Longitudinal Analysis of Personal and Work-Related Factors Associated With Turnover Among Nurses

Situations of anomie and the health workforce crisis: Policy implications of a socially sensitive and inclusive approach to human resources

Health systems in most jurisdictions are facing an unprecedented workforce crisis, manifesting as labour shortages, high staff turnover, and increasing rates of absenteeism and burnout. These issues affect professional and occupational groups in both health and social care and individuals at early and later stages of their career. The intensity and pervasiveness of the crisis suggests that it is a multicausal phenomenon. Studies have focused on the relationship between working environments and worker satisfaction and well-being. However, these are of limited use in understanding the deeper mechanisms behind the large-scale workforce crisis. The subjective experience of work, while rooted in a particular work context, is also shaped by broader social and cultural phenomena that put social norms and individuals' ability to conform to them in tension. The concept of anomie, initially developed by Durkheim and redefined by Merton, focuses on the way social norms that guide conduct and aspirations lose influence and become incompatible with each other or unsuited to contemporary work contexts. Understanding the workforce crisis from the perspective of anomie enables the development and implementation of novel policies based on co-production strategies where concerned publics engage collaboratively in framing the problem and searching for solutions.

From Restricted Resources to Ethical Burden-Former Home Care Workers' Reasons for Leaving Their Jobs

The study examines former home care workers' reasons for leaving their jobs from the perspective of reforms in public services and eldercare policies impacted by New Public Management (NPM) in Finland. Written narratives from former home care workers (n = 39) were collected online and analyzed using thematic content analysis. Former home care workers' reasons for leaving their jobs were connected to four interconnecting themes: mismatch between needs and resources, measurement-driven practices, unbalancing work-life, and ethical burden. These reasons reflected critical changes in the organization of care work and the work environment in older adults' home care. Contradictions between needs, resources, and values lead to ethical dilemmas and push away from the workforce in eldercare. To improve care workers' willingness to remain in the eldercare sector, changes are needed in the resourcing and organization of home care, including managerial support in everyday care work.

Worldwide prevalence and associated factors of nursing staff turnover: A systematic review and meta-analysis

AIMS

To systematically assess the worldwide prevalence of nurse turnover and discuss its influencing factors.

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, the Cochrane Library, Web of Science, CINAHL, China Knowledge Resource Integrated Database, Wanfang Database were searched from their commencement date to 25 March 2021. Two authors independently reviewed the studies. Stata 15.0 software package was used for statistical analysis, with estimates of data on the prevalence of nurse turnover using a random-effects model. This review was performed according to the Joanna Briggs Institute (JBI) manual for evidence synthesis and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement. PROSPERO Registration Number:CRD42020208873.

RESULTS

A total of 15 studies covering 852,317 nurses were included in the analyses. The pooled prevalence of nurse turnover was 18% (95% CI: 11% to 26%, I2  = 99.86%, p < 0.0001). Geographic regions (Asia), published years (2001 to 2010) and respondents (new nurses) were significantly associated with the prevalence of nurse turnover. Additionally, several risk factors for turnover were identified in the literature, involving demographic factors (young, single, have short working hours, lower level of education and male nurses), organizational factors (small-scale hospitals, low salary levels, larger workload, developed region and absence of labour union), satisfaction (dissatisfaction with organization, profession, job and competence).

The Role of Continuing Professional Training or Development in Maintaining Current Employment: A Systematic Review

The impact of continuing job education and professional development on early exit from the labor market is unclear. This systematic review examined how continuing job education or professional development influences the retention of current employment. We searched the PubMed and Embase databases from their start dates to January 2023. Two reviewers screened the full texts of relevant reports and assessed the methodological quality of the included studies using the adapted Effective Public Health Practice Project quality assessment. We qualitatively synthesized the results of the included studies. We screened 7338 publications and included 27 studies consisting of four cohort and 23 cross-sectional studies in the review. The participants of the selected studies were mostly from the health sector (24 studies). There were 19 studies on staying or leaving a current job, six on employee turnover intention, two on job change, one on return to work, one on early retirement, and one on employment. Continuing employee development or training opportunities were associated with increased intention to stay in a current job, decreased intention to leave a current job, decreased employee turnover intention, job change, or early retirement and with faster return to work. One of the two studies that examined the role of age showed that continuing employee development is a more important factor for retaining current employment among younger than older employees. A few studies found that job satisfaction and commitment fully mediated the relationship between employee development and employee intention to leave current employment. This study suggests that participating in professional training/development is related to a lower risk of leaving current employment.

Development of the Workplace Interpersonal Problems Scale for Care Workers (WIPS) and examination of its reliability and validity

Introduction

The turnover rate of care workers has remained high by global standards, with previous studies showing an association between workplace interpersonal relations and care worker turnover and turnover intentions. This study details the development of the Workplace Interpersonal Problems Scale for Care Workers (WIPS) and examines its reliability and validity according to the COSMIN guidelines.

Methods

A total of 476 care workers employed by elder care facilities participated in the study. This study examined the reliability and validity of the WIPS after its development. Reliability was evaluated using Cronbach's α, test reliability with the standard error of measurement, and test-retest reliability with the intraclass correlation coefficient. Content validity, construct validity, and structural validity were examined to evaluate validity.

