Should I stay or should I go? Career change and labor force separation among registered nurses in the U.S

Reinforcement during the COVID-19 pandemic: Perception of nursing students and impact on intention to drop-out of nursing education

Background

Although the COVID-19 pandemic's impact on students has already been studied, its impact on nursing students' perception of their training and their conception of their future profession is unknown.

Aims

To describe nursing students' perception of their involvement in reinforcement during the COVID-19 pandemic and the impact of working as reinforcement staff during the COVID-19 pandemic on nursing students.

Design

Cross-sectional, comparative case/non-case study.

Setting

nurse training institutions in France.

Participants

"Cases" defined as nursing students who worked as reinforcement staff during the COVID-19 pandemic; "non-cases" defined as people who were in final year of nursing studies in 2018-2019 or 2019-2020 and so did not work as reinforcement staff during their nursing studies.

Methods

questionnaire about representations of the nursing profession, role of the nurse in society, previous thinking of dropping out of nursing education.

Results

534 subjects included (310 cases; 214 non-cases). Cases reported feeling useful (38.6%) or very useful (25.7%) as reinforcement workers, while 91.5% concurred that nurses had an important role in the management of COVID-19 patients. Cases more frequently reported that the nursing profession is one where you save lives (61.5% vs 52.5%, p = 0.05). The desire to work as a nurse for a whole life had been more frequently expressed by cases (45.3% vs 34.8%, p = 0.05). Nursing education drop-out has been considered by 63.4% of subjects, without difference between "cases" and "non-cases" (p = 0.63). Subjects who considered dropping out of nursing education were younger (p = 0.01) and less often prone to think that the nursing profession was a profession personally rewarding (p = 0.01) and a life-saving profession (p = 0.03).

Conclusion

The majority of nursing students reported feeling useful during the pandemic, and underlined the importance of the nurse's role in management of COVID-19 patients. Participation in reinforcement staff during the pandemic had no influence on dropping out of nursing education.

Analyzing nurses' decisions to leave their profession-a duration analysis

Many countries suffer from skilled labor shortages in nursing. One way to increase the nurse labor supply is to raise their retention rates. Yet, though several studies exist on factors associated with the nurse labor supply at different levels, literature on factors associated with nurses' decisions to leave their occupation is relatively scarce. Based on German administrative data, I analyze the determinants of nurses' decisions to leave their profession. My results suggest that younger nurses, nurses in the social sector, and nurses working with smaller employers leave their occupation more often than their counterparts, irrespective of their specific nursing occupations and care settings. Nurses leave more often where more alternative occupational options are available. Nurses who have been unemployed and nurses who have been employed in a different field have a higher probability of leaving the occupation, whereas nurses who just finished vocational training only have a moderate propensity to leave. Female nurses leave less often if employed part time. Female nurses in part time leave even more seldom if they have children. A change in the hospital reimbursement system and introducing a nursing minimum wage during the first decade of the century did not change nurses' occupation durations.

[Remaining in the nursing profession depends on vocational training and continuing education: A cross-sectional study]

Remaining in the nursing profession depends on vocational training and continuing education: A cross-sectional study Abstract. Background: The public discussion about nurses leaving the profession has shown increasing dynamics for years. Burdens on the caregivers, political and (vocational) educational policy mistakes and financial as well as structural framework conditions are given as reasons. However, little is known about the influence of the educational biography on remaining in the nursing profession. Aim: This study examines data on formal and alternative sources of education, the timing of educational measures and the changes of nurses' interests in education over time and thus focuses on the group of nursing staff remaining in the profession. Methods: Nurses with many years of experience in their profession were surveyed (N = 200). Results: The results show that 77.6% of long-term nurses have the minimum required school leaving certificate with average final grades. 65.3% of the nurses have attended specialized training and 74.5% vocational training, which was completed over the entire period of employment. The training topics and the sources of education change over the course of the working life. Conclusions: It turns out that the group of nursing staff who have remained in the profession for a long time is characterized by a high willingness to undertake vocational training, with and without relevance to remuneration.

