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

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.

Status and related factors of professional growth among young nursing talents: a cross-sectional study in China

BACKGROUND

The shortage of nurses has been a global human resources problem. A good professional growth environment is essential to developing potential nursing students and attracting nurses to join, and it has great significance in reducing nurse turnover. However, nurses' comprehensive perceptions of professional growth have not yet been examined.

METHODS

A cluster sampling method was used to conduct a professional growth questionnaire survey on young nursing talents from a large Chinese public tertiary A hospital in March 2022.

RESULTS

The score of professional growth among 243 young nursing talents was 57.92 ± 9.607, with a scoring rate of 77.23%. The scores for dimensions of professional growth, from lowest to highest, were rehabilitation growth, promotion speed, professional goal progress, and professional ability development. Attitudes towards participating in training, service as the quality manager or clinical teacher, self-efficacy, professional title, work-family support, education, and organizational commitment of young nursing talents were significantly associated with professional growth.

CONCLUSION

The professional growth of young nursing talents was at a moderate level and needed to be strengthened. Nursing leaders and managers are expected to develop management practices to enhance young nursing talents' professional growth in combination with the related factors.

The mediating role of organizational commitment between workplace bullying and turnover intention among clinical nurses in China: a cross-sectional study

BACKGROUND

Workplace bullying experienced by clinical nurses is a critical and pervasive issue that not only detrimentally impacts nurses but also poses a significant threat to the overall quality of nursing services and patient care. This study aimed to determine the mediating role of organizational commitment in the relationship between workplace bullying and turnover intention among clinical nurses in China.

METHODS

Participants were recruited from 40 hospitals in various provinces of China from December 2, 2021 to February 25, 2023, using convenience sampling. After obtaining hospital ethical approval and participants' informed consent, clinical nurses (n = 585) from different nursing departments in different hospitals completed the questionnaire. The Socio-demographic Questionnaire, Negative Acts Qestionnaire, Chinese Workers' Organizational Commitment Scale and Turnover Intention Questionnaire were used to collect general demographic data of nurses and assess workplace bullying they experienced, their level of organizational commitment and turnover intention. Descriptive statistics, Pearson correlation analyses and structural equation model were adopted to analyze the data.

RESULTS

Pearson's correlation analysis showed that that workplace bullying was significantly negatively correlated with organizational commitment (r = - 0.512, P<0.01) and significantly positively correlated with turnover intention (r = 0.558, P<0.01), organizational commitment was significantly negatively correlated with turnover intention (r = - 0.539, P<0.01). Mediation analysis indicated organizational commitment partially mediated the association between workplace bullying and turnover intention. The total effect (β = 0.69) of workplace bullying on turnover intention consisted of its direct effect (β = 0.41) and the indirect effect mediated through organizational commitment (β = 0.280), with the mediating effect accounting for 40.58% of the total effect.

CONCLUSION

Organizational commitment mediated the associations of workplace bullying and turnover intention. Therefore, healthcare organizations and nursing managers should develop appropriate strategies to enhance nurses' organizational commitment in order to reduce their turnover intention.

How Nurses' Person-Organization Fit Influences Organizational Loyalty

Background

High turnover rates among nurses are a global concern due to the shortage of skilled professionals and increasing demand for high-quality healthcare. This study aims to enhance understanding of organizational fit by examining the impact of Person-organization fit (P-O fit) on organizational loyalty through the mediating role of organizational support and service quality, and the moderating impact of role ambiguity.

Methods

Using a convenience sampling technique, we employed a survey methodology by developing a questionnaire. Data were collected from a sample of 614 nurses in five different healthcare sectors in China. Employing SmartPLS 3.3, we conducted a Structural Equation Modeling (SEM) analysis to examine the relationships among the specified variables.

Results

The findings of the structural analysis suggest that the P-O fit influences organizational loyalty in the healthcare sector. Organizational support and service quality were identified as partial mediators of the P-O fit-organizational loyalty link. Additionally, the role of ambiguity represented a negative moderating impact between service quality and organizational loyalty.

Discussion

Overall, the study's findings extend the understanding of person-organization fit, organizational support, service quality, role ambiguity, and organizational loyalty in the context of healthcare sectors and offer implications for medical authorities. Discussions, limitations, practical implications, and suggestions for further research are also provided.