Results

Both total and subscale scores of the WIPS had a Cronbach's α coefficient >0.75 and high test-retest reliability (intraclass correlation coefficient, 0.75). Content validity analysis showed the item-content validity index of ≥0.90 for all WIPS items, confirming 100% of the hypotheses for testing construct validity. Confirmatory factor analysis showed an acceptable fit for the hypothesized six-factor construct (CFI = 0.92, TLI = 0.91, RMSEA = 0.07, SRMR = 0.05).

Conclusions

The WIPS was found to be a valid and reliable instrument. With the growth of the elderly population worldwide, we believe that the WIPS will be a useful quantitative measure to assess workplace interpersonal problems affecting care workers in various aspects.

Why do workers leave geriatric care, and do they come back? A timing of events study

BACKGROUND

In many industrialized countries, demographic change is accompanied by increasing demand for geriatric care workers, which in turn intensifies the need to retain them or to attract them back after leaving. Although much is known about the intention of workers to leave, little is known about how many of them actually do leave and return to geriatric care at a later stage in a comprehensive framework.

OBJECTIVE

To examine and explain how many workers withdraw from geriatric care, take up other occupations, and return to geriatric care at a later stage in their careers, and the reasons behind this.

DESIGN

This study used administrative daily data that cover all workers in Germany who started working in geriatric care in the period 1996 to 2018 and observed their employment biographies for a maximum of 26 years.

METHODS

Kaplan-Meier survival analysis and parametric regression survival-time analysis were used to estimate the survival rates and to estimate individual, workplace and regional determinants of leaving and returning to geriatric care.

RESULTS

Workers in geriatric care were more likely to leave the profession than other workers, two thirds withdrew within five years of first taking up work in geriatric care. If they remained in employment, they generally chose an occupation related to geriatric care. Half of the leavers returned to geriatric care again within eight years. Individual and workplace-related factors, such as age and remuneration, are statistically significant predictors of leaving and returning.

CONCLUSIONS

The findings emphasize how important it is for organizations to keep in touch with geriatric care workers leaving their job, since a substantial share of them returns again.

Key Factors for Enhancing Home Care Workers' Intention to Stay by Multiple-Criteria Decision Analysis

The ageing population is increasing rapidly in Taiwan, where the ageing rate exceeds even that of Japan, the United States and France. The increase in the disabled population and the impact of the COVID-19 pandemic have resulted in an increase in the demand for long-term professional care, and the shortage of home care workers is one of the most important issues in the development of such care. This study explores the key factors that promote the retention of home care workers through multiple-criteria decision making (MCDM) to help managers of long-term care institutions retain home care talent. A hybrid model of multiple-criteria decision analysis (MCDA) combining Decision-Making Trial and Evaluation Laboratory (DEMATEL) and the analytic network process (ANP) was employed for relative analysis. Through literature discussion and interviews with experts, all factors that promote the retention and desire of home care workers were collected, and a hierarchical MCDM structure was constructed. Then, the hybrid MCDM model of DEMATEL and the ANP was used to analyze the questionnaire data of seven experts to evaluate the factor weights. According to the study results, the key direct factors are improving job satisfaction, supervisor leadership ability and respect, while salary and benefits are the indirect factor. This study uses the MCDA research method and establishes a framework by analyzing the facets and criteria of different factors to promote the retention of home care workers. The results will enable institutions to formulate relevant approaches to the key factors that promote the retention of domestic service personnel and to strengthen the intention of Taiwan's home care workers to stay in the long-term care industry.

Work Environment and Operational Failures Associated With Nurse Outcomes, Patient Safety, and Patient Satisfaction

BACKGROUND

Operational failures, defined as the inability of the work system to reliably provide information, services, and supplies needed when, where, and to who, are a pervasive problem in U.S. hospitals that disrupt nurses' ability to provide safe and effective care.

OBJECTIVES

We examined the relationship between operational failures, patient satisfaction, nurse-reported quality and safety, and nurse job outcomes (e.g., burnout and job satisfaction) and whether differences in hospital work environments explained the relationship.

METHODS

We conducted a cross-sectional analysis using population-based survey data from 11,709 registered nurses in 415 hospitals who participated in the RN4CAST-US nurse survey (2015-2016) and the 2016 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The RN4CAST-US nurse survey focused on hospital quality and safety, job outcomes, and hospital work environments. The HCAHPS survey collected publicly reported patient data on their satisfaction with their care. Operational failures were evaluated using an eight-item composite measure that assessed missing supplies, orders, medication, missing/wrong patient diet, electronic documentation problems, insufficient staff, and time spent on workarounds and nonnursing tasks. Multilevel regression models were used to test the hypothesized relationships.

RESULTS

Operational failures were associated with low patient satisfaction scores, poor quality and safety outcomes, and poor nurse job outcomes, and those associations were partly accounted for by hospital work environments.

DISCUSSION

Operational failures prevent high-quality care and positive patient and nurse outcomes. Operational failures and the hospital work environment should be targeted simultaneously to maximize quality improvement efforts. Hospital leadership should work with frontline staff to identify and target the sources of operational failures in nursing units. Improvements to hospital work environments may reduce the occurrence of operational failures.