Organisational commitment, job satisfaction and intention to leave among physicians in the public health sector of Cyprus: a cross-sectional survey

OBJECTIVES

Organisational commitment, job satisfaction and intention to leave constitute important characteristics of health professionals' employment status. Our study aimed at investigating the level of organisational commitment, job satisfaction in association with intention to leave among physicians.

DESIGN

A cross-sectional study.

SETTING

A survey was conducted using self-administered questionnaires (the Organizational Commitment Questionnaire and the Job Satisfaction Survey) among all physicians working in the public health sector of Cyprus (October 2016-January 2017).

PARTICIPANTS

Out of 690 physicians working in the public health sector who received an invitation to participate, 511 completed the survey and 9 were excluded. Therefore, 502 physicians were included in the final analysis (response rate 73%). A total of 188 cases were excluded because they were undetermined with respect to their intention to leave and a total of 75 cases were excluded from the regression analysis due to missing values on at least one variable or due to having values considered as outliers. Therefore, a total of 239 physicians (120 men and 119 women) were included in the current analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

Physicians' intention to leave.

RESULTS

A considerably large percentage of physicians (72.8%) working in the public hospitals and healthcare centres of Cyprus reported their intention to leave their job. Moreover, the majority of employees in public hospitals (78.4%) intended to leave their job, while only 21.6% of employees in health centres reported an intention to leave (p<0.001). The study also confirmed that organisational commitment and job satisfaction were negatively correlated with intention to leave. In addition, the results of this study demonstrate that certain demographics also influence physicians' intention to leave including age, gender and medical specialisation.

CONCLUSIONS

Certain physicians' demographics, organisational commitment and job satisfaction constitute important parameters influencing physicians' intention to leave their job.

Struggle Turning Back to Professional Nursing Practice in Iran: A Qualitative Study

Background

Current nursing shortage is becoming more complicated because of turnover intention among nurses. Most of the inactive nurses in Iran after a long time for various rations Returned To Professional Nursing Practice (RTPNP). Because the RTPNP program does not exist in Iran to prepare inactive nurses returning to practice, this study aimed to explore the strategies that contribute to preparing nurses for RTPNP.

Materials and Methods

The present study was a part of the findings of a larger grounded theory study that lasted about 9 months from April 2019 to December 2019. The data were collected through semi-structured interviews with participants after signing an informed consent form. The average interview duration was 40 minutes. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Participants included eight nurses, two education supervisors, two matrons, and two head nurses. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method.

Results

Struggle turning back to PNP was the main category that emerged from four categories of "seeking learning resources," "return to practice support," "getting used to a practice," and "building a new family life" from the data analysis process.

Conclusions

Returners struggle to get prepared for providing PNP to clients if there is no definite process of RTPNP. Organizational support and RTPNP programs are efficient strategies and could help these returners get prepared for PNP.

Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public Health Priority

The COVID-19 pandemic has had an unprecedented impact on health systems in most countries, and in particular, on the mental health and well-being of health workers on the frontlines of pandemic response efforts. The purpose of this article is to provide an evidence-based overview of the adverse mental health impacts on healthcare workers during times of crisis and other challenging working conditions and to highlight the importance of prioritizing and protecting the mental health and well-being of the healthcare workforce, particularly in the context of the COVID-19 pandemic. First, we provide a broad overview of the elevated risk of stress, burnout, moral injury, depression, trauma, and other mental health challenges among healthcare workers. Second, we consider how public health emergencies exacerbate these concerns, as reflected in emerging research on the negative mental health impacts of the COVID-19 pandemic on healthcare workers. Further, we consider potential approaches for overcoming these threats to mental health by exploring the value of practicing self-care strategies, and implementing evidence based interventions and organizational measures to help protect and support the mental health and well-being of the healthcare workforce. Lastly, we highlight systemic changes to empower healthcare workers and protect their mental health and well-being in the long run, and propose policy recommendations to guide healthcare leaders and health systems in this endeavor. This paper acknowledges the stressors, burdens, and psychological needs of the healthcare workforce across health systems and disciplines, and calls for renewed efforts to mitigate these challenges among those working on the frontlines during public health emergencies such as the COVID-19 pandemic.