The relationships between burnout, general wellbeing, and psychological detachment with turnover intention in Chinese nurses: a cross-sectional study

Background

It is critical to minimize nurse turnover to improve the quality of care and patient safety. In-depth investigation is required to better understand the factors related to nurses' turnover intentions.

Aim

This study aimed to determine the relationships between burnout, general wellbeing, and psychological detachment with turnover intention among nurses in China.

Methods

A cross-sectional survey using convenience sampling was conducted in one hospital in China between January 2023 and March 2023. A total of 536 nurses were surveyed using the General Wellbeing Schedule (GWB), the Maslach Burnout Inventory scale (MBI), the Psychological Detachment scale, and the Turnover Intention scale. The collected data were analyzed using SPSS 26.0 statistical software. The chi-square test and binary logistic regression analysis were used to explore the factors related to turnover intention.

Results

Our data demonstrated that the turnover intention scores were 13 (10, 15.75), with 56% of nurses exhibiting a high level of turnover intention. Binary logistic regression analysis results indicated that being on a contract (OR = 4.385, 95% CI = 2.196-8.754), working in the pediatrics (OR = 2.392, 95% CI = 1.267-4.514) or obstetrics (OR = 2.423, 95% CI = 1.145-5.126) department, and experiencing burnout (OR = 1.024, 95% CI = 1.008-1.041) were associated with a heightened level of turnover intention. Conversely, organizational satisfaction (OR = 0.162, 95% CI = 0.033-0.787) and general wellbeing (OR = 0.967, 95% CI = 0.946-0.989) were identified as factors that hindered the intention to leave.

Conclusions

Findings from this study suggest that nurses were employed on a contract basis, working in pediatric or obstetric departments, expressing dissatisfaction with the organization, reporting low general wellbeing, and experiencing high levels of burnout that require special attention. The identification of these risk factors can inform targeted interventions and support programs aimed at improving the wellbeing and retention of nurses in these settings.

Work engagement, emotional disorders and conflict management styles in paediatric nurse: A mediating effect model

AIM

The mediating role of emotional disorders between conflict management styles and work engagement was explored based on constructing structural equation models in paediatric nurses.

DESIGN

A cross-sectional study.

METHODS

According to a cross-sectional survey, 300 paediatric nurses were selected from three tertiary hospitals (Chang sha, China), the data were collected using demographic questionnaires, the Rahim Organizational Conflict Inventory-II, Depression, Anxiety and Stress Scales and the Utrecht Work Engagement Scale. The Structural Equation Model was employed to investigate the mediating role of emotional disorders between conflict management styles and work engagement.

RESULTS

Among conflict management styles, emotional disorders and work engagement, the associations were all significant (p < .05). In the mediation models, emotional disorders partially mediate the relationships between conflict management styles and work engagement (indirect effect 0.095, p < .01; direct effect -0.330, p < .01; total effect -0.330, p < .01) and between conflict management styles and work engagement (indirect effect 0.095, p < .01; direct effect 0.329, p < .01; total effect 0.424, p < .01).

Factors related to turnover intention among emergency department nurses in China: A nationwide cross-sectional study

BACKGROUND

Turnover intention among nurses is high, especially in the emergency department. However, factors that are associated with Chinese emergency department nurses' turnover intention have been scarcely studied.

AIMS

The present study examined relationships between turnover intention and demographic characteristics, job-related factors, depressive symptoms, and organizational commitment among emergency department nurses.

STUDY DESIGN

A cross-sectional study of emergency department nurses was conducted in China between July and August 2018. The questionnaire included demographic characteristics (age, gender, level of education, and self-rated health status), job-related factors (qualification title, job seniority, night shifts, and workplace violence), depressive symptoms, organizational commitment, and turnover intention. A hierarchical linear regression model was used to identify factors that are associated with turnover intention among emergency department nurses.

RESULTS

A total of 17 582 emergency department nurses participated in the study. The response rate was 68.9%. The findings indicated that poor self-rated health status (β = 0.25, p < .001), working more than 11 night shifts per month (β = 0.14, p < .01), experiencing workplace violence in the past year (β = 0.08, p < .05), and higher depressive symptom scores (β = 0.07, p < .001) positively correlated with turnover intention. More years of service (β = -0.38, p < .001) and higher organizational commitment scores (β = -0.45, p < .001) negatively correlated with turnover intention.

CONCLUSIONS

Health status, job seniority, night shift frequency per month, workplace violence, depressive symptoms, and organizational commitment were significantly associated with emergency department nurses' turnover intention.