The attractiveness of jobs in the German care sector: results of a factorial survey

The skilled labour shortage in nursing is an issue not unique to Germany. Unattractive characteristics of nursing jobs are one reason for the low supply in nursing personnel. In our study, we analyse the influence of job characteristics on the attractiveness of nursing jobs. We address this issue via factorial survey analysis, an experimental method particularly suited to assessing personal opinions and less prone to social desirability bias than standard interview methods. Around 1300 (current and former) nurses in a distinct region in Germany were asked to rate a set of synthetic job postings, each of which contained information on 9 systematically varied job characteristics. We find that, first, attractiveness of care jobs is most strongly affected by rather "soft" characteristics such as atmosphere within the team and time for patients. "Hard" factors play a considerably smaller role. Second, one hard factor, contract duration, is estimated to be among the most important job factors, however. This is a remarkable finding given that nursing occupations suffer from severe skill shortages. Third, though wage has a statistically significant influence on attractiveness, enormous wage raises would be needed to yield higher attractiveness gains than the top-rated soft factors, or to compensate for less pleasant job characteristics with respect to those factors. Last, even after controlling for other job characteristics, hospital nursing is still rated as more attractive than geriatric nursing.

Does registered nurse involvement in improving healthcare services, influence registered nurse retention?

Background

Registered nurses are ‘critical’ to population health, international responses to emergencies, epidemics and disasters. Retention of registered nurses (RNs) is an international nursing priority. In England, RNs are encouraged to be involved in improving healthcare services. This benefits quality of care, operational and financial performance. However, RN involvement in improvement may reduce RN retention. It is important to understand this relationship when developing effective RN retention strategies.

Aim

The purpose of this research is to describe possible relationships between RN involvement in improving healthcare services and RN retention, using published 2018 data for National Health Service (NHS) Trusts in England.

Methods

The relationship between RN involvement in improving healthcare services and RN retention was explored using a correlational design, involving secondary data from the annual NHS Staff Survey and Model Hospital.

Results

In mental health NHS Trusts in England, a statistically significant, positive correlation of 0.24 was found between RN ‘ab(ility) to make suggestions for improvement’ and RN retention. In mental health NHS Trusts, a statistically significant correlation of 0.278 was found between RNs ‘making improvements happen’ and RN retention. In acute NHS Trusts in England, a statistically significant, negative correlation of −0.15 was identified between RNs ‘mak(ing) improvements happen’ and RN retention.

Conclusions

The findings suggest that RN retention factors in mental health and acute NHS Trusts differ from community and specialist NHS Trusts in England. This is an important consideration for national RN retention programmes as a single approach to RN retention may not be effective across all healthcare settings.

Factors Affecting Turnover Intention among New Graduate Nurses: Focusing on Job Stress and Sleep Disturbance

Despite the high prevalence of nurses’ turnover and the turnover intention of new nurses, there are insufficient studies examining turnover intention at the time when job orientation is completed and independent nursing commences. Thus, this study examined turnover intention levels and identified the factors affecting turnover intention of new Generation Z nurses, focusing on job stress and sleep disturbance, at the eighth week after completing job orientation. This was a cross-sectional descriptive correlational study. Using a convenient sampling method, 133 new nurses were recruited. Data were collected using a structured questionnaire consisting of demographic and occupational characteristics, job stress, sleep disturbance, and turnover intention. Descriptive statistics were computed to describe the sample and interest variables. Logistic regression analysis was performed to examine the association of job stress and sleep disturbance with turnover intention. Most nurses were women (91.7%) and approximately two-thirds worked in the surgical ward (n = 61, 45.9%). Turnover intention was 12.8%, average job stress was 40.11 ± 90.7, and average sleep disturbance was 42.39 ± 15.27. New graduate nurses’ turnover intention was associated with job stress (OR = 1.07, 95% CI = 1.02–1.12) and sleep disturbance (OR = 1.19, 95% CI = 1.05–1.35), and this model explained 47.7% of the variance. Study findings determine that job stress and sleep disturbance were significant predictors of turnover intention in new nurses at the eighth week after joining the hospital. Therefore, nursing administrators should focus on new nurses’ job stress and sleep disturbance, and provide them with timely assessment and management to reduce turnover intention.

The Impact of Hospitality Work Environment on Employees' Turnover Intentions During COVID-19 Pandemic: The Mediating Role of Work-Family Conflict

Employees' turnover intentions and work-family conflict as a result of the hospitality work environment are considered the major global challenges confronted by hospitality organizations, especially in the era of COVID-19. This study aims at identifying the impact of the hospitality work environment on work-family conflict (WFC), as well as turnover intentions and examining the potential mediating role of WFC in the relationship between work environment and turnover intentions, during the COVID-19 pandemic in a sample of three- and four-star resorts in Egypt. A total of 413 resorts employees from Egyptian destinations (Sharm El-Sheikh and Hurghada) participated in the study. The findings of the Structural Equation Modeling (SEM) revealed that the hospitality work environment significantly and positively affects employees' turnover intentions and WFC. In the context of the mediating role of WFC, results illustrated that WFC significantly partially mediates the relationship between the hospitality work environment and turnover intentions. Upon these findings, the study suggests that to prevent WFC and eliminate turnover intentions among resorts' employees, an urgent need to create a better work environment is vitally important. limitations and future research directions have been discussed.