Relationship between work-family conflict and turnover intention in nurses: A meta-analytic review

AIM

This meta-analytic review aimed to synthesize and analyse studies that explored the relationship between nurses' work-family conflicts and turnover intentions.

DESIGN

This meta-analytical review was conducted according to the Joanna Briggs Institute guidelines and PRISMA checklist.

DATA SOURCES

A total of 191 (k = 14) publications published between 2005 and 2019 in English, including grey literature on turnover intention and work-family conflict, were retrieved from PubMed, PsycINFO, Web of Science, ProQuest and Scopus databases.

REVIEW METHODS

Studies on the relationship between work-family conflict and turnover intention were summarized.

RESULTS

An overall effect size of r = .28 (N = 5781, 95% CI [0.23-0.33]) was obtained, indicating a moderate, positive and significant relationship between work-family conflict and turnover intention. The moderator analysis showed that individualism and long-term orientation accounted for 90% of effect size heterogeneity of work-family conflict and turnover intention relationship.

CONCLUSION

Exploring the correlation between work-family conflict and turnover intention can provide guidelines and recommendations for the development of strategies to promote nurse retention and alleviate the nursing shortage. National culture, particularly individualism and long-term orientation, were found to play a significant moderator role in this relationship. Cultures that are highly individualistic and have a long-term orientation have a diminishing effect on the relationship between work-family conflict and turnover intention.

IMPACT

Work-family conflict and turnover intention are significantly correlated factors regardless of the studies' cultural characteristics examined in this study. Policymakers and managers should consider this finding and develop strategies that provide a balance-oriented work design to prevent nurse shortage.

Exploring the process of turning back to professional nursing practice in Iran: A grounded theory

BACKGROUND

The current nursing shortage is complicated because of turnover intention among nurses. Most of the inactive nurses returned to professional nursing practice. Returned to professional nursing practice program was low attrition rates and a more cost-effective strategy that prepared inactive nurses returning to practice. This study aimed to explain the process of returned to professional nursing practice.

MATERIALS AND METHODS

This study was a grounded theory study, which lasted from about 2018 to 2020. Data were collected through semi-structured interviews and observations with participants after signing an informed consent form. The average interview duration was 45 min. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method.

RESULTS

In this study, 16 participants were selected, including ten nurses, two educational supervisors, two head nurses, and two matrons. The "transformed competence" as the core concept and the four main concepts of "feeling alienated with the new environment," "getting prepared for restart," "gradual maturity in clinical practice," and "components of organizational culture" were extracted from the data analysis process.

CONCLUSION

The process of returned to professional nursing practice in the context of the organizational culture of incentive learning leading to a high level of competence, and in the context of the organizational culture of inhibiting learning, is leading to deficiency incompetence.

An International Scoping Exercise Examining Practice Experience Hours Completed by Nursing Students

BACKGROUND

There is global acceptance of the need for prelicensure nursing students to complete practice experience hours during their program of education. Yet questions remain about these practice experiences, including those related to duration.

METHOD

This article reports findings of a scoping exercise that compared the number of practice experience hours mandated for students undertaking courses that lead to RN licensure in Australia, New Zealand, the United Kingdom, and the United States.

RESULTS

Substantial differences were evident between the four countries regarding the number of mandated practice experience hours. There is no clearly linked research evidence to justify the decision made in relation to the mandated number of hours.

CONCLUSION

Internationally, there is a need to reexamine the rationale for mandating a minimum number of practice experience hours for students in programs of education that lead to licensing as an RN. [J Nurs Educ. 2019;58(1):33-41.].

