Testing a model of absence and intent to stay in employment: a study of registered nurses in Malta

Mathematical Modeling of the Evolution of Absenteeism in a University Hospital over 12 Years

Increased absenteeism in health care institutions is a major problem, both economically and health related. Our objectives were to understand the general evolution of absenteeism in a university hospital from 2007 to 2019 and to analyze the professional and sociodemographic factors influencing this issue. An initial exploratory analysis was performed to understand the factors that most influence absences. The data were then transformed into time series to analyze the evolution of absences over time. We performed a temporal principal components analysis (PCA) of the absence proportions to group the factors. We then created profiles with contributions from each variable. We could then observe the curves of these profiles globally but also compare the profiles by period. Finally, a predictive analysis was performed on the data using a VAR model. Over the 13 years of follow-up, there were 1,729,097 absences for 14,443 different workers (73.8% women; 74.6% caregivers). Overall, the number of absences increased logarithmically. The variables contributing most to the typical profile of the highest proportions of absences were having a youngest child between 4 and 10 years old (6.44% of contribution), being aged between 40 and 50 years old (5.47%), being aged between 30 and 40 years old (5.32%), working in the administrative field (4.88%), being tenured (4.87%), being a parent (4.85%), being in a coupled relationship (4.69%), having a child over the age of 11 (4.36%), and being separated (4.29%). The forecasts predict a stagnation in the proportion of absences for the profiles of the most absent factors over the next 5 years including annual peaks. During this study, we looked at the sociodemographic and occupational factors that led to high levels of absenteeism. Being aware of these factors allows health companies to act to reduce absenteeism, which represents real financial and public health threats for hospitals.

Distributed leadership and nurses' job satisfaction: a survey

PURPOSE

The purpose of this paper is to explore the relationship between perceived distributed leadership and job satisfaction among nurses. Leadership is central to improving quality care. Reports following investigations of poor care standards, identified inadequate leadership as a contributory factor and called for a new kind of leadership. One alternative is distributed leadership. Evidence suggests associations between leadership and job satisfaction but, there is a paucity of research examining associations between distributed leadership and job satisfaction: the purpose of this study was to address this gap.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional survey design was used and data collected via questionnaires. Using census sampling, 350 nurses in a hospital in Malta were selected. A response rate of 50% (n = 176) was achieved. Data were analysed using Spearman's correlation coefficient and multiple regression. Ethical approval was obtained from relevant committees/individuals.

FINDINGS

Results indicated a moderate application of perceived distributed leadership and application of all components of distributed leadership could be improved. Nurses were neither satisfied nor dissatisfied with their jobs. Correlation analysis showed a positive relationship between distributed leadership and job satisfaction. Multiple regression showed that commitment and participative decision-making were major predictors of job satisfaction while supervision by managers had a negative effect.

PRACTICAL IMPLICATIONS

Improving distributed leadership is a priority in the nursing profession.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this study is the first to show that distributed leadership has a positive effect on job satisfaction among nurses. Supervision, a constituent of distributed leadership, was associated with reduced job satisfaction, therefore reducing this is paramount.

Analysing drivers and outcomes of job and professional satisfaction at health centres in Portugal

Purpose

The purpose of this paper is to analyse antecedents, associations and outcomes of job and professional satisfaction of doctors and nurses in Portuguese health centres.

Design/methodology/approach

The authors have used structural equation modelling to examine the causal relationships between multiple variables placed in a path model reflecting the theoretical foundation.

Findings

The percentage of those satisfied or very satisfied with their jobs was just above 50 per cent. Doctors’ satisfaction stems from personal achievement and the formal component of work environment, leading them to strongly recommend their work in the health centre to dear ones but not to put aside other job options. Nurses’ level of job satisfaction seems to be affected by co-workers and interpersonal relationships beside personal achievement and has more strong and multifaceted impact on their feelings and behaviour that goes from recommending their job position to considering to quit job and even regretting the option made in terms of career.

Originality/value

This study represents the first attempt to conceptualise and test a simultaneous model comprising antecedents and outcomes of both job satisfaction and professional satisfaction in primary care, investigating also differences between genders and professions. Results shed light on determinants of satisfaction among specialised staff in Portuguese primary care and how they affect commitment to the organisation and the way career choice is regarded.

Development and Psychometric Testing of the Croatian Version of the Job Satisfaction Scale in Hospital Nurses

BACKGROUND AND PURPOSE

The aim of the study was to develop and psychometrically test a Job Satisfaction Survey (JSS) that measures attitudes toward job satisfaction among hospital nurses in Croatia.

METHODS

A cross-sectional design was applied with 584 nurses.

RESULTS

A seven-factor model of the measure was confirmed relative χ2 = 2.8, goodness of fit index = .9, comparative fit index = .83. The Cronbach's α was 0.83 for the total scale.