Explaining nursing attrition through the experiences of return-to-practice students: a mixed-methods study

BACKGROUND

Nurse shortage is an international issue that has adverse effects on health and the quality of care of whole populations.

AIMS

The study aimed to explore attrition experienced by return-to-practice students attending higher education institutions in England.

METHODS

A mixed-methods design, involving questionnaires (n=114) and in-depth interviews (n=20), was used.

FINDINGS

Just over half (52%) of respondents left nursing after ≥10 years. Most of these (84%) stayed in alternative employment during their break from nursing. There were two distinct reasons for leaving nursing: the inability to maintain a positive work/life balance and a lack of opportunity for career advancement while retaining nursing registration. Respondents reflected positively on their nursing experience yet frequently reported significant personal or professional incidents prompting their decision to leave.

CONCLUSION

The reasons nurses leave are complex. Professional bodies and managers need to work together to address concerns many nurses have during their careers that lead to them deciding to leave the profession.

Influence of Striving for Work-Life Balance and Sense of Coherence on Intention to Leave Among Nurses: A 6-Month Prospective Survey

The increase in the elderly population in need of healthcare services has led to a serious shortage in the nursing workforce. To retain a large nursing workforce, a strong work–life balance among nurses is needed along with a healthy work environment. This prospective study investigates the influence of work–life balance and sense of coherence on intention to leave among hospital nurses. A questionnaire survey was conducted with 2239 nurses as a baseline. The explanatory variables included striving for work–life balance behavior, a sense of coherence in terms of personal resources, and work-, organizational-, and individual-related factors. Using a cohort of 1368 valid responses, we measured intention to leave among 975 nurses with whom we were able to follow up 6 months after the baseline survey. We then performed multiple regression analysis. The behavior striving for work–life balance was shown to influence nurses’ intention to leave. Nurses who exhibited less striving for work–life balance behavior showed higher intentions to leave. The sense of coherence was not identified as a factor affecting intention to leave. Securing a comfortable work–life balance would reduce the nurses’ desire to quit the hospital. To reduce nurse turnover, nurse managers should develop support programs that can help nurses achieve a better work–life balance.

Generational Differences in Nurses' Intention to Leave

There are many studies about nurses' intention to leave their jobs and contributing factors. However, there is a lack of research about generational differences in nurses' intention to leave. This evidence may help with workforce planning and targeting specific generations of nurses with retention interventions. Using the National Database of Nursing Quality Indicators 2018 Annual Registered Nurse Survey, we used descriptive statistics and multivariate logistic regression to examine the prevalence of and reasons for nurses' intention to leave in the next year by generational age group. Our sample included 207,636 hospital nurses from across the United States. We found that 21% of nurses (n = 44,082) reported intention to leave. When comparing generations, there were differences in intention to leave, as well as differences in potentially preventable, career advancement, and personal intention to leave reasons. Workload/staffing was a common reason across generations, indicating that certain interventions may be applicable regardless of generation.

Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context

OBJECTIVE

The aim of this study was to assess whether frequency of occupational violence (OV) affects posttraumatic stress disorder (PTSD) symptoms through nontraumatic strains in the occupational context.

METHODS

Twelve-month prospective survey data on 1763 Social educators were used. Path-analysis measured direct and indirect pathways of frequency of OV on PTSD through change in time pressure, change in burnout, change in sense of safety at work, and change in coping with regret in patient work.

RESULTS

Forty-two pct. of the variance in PTSD symptoms was predicted; F (20, 1541) = 36.8, P < 0.001, R = 0.42. Frequency of OV indirectly affected level of PTSD through all the mediators; estimated indirect effects = 0.14, 95% confidence interval 0.07 to 0.22.

CONCLUSION

PTSD resulting from OV is not only a result of the violent acts themselves but is also caused by nontraumatic strains. It is essential to include the broader context of work environment factors in prevention of work-related PTSD.

A pilot study on the possibility of human-centred participative redesign of work organization at psychiatric wards

WHAT IS KNOWN ON THE SUBJECT?: Rationalization and an increasing shortage of nurses in psychiatric care require the improvement of working conditions. Work organization of hospital wards determines nurses' well-being on the job. In somatic care, observation-based assessments and participative improvements of work organization in the wards by involved nurses can reduce workload. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: In psychiatric nursing, observation-based assessment as well as nurses' self-reports may identify characteristics of ward organization that determine nurses' well-being. This study suggests a system of characteristics of work organization at psychiatric wards that may guide participative analyses and improvement measures. This may contribute to the research on prevention of conflicts and aggressive behaviour in psychiatric wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Participative analysis and, if necessary, participative redesign of work organization at psychiatric wards may reduce nurses' perceived work load. An approach to address the above is suggested for psychiatric nursing, which, in another version, is proven effective in somatic care. ABSTRACT: Introduction The study was based on an approach for participative improvement of work organization at somatic hospital wards related to characteristics that determine nurses' health. It differed from research seeking to adjust the environment to prevent aggressive behaviour at psychiatric wards. The focus was on the ergonomic principles of the whole work system and its impact on the nurses' health. Aim/Question We analysed the prerequisites for a transfer of this approach to psychiatric nursing. Method This study employed a cross-sectional design examining 11 wards of a hospital for psychiatry and neurology; 109 nurses participated. We used a multi-method design with observation-based assessments and nurses' self-reports of ward organization. Results Two clusters with wards of different work organization were identified. One cluster consisted of better-organized wards. The other included wards with a worse organization. We found substantial convergence between the observation-based assessments and nurses' self-reports. Discussion This study results indicated that observation-based assessments were an acceptable alternative to nurses' self-reports, enabling the evaluation of ward organization in a feasible and reliable way. Implications for practice This study showed an approach with a specific view on the structural quality of psychiatric wards; this may support work improvement processes in a more systematic way.