Primary Care Nurse Practitioner Wage Differences by Employment Setting

BACKGROUND

Previous studies reported that primary care nurse practitioners working in primary care settings may earn less than those working in specialty care settings. However, few studies have examined why such wage difference exists.

PURPOSE

This study used human capital theory to determine the degree to which the wage differences between dingsPCNPs working in primary care versus specialty care settings is driven by the differences in PCNPs' characteristics. Feasible generalized least squares regression was used to examine the wage differences for PCNPs working in primary care and specialty care settings.

METHODS

A cross-sectional, secondary data analysis was conducted using the restricted file of 2012 National Sample Survey of Nurse Practitioners.

FINDINGS

Oaxaca-Blinder decomposition technique was used to explore the factors contributing to wage differences.The results suggested that hourly wages of PCNPs working in primary care settings were, on average, 7.1% lower than PCNPs working in specialty care settings, holding PCNPs' socio-demographic, human capital, and employment characteristics constant. Approximately 4% of this wage difference was explained by PCNPs' characteristics; but 96% of these differences were due to unexplained factors.

DISCUSSION

A large, unexplained wage difference exists between PCNPs working in primary care and specialty care settings.

Retirement planning and work-related variables in Chinese older nurses: A cross-sectional study

AIM

To explore the situation of older nurses approaching retirement with regard to their retirement planning, and the relationship of their retirement planning behaviour with the job environment and job satisfaction under their current employment arrangements and other work-related variables.

BACKGROUND

Nurse shortage has become a global phenomenon that can be alleviated by retaining older nurses in service. The Chinese government proposed the "Incremental Delay Retirement Age Policy." However, older nurses face delayed retirement but lack retirement plans.

METHOD

A cross-sectional questionnaire survey was conducted among a convenience sample of older retiring nurses (n = 152; 84.92% response rate) recruited from every department of four large general hospitals in Changchun, Jilin Province from June to August 2016.

RESULT

The majority of the respondents presented poor retirement planning (n = 122, 80.3%). The independent variables of information exchange with patients, teamwork and personal growth and development explained approximately 16.6% of the variance in retirement planning. Nurse-patient communication and personal growth and development can promote retirement planning, but teamwork is negatively related to retirement planning.

CONCLUSION

Retirement planning by Chinese older nurses is related to certain work-related variables. However, many other work-related variables were not associated with retirement planning and require further research. Overall, Chinese older retiring nurses must improve their retirement planning practices.

Job and Professional Leaving Among Newly Licensed RNs: A Structural Equation Model

With more than 50% of the nursing workforce close to retirement, it is especially important to keep younger nurses in nursing jobs and careers. This study empirically tests a structural equation model of registered nurse (RN) intent to leave the job and profession using data from a survey of newly licensed RNs (NLRNs). Job demands, difficulties and control, intent to leave the job, and intent to leave the profession were latent variables. A number of direct, indirect, and mediating relationships were modeled. Measurement models for all latent variables and the structural model had good fit. The final model showed a path from job demands, difficulties, and control to job satisfaction to intent to leave the job to intent to leave the profession. The results suggest that the process of an NLRN intending to leave the job and profession involves a number of mediators between the work environment and this intent.

Retirement financial planning and the RN: an integrative literature review

This integrative literature review examined the current research on RN retirement. The review identified 3 critical gaps in knowledge: (a) minimal knowledge regarding the economic impact on RN retirement, (b) incomplete information regarding the demographics of RN retirement, and (c) a scarcity of prospective longitudinal RN workforce studies. Future research must address these gaps to better address RN workforce sustainability.

The research and policy importance of nursing sample surveys and minimum data sets

This article reviews the information gathered by the National Sample Survey of Registered Nurses (NSSRN) and other sources of data on the registered nurse (RN) workforce. It examines how the data have been used to create knowledge about the RN workforce and highlights the relative strengths and weaknesses of different data sets. Recommendations for future data collection affirm the Institute of Medicine's recommendation that both license-record based minimum data and the NSSRN be collected in order to help the United States and states meet current and future nursing needs.