CONCLUSION

The factor structure of the Croatian version of the JSS was found to be similar to that of the original scale, and it is valid and reliable for measuring attitudes toward job satisfaction among hospital nurses. JSS allows the comparison of self-reported job satisfaction among hospital nurses in different countries and cultures.

Absenteeism amongst health workers--developing a typology to support empiric work in low-income countries and characterizing reported associations

The contribution of inadequate health worker numbers and emigration have been highlighted in the international literature, but relatively little attention has been paid to absenteeism as a factor that undermines health-care delivery in low income countries. We therefore aimed to review the literature on absenteeism from a health system manager's perspective to inform needed work on this topic. Specifically, we aimed to develop a typology of definitions that might be useful to classify different forms of absenteeism and identify factors associated with absenteeism. Sixty-nine studies were reviewed, only four were from sub-Saharan Africa where the human resources for health crisis is most acute. Forms of absenteeism studied and methods used vary widely. No previous attempt to develop an overarching approach to classifying forms of absenteeism was identified. A typology based on key characteristics is proposed to fill this gap and considers absenteeism as defined by two key attributes, whether it is: planned/unplanned, and voluntary/involuntary. Factors reported to influence rates of absenteeism may be broadly classified into three thematic categories: workplace and content, personal and organizational and cultural factors. The literature presents an inconsistent picture of the effects of specific factors within these themes perhaps related to true contextual differences or inconsistent definitions of absenteeism.

Thirty years of nursing turnover research: looking back to move forward

Despite the substantial amount of useful prior work on turnover among nurses, our understanding of the causal mechanisms explaining why nurses voluntarily leave their jobs is limited. The purpose of this article is to promote the development of stronger conceptual models of the causes of voluntary turnover among nurses. The author compares the nursing-specific literature to research on voluntary turnover from the general management field over the past 30 years and examines the evolution of key theories used in the nursing literature. Results of this review comparing nursing research with that in the broader field suggest that, over time, nursing research has not kept pace with conceptualizations from general management explaining why people either remain at or quit their jobs. The author argues that conceptual models of turnover among nurses can benefit significantly from drawing more effectively on particular models and concepts available in general management studies of turnover.

Predictors of hospital nurses' intent to stay: a cross-sectional questionnaire survey in Shanghai, China

AIM

To investigate predictors of hospital nurses' intent to stay in the nursing profession.

METHODS

A cross-sectional survey design was adopted. Over 1000 nurses working in hospitals in Shanghai, China, were invited to complete a survey questionnaire between May and October 2009 and 919 nurses responded for an 82% response rate.

FINDINGS

Regression models explained 41.3% of variance in nurse intent to stay. Although the proposed model hypothesized 18 predictors of intent to stay, only seven were statistically significant factors of nurse intent to stay: normative commitment, economic costs commitment, age, limited alternatives commitment, praise/recognition, professional advancement opportunities and the hospital classification. Of these, the strongest predictors were normative commitment, economic costs commitment and age, which explained 37.3% of variance in nurse intent to stay.

CONCLUSION

Possible strategies to improve nurses' intent to stay include employment practices that improve the work environment, increased wages and benefits, and greater professional opportunity for nurses' personal growth development and promotion. Healthcare organizations should establish an asserting and nurturing environment for nurses and improve nurses' normative commitment and economic costs commitment. Increased effort should be made to improve nurses' conditions in primary and secondary hospitals where nurses report a lower level of intent to stay in nursing.

STUDY LIMITATIONS

Participants came from a limited number of hospitals in Shanghai. A larger sample from different hospitals in Shanghai and other districts in Mainland China could have enhanced the generalizability of the results and increased the power of the study.

Job satisfaction among hospital nurses revisited: a systematic review

BACKGROUND

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any healthcare delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction.

OBJECTIVE

To update review paper published in 2005.

DESIGN

This paper analyses 100 papers relating to job satisfaction among hospital nurses derived from systematic searches of seven databases covering English and Chinese language publications 1966-2011 (updating the original paper with 46 additional studies published 2004-2011).

FINDINGS

Despite varying levels of job satisfaction across studies, sources and effects of job satisfaction were similar. Hospital nurse job satisfaction is closely related to working conditions and the organizational environment, job stress, role conflict and ambiguity, role perception and role content, organizational and professional commitment.

CONCLUSIONS

More research is required to understand the relative importance of the many identified factors relating to job satisfaction of hospital nurses. It is argued that the absence of a robust causal model reflecting moderators or moderator is undermining the development of interventions to improve nurse retention.

Regional differences in job satisfaction for mainland Chinese nurses

Background

Although there is an abundance of research on nurses’ job satisfaction, there is a paucity of publications on the regional differences that impact on nurses’ job satisfaction.