Self-Leadership Among Healthcare Workers: A Mediator for the Effects of Job Autonomy on Work Engagement and Health

Due to the high workload, working within the healthcare industry can be quite demanding. This often results in high rates of absenteeism, unfulfilled vacancies, and voluntary turnover among healthcare workers. We expect that job autonomy is an important resource for work engagement and health of healthcare workers because it satisfies the basic need for autonomy. However, we propose that this relationship between job autonomy and work engagement and health can be explained by self-leadership. Self-leading individuals take initiative and responsibility and are assumed to use self-influencing strategies (e.g., goal setting, self-observation, creating natural rewards) as a way to improve motivation and general well-being. Employees from two healthcare organizations (N = 224 and N = 113) completed a questionnaire containing measures of job autonomy, work engagement, general health, and self-leadership. The hypothesized model was tested using a series of regressions, and the results confirmed the indirect relationships between job autonomy and work engagement and general health, respectively, through natural rewards strategies. The behavior-focused and cognitive self-leadership strategies were, as mediator, marginally significant: positively for work engagement and negatively for general health. Self-leadership behavior was not related with work engagement and general health. Implications of the findings for theory and practice on healthy healthcare workers are discussed.

Association between Health Problems and Turnover Intention in Shift Work Nurses: Health Problem Clustering

Shift work nurses experience multiple health problems due to irregular shifts and heavy job demands. However, the comorbidity patterns of nurses’ health problems and the association between health problems and turnover intention have rarely been studied. This study aimed to identify and cluster shift work nurses’ health problems and to reveal the associations between health problems and turnover intention. In this cross-sectional study, we analyzed data from 500 nurses who worked at two tertiary hospitals in Seoul, South Korea. Data, including turnover intention and nine types of health issues, were collected between March 2018 and April 2019. Hierarchical clustering and multiple ordinal logistic regressions were used for the data analysis. Among the participants, 22.2% expressed turnover intention and the mean number of health problems was 4.5 (range 0–9). Using multiple ordinal logistic regressions analysis, it was shown that sleep disturbance, depression, fatigue, a gastrointestinal disorder, and leg or foot discomfort as a single health problem significantly increased turnover intention. After clustering the health problems, four clusters were identified and only the neuropsychological cluster—sleep disturbance, fatigue, and depression—significantly increased turnover intention. We propose that health problems within the neuropsychological cluster must receive close attention and be addressed simultaneously to decrease nurse’s turnover intentions.

How Perceived Quality of Care and Job Satisfaction Are Associated with Intention to Leave the Profession in Young Nurses and Physicians

German hospitals are now confronted with major challenges from both shortages and fluctuations in the numbers of physicians and nurses. This makes it even more important that physicians and nurses do not prematurely leave patient care. The objective of the present study was to improve our understanding of the factors that trigger intentions to leave the profession. For this purpose, data from 1060 young physicians and nurses in hospital care were analysed. Intentions to leave the profession was assessed with the Copenhagen Psychosocial Questionnaire (COPSOQ). In the first step, the association was determined between intention to leave the profession and the factors of perceived quality of care and job satisfaction. In a second step, a mediation analysis was performed to determine the effect of perceived quality of care after correction for the possible mediator of job satisfaction. There were statistically significant negative associations between perceived quality of care and intention to leave the profession (beta: −2.9, 95% CI: −4.48–−1.39) and job satisfaction and intention to leave the profession (beta: −0.5, 95% CI: −0.64–−0.44). The effect of perceived quality of care on intention to leave the profession was partially mediated by job satisfaction. Thus, high perceived quality of care and high job satisfaction are both important factors that tend to prevent young physicians and nurses from leaving their professions.

Problems and Strengths in Psychiatric Nursing in Poland: Current Legal Regulations and Results of Survey

Introduction: National health resources are considered inadequate to meet the needs of Mental Health services in Poland due in part to insufficient funding. The status of the nursing profession is autonomous and independent, and one that bears much public trust. Nevertheless, psychiatric nursing is in deep crisis.Aim of the study: To determine the strengths and limitations of the psychiatric nursing system in Poland.Method: Participants of a major Psychiatric Nursing Conference in Poland were surveyed in terms of professional job satisfaction and current problems encountered in psychiatric nursing. Results were appropriately categorized and subjected to quantitative analysis.Results: There were 74 subjects, amounting to a 70% response rate who completed the study questionnaire. Problem areas were focused on how the mental health system is organized and on staff working conditions that included terms of employment and salaries. The main reasons for job satisfaction were those issues associated with the treatment process. Two participants replied that they were not satisfied.Discussion: The numerous problems encountered in Polish psychiatry nursing require further debate and the updating of legal regulations to increase funding. Recently introduced regulations on the minimal standards acceptable for nurse/bed ratios have however been postponed until 2021. The issues concerning job satisfaction have also been referred to in previous studies.Implication for practice: The crisis facing psychiatric nursing in Poland requires systemic changes in both legal regulations and financing. Notwithstanding, such professionals and their societies could facilitate the necessary changes through enhancing public debate and stimulating nursing-focused research.