RELEVANCE TO CLINICAL PRACTICE

To reduce turnover intention in the emergency department nurses, hospital administrators and managers should implement measures to improve their physical and mental health, increase organizational commitment, develop staff acceptable shift schedules, and reduce incidences of workplace violence.

An Explanatory Model of Work-family Conflict and Resilience as Predictors of Job Satisfaction in Nurses: The Mediating Role of Work Engagement and Communication Skills

BACKGROUND

The Job Demands and Resources (JD-R) model is used to examine predictors of well-being, work engagement, and individual or organizational outcomes. According to the model, work engagement and communication skills play a mediating role between work-family conflict and resilience to job satisfaction in nurses.

METHODS

A cross-sectional study was conducted considering 431 Peruvian nurses of mean age (M = 40.31 years; SD = 10.94) ranging from 22 to 68 years working in public hospitals in the Lima region. Data were collected using a self-reported form of the Job Satisfaction Scale, communication skills, work engagement, work-family conflict, and resilience. The theoretical model was evaluated using structural equation modeling (SEM).

RESULTS

A theoretical model with adequate fit was obtained [χ²(2) = 6.0, P < .001, CFI = 0.995, RMSEA = 0.068, SRMR = 0.015]. Results indicated an inverse relationship between work-family conflict with communication skills (β = -.24, P < .001) and work engagement (β = -.10, P = .003). Likewise, resilience had an influence on communication skills (β = .55, P < .001) and work engagement (β = .33, P < .001). In addition, the model explains 71% of job satisfaction. Also, the results indicate the influence of work-family conflict and resilience through the mediating role of work engagement and work-family conflict on job satisfaction.

CONCLUSIONS

The model confirmed that work engagement and communication skills are valid moderators to mitigate work-family conflict and strengthen resilience that favors job satisfaction in nurses.

Serial multiple mediation of psychological empowerment and job burnout in the relationship between workplace bullying and turnover intention among Chinese novice nurses

AIM

This study aimed to examine the direct and indirect effects of workplace bullying on turnover intention using the serial multiple mediators of psychological empowerment and job burnout.

DESIGN

A cross-sectional study was conducted.

METHODS

A convenience sample of 506 novice nurses from five Triple A hospitals in China's S province from November 2020 to February 2021 and were evaluated using online questionnaires on workplace bullying, psychological empowerment, job burnout, and turnover intention.

RESULTS

The prevalence of turnover intention was 51.9%. In the serial multiple mediator model, workplace bullying had a direct effect (c = 0.452, p < 0.001) and indirect effect (c' = 0.229, p < 0.001) on turnover intention through the serial multiple mediators of psychological empowerment (B = -0.093, p = 0.020) and job burnout (B = 0.127, p < 0.001); hence, the proposed model explained the total variance of 32.2% in turnover intention.

PATIENT OR PUBLIC CONTRIBUTION

Nursing managers should use effective measures for strengthening the psychological empowerment to minimize novice nurse burnout and turnover intention resulting from workplace bullying.

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.

Work stress, burnout, occupational commitment, and social support among Chinese pediatric nurses: A moderated mediation model

PURPOSE

Pediatric nurses are at high risk for burnout, resulting in unsatisfactory care quality. Although job resources like social support can prevent the development of burnout under work stress, the mediating role of personal resources like occupational commitment is not well studied. This study was to examine the mediating role of occupational commitment in the relationship between work stress and burnout, and test if the effect of work stress on occupational commitment varies at different levels of social support among pediatric nurses.

METHODS

A cross-sectional survey was conducted to collect data of pediatric nurses from 6 hospitals in Chengdu, China. Multiple linear regressions and bias-corrected bootstrap confidence intervals were used to test the proposed model.

RESULTS

In this sample of 488 pediatric nurses, work stress was significantly associated with emotional exhaustion (β = 0.278, p < 0.001), depersonalization (β = 0.112, p < 0.001), and personal accomplishment (β = -0.047, p < 0.05). Occupational commitment partly mediated the links of work stress and emotional exhaustion (β = 0.056, 95%CI: 0.034-0.082), and depersonalization (β = 0.026, 95%CI: 0.014-0.041), and fully mediated the relationship between work stress and personal accomplishment (β = -0.059, 95%CI: -0.080 ∼ -0.039). Social support significantly moderated the relationship between work stress and occupational commitment (β = 0.007, p < 0.01).