Purpose

To compare the differences between northern and southern hospitals in Mainland China with respect to nurses’ job satisfaction.

Methods

A cross-sectional survey design was selected. Data were analyzed using descriptive statistics, independent t test, chi-square test, correlation, and linear regression.

Results

Nurses in northern hospitals were older, had higher educational levels yet received lower pay in comparison with their counterparts in the southern region. Despite these salary differences, those in the north consistently rated their job satisfaction greater in all areas except professional opportunities.

Conclusion

Regional differences were related to nurses’ job satisfaction. Potential contributing factors included philosophical, cultural, and economic differences between the 2 regions. The noteworthy regional differences that potentially related to nurse’ job satisfaction should be investigated in future studies.

The retention of recalled United States Navy nurse reservists

The purpose of this study was to identify factors that contribute to the retention of United States Navy Nurse Corps reservists called to duty in 2003. Data were collected by questionnaires based on Price and Mueller's causal model of voluntary turnover and were analyzed via descriptive statistics, multiple regression analysis, exploratory factor analysis, and structural equation modeling. The data indicate that the model fits the data well, with job satisfaction having the strongest influence on one's intent to stay in the Reserve. The data analyses did not support the concern that a negative experience with a recall could make a reservist resign his/her commission. The results may prove useful to any nation that relies on a volunteer reserve force to augment its day-to-day nursing capabilities.

Is satisfaction a direct predictor of nursing turnover? Modelling the relationship between satisfaction, expressed intention and behaviour in a longitudinal cohort study

BACKGROUND

The theory of planned behaviour states that attitudinal variables (e.g. job satisfaction) only have an indirect effect on retention whereas intentions have a direct effect. This study uses secondary data from a longitudinal cohort of newly qualified nurses to test for the direct and indirect effects of job satisfaction (client care, staffing, development, relationships, education, work-life interface, resources, pay) and intentions to nurse on working as a nurse during the 3 years after qualification.

METHODS

A national sample (England) of newly qualified (1997/98) nurses (n=3669) were surveyed at 6 months, 18 months and 3 years. ANOVA and MANOVA were used for comparison of mean job satisfaction scores between groups; intentions to nurse (very likely, likely vs. unlikely, very unlikely and unable to say at this stage); working (or not working as a nurse) at each time-point. Indirect and direct effects were tested using structural equation and logistic regression models.

RESULTS

Intentions expressed at 6 months to nurse at 18 months were associated with higher scores on pay and relationships, and intentions at 3 years were associated with higher scores on care, development, relationships, work-life interface, resources, pay respectively. Intentions expressed at 18 months to nurse at 3 years were associated with higher scores on development, relationships, education and work-life interface. Associations with actual nursing were fewer. Those working as a nurse had higher satisfaction scores for development (18 months) and relationships (3 years). Regression models found significant associations between the pay and staffing factors and intentions expressed at 6 months to nurse at 18 months, and between pay and intentions to nurse at 3 years. Many of the associations between intentions and working as a nurse were significant. Development was the only job satisfaction factor significantly associated with working as a nurse and just at 18 months.

CONCLUSION

Results partially support the theory of planned behaviour. Intentions expressed by nurses are stronger predictors of working as a nurse than job satisfaction. Retention strategies should focus on identifying nurses showing early signs of departure with emphasis on developmental aspects, mentoring and support.

Predictors of hospitals' organizational climates and nurses' intent to stay in Jordanian hospitals

This paper aimed at studying variables of hospitals' organizational climates and nurses' intent to stay and determine predictors of the two concepts. A survey using a convenience sampling technique was used to collect data. A total of 362 nurses from three types of hospitals were recruited. Farly's Nursing Practice Environment Scale (NPES) was used to assess the organizational climates at Jordanian hospitals (Farly and Nyberg, 1990). McCain's Behavioral Commitment Scale (McCloskey, 1990) was used to measure nurses' intent to stay. Stepwise regression analyses were used to indicate predictors of hospitals' organizational climates and nurses' intent to stay.

Quality of care and professionalism were major variables influenced hospitals' organizational climates. Nurses reported that they plan to keep their jobs for at least two or three years. Nurses' intent to stay, time commitment, types of hospitals and average daily census were predictors of hospitals' organizational climates. Predictors of nurses' intent to stay were hospitals' organizational climates, decision-making style, age and organizational structures.

Managerial interventions that would create supportive work environments are needed to encourage nurses to stay longer at their jobs. These interventions include, but are not limited to, using participative management and supportive leadership, decreasing workload and employing nurses who work on a full-time basis.