Student nurse socialisation in compassionate practice: a Grounded Theory study

Compassionate practice is expected of Registered Nurses (RNs) around the world while at the same time remaining a contested concept. Nevertheless, student nurses are expected to enact compassionate practice in order to become RNs. In order for this to happen they require professional socialisation within environments where compassion can flourish. However, there is concern that student nurse socialisation is not enabling compassion to flourish and be maintained upon professional qualification. In order to investigate this further, a glaserian Grounded Theory study was undertaken using in-depth, digitally recorded interviews with student nurses (n=19) at a university in the north of England during 2009 and 2010. Interviews were also undertaken with their nurse teachers (n=5) and data from National Health Service (NHS) patients (n=72,000) and staff (n=290,000) surveys were used to build a contextual picture of the student experience. Within the selected findings presented, analysis of the data indicates that students aspire to the professional ideal of compassionate practice although they have concerns about how compassionate practice might fit within the RN role because of constraints on RN practice. Students feel vulnerable to dissonance between professional ideals and practice reality. They experience uncertainty about their future role and about opportunities to engage in compassionate practice. Students manage their vulnerability and uncertainty by balancing between an intention to uphold professional ideals and challenge constraints, and a realisation they might need to adapt their ideals and conform to constraints. This study demonstrates that socialisation in compassionate practice is compromised by dissonance between professional idealism and practice realism. Realignment between the reality of practice and professional ideals, and fostering student resilience, are required if students are to be successfully socialised in compassionate practice and enabled to retain this professional ideal within the demands of 21st century nursing.

Burnout during nursing education predicts lower occupational preparedness and future clinical performance: a longitudinal study

BACKGROUND

Early-career burnout among nurses can influence health and professional development, as well as quality of care. However, the prospective occupational consequences of study burnout have not previously been investigated in a national sample using a longitudinal design.

OBJECTIVES

To prospectively monitor study burnout for a national sample of nursing students during their years in higher education and at follow-up 1 year post graduation. Further, to relate the possible development of study burnout to prospective health and life outcomes, as well as student and occupational outcomes.

DESIGN

A longitudinal cohort of Swedish nursing students (within the population-based LANE (Longitudinal Analysis of Nursing Education/Entry) study) from all sites of education in Sweden was surveyed annually. Data were collected at four points in time over 4 years: three times during higher education and 1 year post graduation.

PARTICIPANTS

: A longitudinal sample of 1702 respondents was prospectively followed from late autumn 2002 to spring 2006.

METHODS

Mean level changes of study burnout (as measured by the Oldenburg Burnout Inventory, i.e. the Exhaustion and Disengagement subscales) across time, as well as prospective effects of baseline study burnout and changes in study burnout levels, were estimated using Latent Growth Curve Modeling.

RESULTS

An increase in study burnout (from 30% to 41%) across 3 years in higher education was found, and levels of both Exhaustion and Disengagement increased significantly across the years in education (p<0.001). Baseline levels, as well as development of study burnout, predicted lower levels of in-class learner engagement and occupational preparedness in the final year. At follow-up 1 year post graduation, earlier development of study burnout was related to lower mastery of occupational tasks, less research utilization in everyday clinical practice and higher turnover intentions.

CONCLUSIONS

The results suggest that study burnout may have interfered with learning and psychological well-being. Aspects related to work skills and intention to leave the profession were also affected. Thus, burnout development during higher education may be an important concern, and effective preventive measures to counteract burnout development may be necessary already at the outset of nursing education.

