69.21%)), education (associate, 444 (14.59%); baccalaureate, 2250 (73.94%); and master, 349 (11.47%)), and body mass index (> 24.6 kg/m(2), 2514 (49.75%); and < 24.6 kg/m(2), 1529 (50.25%)) showed no significant association with the level of stress (P > 0.05 for all parameters).

CONCLUSIONS

Considering the personal and background characteristics of personnel and understanding their association with stress and stressful situations encompasses the ability to persevere and adapt to contextual stressors.

Impact of HR retention strategies in healthcare: The case of Qatar

Retention of healthcare workers is an international challenge. The World Health Organization (WHO) warned that in two decades, the shortage of healthcare workers will double. This puts a pressure on the policy makers to come up with serious HR interventions to retain their employees and ensure the delivery of high quality care. In Qatar, the healthcare sector depends greatly on expatriates. This unique characteristic imposes risk on the stability of the healthcare workforce. Therefore, the Qatar National Health Strategy (2011–2016) emphasises the importance of exercising effective HR retention strategies. This review tries to explain the relationship between the retention strategies and employees’ satisfaction and performance and how they impact the quality of care as perceived by patients/clients.

Intent to stay in the nursing profession and associated factors among nurses working in Amhara Regional State Referral Hospitals, Ethiopia

Background

Nurses are essential to the health care delivery system especially to meet the health related millennium development goals. However, despite the significant shortage of nurses in Ethiopia, research in the country regarding nurses’ intent to stay in their profession is lacking. This study assessed intent to stay in the nursing profession and associated factors among nurses working in referral hospitals, Amhara Regional State, Ethiopia.

Methods

Institution-based cross-sectional study was conducted among 389 nurses from April 8 to May 5, 2013. Stratified random sampling technique was used to select the study participants from five referral hospitals. Data were collected using pretested and structured self-administered questionnaires. Descriptive statistics were conducted to summarize the sample characteristics. Backward stepwise logistic regression model was fitted and adjusted odds ratio with 95% confidence interval was calculated to identify associated factors.

Results

The proportion of nurses who reported intent to stay in the nursing profession was 39.8%. Age 40 to 49 (AOR [95% CI] 4.5 [1.6-12.8]), being married (AOR [95% CI] 2.0 [1.0-3.8]), having a bachelor degree in nursing (AOR [95% CI] 2.2 [1.2-4.1]), satisfaction with: autonomy and professional opportunities (AOR [95% CI] 2.6 [1.2-5.9]), scheduling (AOR [95% CI] 3.4 [1.6-7.5]), and pay and benefits (AOR [95% CI] 8.8 [4.5-17.1]); high continuance commitment (AOR [95% CI] 2.4 [1.3-4.8]) and high normative commitment (AOR [95% CI] 3.7 [1.9-7.2]) were the significant predictors of intent to stay in the nursing profession.

Conclusions

Intent to stay in the nursing profession was low among nurses working in Amhara Regional State referral hospitals. Interventions aimed at increasing the professional autonomy of nurses and revising the current salary and other duty payments are vital.

A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon

BACKGROUND

Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon.

METHODS

This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas.

RESULTS

A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to stay were younger, unmarried, with less years of work experience and were not working towards a higher degree. Analysis reveals a directly proportional relationship between nurses' reported job satisfaction and their intent to stay.

CONCLUSION

This study reveals poor retention of nurses in rural and underserved areas in Lebanon, especially in the hospital sector. The status quo is disquieting as it reflects an unstable and dissatisfied nursing workforce. Developing targeted retention strategies for younger nurses and those working in hospitals as well as the offering of professional development opportunities and devising an incentive scheme targeting rural nurses is pivotal to enhance nurses' job satisfaction and retention in rural settings.