Giving voice to registered nurses' decisions to work

The purpose of this paper was to give voice to the concerns of registered nurses (RNs) who wrote comments on a survey about RNs' intent to work. Each comment (n = 472) was analyzed using thematic analysis. Four themes describe RNs' reflections on working: (a) competing priorities, (b) balancing priorities, (c) practice deterrents, and (d) collegial support encourages nurses to stay in practice. Understanding these reflections gives insight into the complexity of decisions to work and the RNs' struggle to practice. With this insight, RNs may consider decisions about their work throughout their job trajectories that may foster a more fulfilling nursing career.

Job satisfaction in a Norwegian population of nurses: A questionnaire survey

BACKGROUND

Although job satisfaction is a factor that influences retention, turnover and quality of nursing care globally, there are few studies exploring these factors in European countries.

OBJECTIVES

To describe job satisfaction among hospital nurses in Norway, to explore the relationship between nurses' job satisfaction and participation in a clinical ladder program and to explore relationships between several variables and intent to stay. A secondary purpose was to investigate the use of a job satisfaction instrument in a different culture than its origin.

DESIGN

In a survey, 2095 nurses in four different hospitals answered a questionnaire that included demographic data, intent to stay and a job satisfaction instrument covering the importance of and actual satisfaction with different job factors.

RESULTS

Interaction, followed by pay and autonomy were the most important job factors for Norwegian nurses. Actual job satisfaction was similar to nurses in other countries. There was no significant difference in job satisfaction between participants and non-participants in a clinical ladder. Nurses intending to stay more than a year were significantly more satisfied in their job. Further education and 1 day or more scheduled for professional development were factors that were positively related to intent to stay in the hospital.

CONCLUSIONS

Norwegian nurses' views on the importance of different job factors mirrored views of the importance ascribed to working milieu in the Norwegian society. As such, the instrument used seemed sensitive to cultural differences. Nurses' actual satisfaction with their job was similar to respondents in many other countries and may imply that structures and content defining nurses' working situation are similar in many parts of the world. Participation in a clinical ladder did not increase nurses' overall job satisfaction. However, further education and the opportunity for professional development increased nurses' intention to stay in the organization.

Nurse turnover: a literature review

Ongoing instability in the nursing workforce is raising questions globally about the issue of nurse turnover. A comprehensive literature review was undertaken to examine the current state of knowledge about the scope of the nurse turnover problem, definitions of turnover, factors considered to be determinants of nurse turnover, turnover costs and the impact of turnover on patient, and nurse and system outcomes. Much of the research to date has focused on turnover determinants, and recent studies have provided cost estimations at the organizational level. Further research is needed to examine the impact of turnover on health system cost, and how nurse turnover influences patient and nurse outcomes.

Job satisfaction among nurses: a literature review

The current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any health-care delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction. This paper analyses the growing literature relating to job satisfaction among nurses and concludes that more research is required to understand the relative importance of the many identified factors to job satisfaction. It is argued that the absence of a robust causal model incorporating organizational, professional and personal variables is undermining the development of interventions to improve nurse retention.

Predictors of nurses' intent to stay at work in a university health center

The purpose of the present study was to evaluate nurses' intent to stay at work and to determine the associations between intent to stay and various predictors. A sample of 108 nurses at a single tertiary care hospital filled in a questionnaire on intent to stay, satisfaction at work, satisfaction with administration, organizational commitment and work group cohesion. The results showed that the majority of nurses are planning to stay in their current job. Satisfaction at work and satisfaction with administration are the best predictors of intent to stay and explained 25.5% of intent to stay variance. It is possible that developing strategies based on the predictors of intent to stay at work could improve that intent. Healthcare organizations could consider this with the objective of increasing nurses' intent to stay at work and, consequently, retention.

Staff satisfaction and its components in residential aged care

OBJECTIVE

The purpose of this study was to assess the direction and magnitude of the effects among the components of staff satisfaction in residential aged care and to examine whether the relationships among satisfaction components vary according to facility type (i.e. nursing homes and hostels). A hostel is a low care facility in which residents are more independent, have a lower level of care needs, and receive personal but not nursing care.

DESIGN

A cross-sectional survey design was adopted to collect the required information, and a stratified random sampling approach was utilized to select facilities. Structural equation modeling was used to examine relationships among satisfaction components.

SETTING

Seventy residential aged care facilities in Western Australia.

STUDY PARTICIPANTS

The sample includes 610 nursing home and 373 hostel care staff.

RESULTS

The relationships among satisfaction components are different for nursing home and hostel staff. Professional support is found to have a strong and positive effect on all other aspects of staff satisfaction.

CONCLUSION

The findings lead to an improved understanding of the interrelationship among staff satisfaction components, which has important implications through enhancing professional support. This needs to be recognized and emphasized by managers, care providers, and policy makers so as to maintain stable personnel and continuity of care.