CONCLUSION

Among pediatric nurses, work stress has an indirect influence on burnout through occupational commitment, and such an effect is weakened when social support is high.

PRACTICE IMPLICATIONS

Nurse managers could consider developing interventions by promoting both occupational commitment and social support to prevent burnout of employees.

Verbal Violence and Turnover Intention Among New Nurses in Korea: A Time-Lagged Survey

AIM

To test a model examining the impact of verbal violence against new nurses on their turnover intention and the mediating effects of emotional reaction and burnout based on affective events theory.

BACKGROUND

In Korea, turnover rate of nurses, especially new nurses, is at a serious level. Verifying the paths is important by which nurses decide to turnover intention after experiencing verbal violence, which is the most common form of workplace violence. In particular, Research on new nurses who are vulnerable to exposure to verbal violence and have a high turnover rate is insufficient.

METHODS

Data was collected using a time-lagged online surveys from 212 Korean new nurses. Structural equation modelling was used to test the hypothesized model.

RESULTS

The level of the turnover intention of new nurses was almost 4 out of 5. Verbal violence not only has a direct effect on turnover intention, but also has an indirect effect through burnout. Emotional reactions and burnout sequentially mediated the relationship between verbal violence and turnover intention; these variables explained approximately 57% of turnover intention.

CONCLUSIONS

To decrease negative emotional reactions and burnout caused by verbal violence may benefit to reduction of turnover intention of new nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The critical need for new nurses' violence interventions that focus on emotional reactions and burnout, and subsequently improving desirable patient-coworker-nurse relationships and quality of life for new nurses.

Factors Influencing Pediatric Hematology/Oncology Nurse Retention: A Scoping Review

Background: Nursing staff retention is an ongoing concern within pediatric hematology/oncology settings globally. Work-related stressors cause emotional burden, psychological distress, and burnout to which nurses respond by leaving their workplace. Consequently, workplace culture and functionality are negatively impacted, quality of care reduces, and potential harm to patients increases. This paper aims to identify the "most" influencing factors for intention to leave among pediatric hematology/oncology nurses. Methods: A systematic search was undertaken on 29 July 2021 across five electronic databases, Cumulative Index to Nursing and Allied Health Literature, Joanna Briggs Institute, MEDLINE, PubMed, and Web of Science, using MeSH and keywords related to pediatric hematology/oncology nurse retention. Results: The initial search yielded 283 articles. Following abstract and full-text review, nine articles met inclusion criteria. Across all studies, strong links between health service organizational factors (e.g., unit acuity and time constraints), clinician demographics (e.g., age, education, experience, and coping mechanisms), and nursing retention within pediatric hematology/oncology settings were observed. Direct patient care and long-term relationships with pediatric hematology/oncology patients were identified as the most frequent and intense stressors, while also presenting the most rewarding aspect of the nurse's work. Discussion: Clinician burnout and retention were found to be complex and multifaceted organizational and individual issues, which most importantly evolved from accumulative exposure to specialty-specific stressors. Interventions to prevent clinician burnout and improve staff retention, therefore, need to comprise individual and organizational level strategies specific to the healthcare context.

Perceived Family Function and Associated Predictors in Nurses: A Cross-Sectional Study

Background

Nurses play a key role in the health care system. However, clinical nurses experience different kinds of stressors that might impact the nurses' quality of life or quality of care. Family is one of the main social support resources, and quality family function might improve the quality of care provided by nurses. However, evidence on family function in Chinese clinical nurses is quite limited.

Objectives

The current study was to evaluate the family function of the Chinese clinical nurses, and to explore associated predicting factors.

Methods

A multi-center cross-sectional anonymous online survey was carried out. Chinese Family Function Scale was used in the study. Spearman's rank correlation analysis, Mann-Whitney U test, or Kruskal-Wallis H test was performed in the univariate analysis. The pairwise comparison method was used to determine whether the difference was significant between pair groups. Categorical regression (optimal scaling regression) was the main method to analyze factors that had been confirmed to be statistically significant in the univariate analysis.

Results

Nineteen thousand four hundred and twenty-two nurses completed the online questionnaires. The median of the nurse's perceived family function score was three (Inter-quartile Range: IQR 2-5). The multivariate analysis showed that the highest education level (P <0.001), the hospital level (P <0 .001), rotation shift status (P <0.001), working department (P < 0.001), number of children (P < 0.001), monthly income per family member (P < 0.001) were significantly associated with family function. Moreover, the importance of the factors was the number of children (49.1%), monthly income per family member (20.7%), rotation shift status (12.4%), the highest education level (8.0%), the hospital level (7.6%), and working department (2.4%) in turn.