Arbeitsbedingungen und Gesundheitszustand junger Ärzte und professionell Pflegender in deutschen Krankenhäusern

Hintergrund

Tief greifende Veränderungen im Gesundheitswesen haben für junge Angestellte in der stationären Patientenversorgung zu einem stark verdichteten Arbeitsalltag geführt. Vorarbeiten legen eine Gesundheitsgefährdung durch diese Arbeitsbedingungen nahe.

Ziel der Arbeit

Diese Studie hatte zum Ziel, mit einer interprofessionellen Erhebung aktuelle Belastungsfaktoren, deren Konsequenzen und subjektive Verbesserungsbedarfe zu untersuchen.

Methoden

Im September 2017 wurde eine anonymisierte Querschnittserhebung unter Ärzten und professionell Pflegenden bis ≤35 Jahre und mit maximal 6 Jahren Berufserfahrung in der stationären Patientenversorgung durchgeführt. Der Feldzugang erfolgte über sieben teilnehmende Fachgesellschaften und Berufsverbände. Der elektronische Fragebogen enthielt überwiegend validierte Erhebungsinstrumente. Durch Regressionsmodelle wurden mögliche Störfaktoren in die Datenanalyse einbezogen.

Ergebnisse

In die endgültige Analyse gingen 1060 komplette Fälle ein. Die Teilnahmequote lag bei 13 %. Es wurden u. a. zeitliche und psychosoziale Belastungsfaktoren mit überwiegend erheblicher Ausprägung festgestellt. Diese Belastungsfaktoren sind mit einem reduzierten Gesundheitszustand und erhöhtem Burn-out-Risiko sowie einer subjektiv schlechteren Versorgungsqualität assoziiert. Junge Ärzte wünschen sich weniger Dokumentation und eine Reduktion der Arbeitsverdichtung; junge Pflegende erwarten eine leistungsgerechte Bezahlung und festgelegte Personalschlüssel.

Diskussion

Aktuelle Arbeitsbedingungen stellen eine Gesundheitsgefährdung junger Angestellter in der stationären Patientenversorgung dar. Es müssen Rahmenbedingungen geschaffen werden, die den Leistungserbringern nachhaltig ein gesundes und effektives Arbeiten ermöglichen.

Turnover intention of hospital staff in Ontario, Canada: exploring the role of frontline supervisors, teamwork, and mindful organizing

BACKGROUND

This study contributes to a small but growing body of literature on how context influences employee turnover intention. We examine the impact of staff perceptions of supervisory leadership support for safety, teamwork, and mindful organizing on turnover intention. Interaction effects of safety-specific constructs on turnover intention are also examined.

METHODS

Cross-sectional survey data were collected from nurses, allied health professionals, and unit clerks working in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario.

RESULTS

Hierarchical regression analyses showed that staff perceptions of teamwork were significantly associated with turnover intention (p < 0.001). Direct associations of supervisory leadership support for safety and mindful organizing with turnover intention were non-significant; however, when staff perceived lower levels of mindful organizing at the frontlines, the positive effect of supervisory leadership on turnover intention was significant (p < 0.01).

CONCLUSIONS

Our results suggest that, in addition to teamwork perceptions positively affecting turnover intentions, safety-conscious supportive supervisors can help alleviate the negative impact of poor mindful organizing on frontline staff turnover intention. Healthcare organizations should recruit and retain individuals in supervisory roles who prioritize safety and possess adequate relational competencies. They should further dedicate resources to build and strengthen the relational capacities of their supervisory leadership. Moreover, it is important to provide on-site workshops on topics (e.g., conflict management) that can improve the quality of teamwork and consequently reduce employees' intention to leave their unit/organization.

Impact of Job Demands and Resources on Nurses' Burnout and Occupational Turnover Intention Towards an Age-Moderated Mediation Model for the Nursing Profession

This longitudinal study among Registered Nurses has four purposes: (1) to investigate whether emotional, quantitative and physical demands, and family-work conflict have a negative impact on nurses' perceived effort; (2) to investigate whether quality of leadership, developmental opportunities, and social support from supervisors and colleagues have a positive impact on meaning of work; (3) to investigate whether burnout from the combined impact of perceived effort and meaning of work mediates the relationship with occupational turnover intention; and (4) whether the relationships in our overall hypothesized framework are moderated by age (nurses categorized under 40 years versus ≥ 40 years old). In line with our expectations, emotional, quantitative, and physical demands, plus family-work conflict appeared to increase levels of perceived effort. Quality of leadership, developmental opportunities, and social support from supervisors and colleagues increased the meaning of work levels. In addition, increased perceived stress resulted in higher burnout levels, while increased meaning of work resulted in decreased burnout levels. Finally, higher burnout levels appeared to lead to a higher occupational turnover intention. Obviously, a nursing workforce that is in good physical and psychological condition is only conceivable when health care managers protect the employability of their nursing staff, and when there is a dual responsibility for a sustainable workforce. Additionally, thorough attention for the character of job demands and job resources according to nurses' age category is necessary in creating meaningful management interventions.