Developing a model of source-specific interpersonal conflict in health care

Nurses work in complex social environments, and conflict may arise with fellow coworkers, their supervisor, physicians or the patients and family they care for. Although much research has documented the negative effects of conflict on nurses, no research to date has examined the comparative effect that conflict from all four sources can have on nurses. The purpose of this study is to test a model of workplace conflict where the negative effect of conflict on nurses will be experienced via emotional exhaustion. We test the mediator model by analysing the cross-sectional data collected within one hospital (N1=182) and cross-validating those results in a second hospital (N2=161). The pattern of results was largely consistent across the two samples indicating support for a mediated model of workplace conflict for physician, supervisor and patient. Conflict with other nurses, however, did not have a relationship with either emotional exhaustion or other personal and organizational outcomes. The theoretical and practical implications of the current findings, as well as the limitations and future research directions, are discussed.

The experience of being an advanced practice nurse in Australian acute care settings: A systematic review of qualitative evidence

BACKGROUND

There is a vast amount of international literature which, although agreeing on the need for advanced practice nurse roles, simultaneously debates and discusses the difficulties with nomenclature, definition and subsequent implementation of such roles. Due to this ambiguity it is difficult to equally compare evidence in this field across different countries. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. With the creation of a national nursing regulating authority in 2010, it is timely to explore in-depth the experience of being an advanced practice nurse from a national perspective.

OBJECTIVE

To identify the experience of being an advanced practice nurse working in Australian acute care settings.

INCLUSION CRITERIA

Registered nurses working in advanced practice roles in acute care settings throughout Australia.The experience of being an advanced practice registered nurse working in an Australian acute care setting, as reported by the nurses themselves.Interpretive qualitative studies including designs such as phenomenology, grounded theory and ethnography.

SEARCH STRATEGY

A three step search strategy was used to identify published and unpublished studies. The search process was conducted from August to October 2011 and considered published and unpublished studies from 1990 to October 2011.

METHODOLOGICAL QUALITY

Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Qualitative Assessment and Review Instrument.

DATA EXTRACTION

Data was extracted from the papers included in the review using the standardised Joanna Briggs Institute Qualitative Assessment and Review Instrument data extraction tool.

DATA SYNTHESIS

Research findings were pooled using the Joanna Briggs Institute Qualitative Data and Review Instrument.

RESULTS

Three published studies and one unpublished dissertation were included in the review. From these four studies, 216 findings were extracted, forming 18 categories which were then analysed to create six synthesised findings. Six meta-syntheses under the headings of expert knowledge, confidence, education, relationships, negative experiences and patient centred experience were formed from the findings.

CONCLUSIONS

The synthesised findings confirm that the experience of advanced practice nurses in Australian acute care settings is complex and greatly influenced personally and professionally by the organisation as well as the unpredictable nature of working with people.

IMPLICATIONS FOR PRACTICE

A deeper understanding of the essence of being an advanced practice nurse may be of benefit for recruitment and retention planning. Health care organisations must also be aware of the impact they have on the nurse's experience if they are to commit to retention of nurses and to patient safety.

IMPLICATIONS FOR RESEARCH

If the topic of advanced practice is to remain current in the Australian nursing profession then ongoing research must be conducted to identify if the title is being used more frequently within the nursing research. Nurses must be supported in publishing quality research if they are to improve articulation of their experiences.

Toward standardization (part 1): assessment of state and national nursing workforce data sources

Despite concerns expressed over the past 25 years, little progress has been made in improving the accuracy, availability, and timeliness of national data on the U.S. nursing workforce. In Part 1 of this two-part series, we review the current national data sources on nurse supply, demand, and education programs. We discuss the advantages that state-level data collection efforts enjoy in many states and propose that national data sets could be easily and cost-effectively built from state-level contributions-if states collected a standardized set of information. As part of a larger effort to standardize state-level data, from July to December 2008, we analyzed surveys and codebooks from 26 states collecting nurse workforce data. We present the results of this data assessment and conclude that data collection practices as of 2008 varied substantially from state to state. Creation and adoption of standardized minimum nursing workforce data sets is suggested to bring states into alignment.