Conclusions

The family function was associated with multiple factors, which hints that managers, leaders, and government could make strategies to improve nurses' family function in order to lead nurses to make a balance between family and work. Policymakers, nursing managers, and employers should make strategies such as promoting children-care services, increasing nurses' income, educating and training enough nurses, and building a well-established system of career development to help clinical nurses improve their family function so that to improve the quality of care.

Distributive Justice and Turnover Intention Among Medical Staff in Shenzhen, China: The Mediating Effects of Organizational Commitment and Work Engagement

Background

Turnover of medical staff is a vital issue in the global healthcare system. Previous evidence has confirmed the critical effect of distributive justice on turnover intention, but few studies have focused on the mediating mechanism behind this relationship or the medical staff. This study aimed to examine the mediating roles of organizational commitment and work engagement in the relationship between distributive justice and turnover intention of medical staff, and explore potential occupational differences.

Methods

Stratified random sampling was adopted to select qualified medical staff from each clinical department of a large general hospital in Shenzhen, China, at a physician-to-nurse ratio of 1:1.5. The medical staff were surveyed using the Distributive Justice Scale, the Organizational Commitment Scale, the Work Engagement Scale, and the Turnover Intention Scale from May to July 2020. Of the 500 medical staff sampled, 480 responded (response rate: 96.00%), and 457 were finally included for analysis (effective response rate: 95.21%). A mediation analysis was performed using Model 6 of the SPSS macro PROCESS program.

Results

There were significant positive correlations among distributive justice, organizational commitment, and work engagement and significant negative correlations among distributive justice, organizational commitment, work engagement, and turnover intention. Distributive justice directly and negatively affected the turnover intention of physicians and nurses, but there were occupational differences in the underlying mechanism between distributive justice and turnover intention. Distributive justice indirectly affected turnover intention among physicians mainly through the mediating effect of organizational commitment, and indirectly among nurses through three different pathways: the mediating effect of organizational commitment, the mediating effect of work engagement, and the chain mediating effect of organizational commitment and work engagement.

Conclusion

The relationship between distributive justice and turnover intention was found to be mediated by organizational commitment and work engagement among medical staff in Shenzhen, with variations between physicians and nurses. Thus, appropriately targeted interventions are needed for physicians and nurses to reduce turnover intention.

Study on the associated factors of turnover intention among emergency nurses in China and the relationship between major factors

BACKGROUND

In China, the demand for emergency medical services is increasing. However, there is a shortage of nurses and a high turnover rate. The study has three purposes: (1) to investigate the turnover intention of emergency nurses in China; (2) to analyze the associated factors of turnover intention; and (3) to clarify the relationship between work stress, job burnout, perceived organization support, job satisfaction and turnover intention.

METHODS

A cross-sectional study was conducted to investigate 56 hospitals with independent emergency departments in Chongqing. A total of 522 emergency nurses were included. Descriptive statistics, One-way analysis of variance, Pearson correlated analysis and a mediation regression analysis were used to analyze the turnover intention, associated factors, and the relationship between the major study variables.

RESULTS

The score of turnover intention was 2.38 ± 0.57, and the proportion of nurses with high turnover intention was 40.61%. Age, working years in emergency department (ED), marital status, employment forms, professional title, promotion opportunities, weekly working hours, monthly night shifts and exposure to workplace violence during the year influenced turnover intention of emergency nurses. Work stress and job burnout were positively correlated with turnover intention (r = 0.189, r = 0.391), while perceived organization support and job satisfaction were negatively correlated with turnover intention (r = - 0.349, r = - 0.485). perceived organization support plays a mediating role between work stress and job burnout, between work stress and job satisfaction, and between work stress and turnover intention.

CONCLUSION

Work stress, job burnout, perceived organization support and job satisfaction are important associated factors of emergency nurses' turnover intention in China. It is suggested to take intervention measures to reduce work stress and job burnout and to improve perceived organization support and job satisfaction.

The Effect of Burnout and Its Dimensions on Turnover Intention Among Nurses: A Meta-Analytic Review

AIM

The objective of this study is elaborating on the relationship between burnout and turnover intention.