Factors associated with internal medicine physician job attitudes in the Veterans Health Administration

Background

US healthcare organizations increasingly use physician satisfaction and attitudes as a key performance indicator. Further, many health care organizations also have an academically oriented mission. Physician involvement in research and teaching may lead to more positive workplace attitudes, with subsequent decreases in turnover and beneficial impact on patient care. This article aimed to understand the influence of time spent on academic activities and perceived quality of care in relation to job attitudes among internal medicine physicians in the Veterans Health Administration (VHA).

Methods

A cross-sectional survey was conducted with inpatient attending physicians from 36 Veterans Affairs Medical Centers. Participants were surveyed regarding demographics, practice settings, workplace staffing, perceived quality of care, and job attitudes. Job attitudes consisted of three measures: overall job satisfaction, intent to leave the organization, and burnout. Analysis used a two-level hierarchical model to account for the nesting of physicians within medical centers. The regression models included organizational-level characteristics: inpatient bed size, urban or rural location, hospital teaching affiliation, and performance-based compensation.

Results

A total of 373 physicians provided useable survey responses. The majority (72%) of respondents reported some level of teaching involvement. Almost half (46%) of the sample reported some level of research involvement. Degree of research involvement was a significant predictor of favorable ratings on physician job satisfaction and intent to leave. Teaching involvement did not have a significant impact on outcomes. Perceived quality of care was the strongest predictor of physician job satisfaction and intent to leave. Perceived levels of adequate physician staffing was a significant contributor to all three job attitude measures.

Conclusions

Expanding opportunities for physician involvement with research may lead to more positive work experiences, which could potentially reduce turnover and improve system performance.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3015-z) contains supplementary material, which is available to authorized users.

Consistent Use of Assistive Devices for Patient Transfer Is Associated With Less Patient-Initiated Violence: Cross-Sectional Study Among Health Care Workers at General Hospitals

This study investigated whether factors related to bodily contact between health care workers and patients were associated with patient-initiated violence. This cross-sectional study surveyed 496 Danish health care workers measuring patient-initiated violence, use of assistive devices, body mass index, physical exertion, frequency of patient transfers, psychosocial work environment, gender, age, and seniority. Associations were modeled using logistic regression analyses using patient-initiated violence as the outcome. Twenty-five percent of the respondents had experienced physical or verbal violence during the past year. Infrequent use of assistive devices, high physical strain, and severe obesity all significantly increased the risk of physical violence (risk ratio [RR] = 1.18, RR = 1.18, and RR = 1.16, respectively), whereas only the lack of assistive device use significantly increased the risk of verbal violence (RR = 1.13 and RR = 1.08). Consistent use of assistive devices appears to reduce the risk of patient-initiated violence. Managers should require the use of assistive devices when designing work processes for patient transfers.

Human Factors Evaluation of Surgeons' Working Positions for Gynecologic Minimal Access Surgery

STUDY OBJECTIVE

To investigate work-related musculoskeletal disorders (WRMSD) in gynaecological minimal access surgery (MAS), including bariatric (plus size) patients DESIGN: Mixed methods (Canadian Task Force classification III).

SETTING

Teaching hospital in the United Kingdom.

MEASUREMENTS

Survey, observations (anthropometry, postural analysis), and interviews.

RESULTS

Work-related musculoskeletal disorders (WRMSDs) were present in 63% of the survey respondents (n = 67). The pilot study (n = 11) identified contributory factors, including workplace layout, equipment design, and preference of port use (relative to patient size). Statistically significant differences for WRMSD-related posture risks were found within groups (average-size mannequin and plus-size mannequin) but not between patient size groups, suggesting that port preference may be driven by surgeon preference (and experience) rather than by patient size.

CONCLUSION

Some of the challenges identified in this project need new engineering solutions to allow flexibility to support surgeon choice of operating approach (open, laparoscopic or robotic) with a workplace that supports adaptation to the task, the surgeon, and the patient.

The Impact of Heavy Perceived Nurse Workloads on Patient and Nurse Outcomes

This study investigated the relationships between seven workload factors and patient and nurse outcomes. (1) Background: Health systems researchers are beginning to address nurses’ workload demands at different unit, job and task levels; and the types of administrative interventions needed for specific workload demands. (2) Methods: This was a cross-sectional correlational study of 472 acute care nurses from British Columbia, Canada. The workload factors included nurse reports of unit-level RN staffing levels and patient acuity and patient dependency; job-level nurse perceptions of heavy workloads, nursing tasks left undone and compromised standards; and task-level interruptions to work flow. Patient outcomes were nurse-reported frequencies of medication errors, patient falls and urinary tract infections; and nurse outcomes were emotional exhaustion and job satisfaction. (3) Results: Job-level perceptions of heavy workloads and task-level interruptions had significant direct effects on patient and nurse outcomes. Tasks left undone mediated the relationships between heavy workloads and nurse and patient outcomes; and between interruptions and nurse and patient outcomes. Compromised professional nursing standards mediated the relationships between heavy workloads and nurse outcomes; and between interruptions and nurse outcomes. (4) Conclusion: Administrators should work collaboratively with nurses to identify work environment strategies that ameliorate workload demands at different levels.