BACKGROUND

Burnout and its dimensions have a significant effect on turnover intention.

EVALUATION

Meta-analysis technique is used. 44 studies were brought together to form four data sets. These data sets were heterogeneous and they did not include publication bias. The effect sizes of burnout, emotional exhaustion, depersonalization, and professional efficacy on turnover intention among nurses were computed.

KEY ISSUES

Random effects model was used. The groups including 2 or more studies were added into moderator analysis.

CONCLUSIONS

The effect size of the relationship between professional efficacy and turnover intention was small, and the effect size of the other surveyed reationships were medium among both nurses and other health employees. The moderator analysis results suggested that the effect size of the relationship between professional efficacy and turnover intention among nurses is significantly different from the other health employees.

CONCLUSION

Being a nurse was determined as a significant moderator for the relationship between professional inefficacy and turnover intention and it weakened this relationship.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study can be used by health managers as burnout and turnover intention are important to determine organizational policies.

Correlation of Job stress and self-control through various dimensions in Beijing Hospital staff

BACKGROUND

Mental, emotional and physical exhaustion has been increasing in humans due to work related stress. Many studies have been conducted on various variables contributing to and counteracting job stress. In our study, we aimed to examine the effect of different demographic and personal variables on job stress and its correlation with self-control in a hospital setting.

METHOD

Our cross-sectional study involved 220 healthy staff members from Beijing hospital. Job stress and self-control were measured via the Chinese versions of the House and Rizzo Work Scale and the Self-Control Scale, respectively.

RESULT

Participants with male gender and those with leading positions of authority reported higher job stress and poorer self-control (P < 0.01). Smokers also showed poorer self-control (P < 0.05, Bonferroni corrected P > 0.05). Poor physical and mental health conditions were observed to be significantly related to poor self-control (Bonferroni corrected P < 0.01) and higher job stress (Bonferroni corrected P < 0.05). Moreover, negative correlation was found between job stress and self-control and its dimensions (P < 0.001). Furthermore, job stress group and leadership position could interact to influence self-control, healthy habit, and resistance to temptation.

CONCLUSION

We concluded that gender difference, leadership position, physical and mental health conditions all can affect work stress and an individual's self-control. Moreover, self-control dimensions like impulse control and attention to work correlated to job stress. Furthermore, the interaction between job stress and leadership could affect self-control and its dimensions. Future studies can be focused on using these variables to cope up with the ever increasing work related stress in the modern world.

Model of Organizational Commitment Applied to Health Management Systems

In this paper, we try to build on the problems surrounding the management of human resources in health care organizations worldwide. After the analysis of the reviewed literature, we detected that the scientific community considers several recurring themes that need attention: stress, burnout, and turnover intention. Based on this, we developed a model of organizational commitment that aims to achieve performance and health quality, its main result the establishment of the appropriate management policies in order to avoid the abandonment of the organization through the search for commitment and job satisfaction. Amongst our main conclusions, we highlight the need to implement a human resources model for hospital administrators based on the relationships with "patients" not "clients" through the maintenance of a positive and strong atmosphere of staff participation. It is important to develop innovative practices related to clear job design that eliminate reasons for ambiguity and stress in executing the tasks of the healthcare system. Finally, we urge training programs in transformational leadership to promote the well-being and organizational commitment of employees.

The Turnover Intention among Grassroots Family Planning Staff in the Context of China's Universal Two-Child Policy: A Case Study of the Xi'an City

The introduction of the universal two-child policy in 2016 marked a major social transition in China and raised a requirement for family planning services; however, the turnover in family planning staff poses a challenge to satisfying the requirement. Thus far, after implementation of the policy, there have been few surveys investigating turnover intention and the underlying motivations in grassroots family planning staff, the major component of China's family planning system. A survey conducted in Xi'an in 2019 shows that nearly one in three grassroots members had an explicit or implicit turnover intention. Basically consistent with our conceptual framework, the structural equation modeling further indicates that the affective organizational commitment had the largest direct effect on turnover intention and also partly mediated effects of other significant factors (ranked by the size of total effect): Age, specific job satisfactions (i.e., satisfactions with job prospects, relationship with colleagues, and working environment), frequency of working overtime, length of service, and opportunity of professional training. As predicted, turnover behavior in colleagues also directly affected turnover intention in such staff. The above findings have important policy implications for the sustainable development of family planning work in China.