Norwegian nurses’ quality of life, job satisfaction, as well as intention to change jobs

With the expected future nurse shortage we need knowledge on nurses’ life and work situation. The aim of this study is to examine 498 nurses’ satisfaction with life (SwL) and job (SwJ), and intention to change job (IchJ), and to compare this with a control group of non-nurses ( n = 3,714). With data from a Norwegian population-based survey, we analysed associations between socio-demographic and work-related variables. In order to study SwL, SwJ and IchJ we performed bivariate and multivariate statistical analyses. The results show that nurses reported significantly higher SwL and SwJ than non-nurses. For nurses, high SwL was significantly associated with lower age, higher SwJ and appreciative leaders. Significant predictors of higher SwJ were: intention to stay in current job, autonomy, appreciative leader, less monotonous tasks and less stressful work. Intention to change job was associated with low age, nagging colleagues, temporary position and low SwJ. The conclusion is that nurses reported high SwL and SwJ; however, leaders should aim to promote permanent positions, and to minimize stressful work conditions and nagging coworkers.

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

Introduction:

Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care.

Aim:

This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries.

Methods:

Data on elements at the macro-level (policy), meso-level (care organisations) and micro-level (clients) are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques.

Conclusions and Discussion:

These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.

Impact of transformational leadership on nurse work outcomes

AIMS

To examine the effect of transformational leadership on early career nurses' intent to stay, job satisfaction and organizational commitment.

BACKGROUND

Lack of leadership support is one of the top reasons staff nurses leave. Current studies reported mixed results about the impact of transformational leadership on key nurse outcomes. However, little is known whether leadership directly or indirectly affects satisfaction, organizational commitment and intent to stay.

DESIGN

This study was a cross-sectional study of nurses who had been licensed for 7·5-8·5 years which was part of a 10-year longitudinal panel design.

METHODS

The analytic sample was 1037 nationally representative newly licensed Registered Nurses. Data were collected from January-March 2013. We used a probit model to model the relationship between transformational leadership and intent to stay, organizational commitment and job satisfaction.

RESULTS

Transformational leadership did not have a significant impact on intent to stay and job satisfaction, but significantly associated with organizational commitment. Organizational commitment, job satisfaction, mentor support, promotional opportunities and age were positively associated with intent to stay, while ethnicity, non-local job opportunities and work settings were negatively associated with intent to stay.

CONCLUSIONS

Transformational leadership had no direct relationship with intent to stay and job satisfaction and had a small direct positive effect on organizational commitment. Transformational leadership has potential to slow attrition and retain nurses by creating a positive work environment that supports nurses. Any improvement in job satisfaction and organizational commitment would positively increase the change in probability for intent to stay.

Does Organizational Justice Modify the Association Between Job Involvement and Retirement Intentions of Nurses in Finland?

Given the growing aging population in Finland, retaining health staff to care for them is important. In an exploration of predictors of quitting before the typical retirement age, which ranges from 63 to 68 years in Finland, we examined whether organizational justice moderated the association between job involvement and retirement intentions among nurses 50 years and over. The sample was 446 nurses (70% practical nurses) working in 134 assisted living facilities providing 24-hour care for older residents in Finland. Job involvement was measured with the Job Involvement Questionnaire, and organizational justice with a scale that tapped its three dimensions: distributive justice, procedural justice, and interactional justice. In covariance analyses, low organizational justice and low job involvement were associated with a higher likelihood of retirement intention. Both interactional justice and procedural justice moderated the association of job involvement with retirement intentions. Among nurses with low job involvement, those who experienced unjust treatment, that is, low interactional justice, and evaluated organizational procedures as unjust had significantly stronger retirement intentions than nurses with high levels of interactional and procedural justice. Distributive justice was associated with retirement intentions in both high and low job-involved respondents. Organizational justice may act as a buffer against retirement intention as one consequence of nurses' low job involvement. © 2016 Wiley Periodicals, Inc.

Understanding Turnover as a Lifecycle Process: The Case of Young Nurses

Based on the life course perspective and the sociology of individuation, this article aims to examine the temporal processes at work in the decision of nurses to leave their jobs and the role played by different life contexts in guiding this decision. A qualitative study was conducted with nurses in order to gain an in-depth understanding of the reasons why so many young nurses decide to leave their jobs.

The theoretical perspective used focuses on the importance of considering the interaction between the different spheres of a person’s life, the social environment in which they live and the work-related decisions they make. We conducted life-narrative interviews during which the nurses were asked about their overall work trajectory and the events in their work, personal, family, and social lives which, in their opinion, contributed to their decision to leave their jobs. A total of 26 nurses under the age of 35 were interviewed. The data analysis helped to identify several job-leaving pathways structured around three main dimensions: 1- the temporal aspects of the job-leaving pathways (short or long term); 2- the nurses’ subjective work experience; and 3- the stage in the nurses’ work lives or personal lives in which they found themselves when they made the decision.

The findings reveal that the nurses’ decision to leave their jobs represents a complex process that developed over a short or longer period of time and involved various dimensions of their lives. Our analysis brought out two sources of tension underlying the nurses’ decision to leave their jobs: 1- a gap between their expectations regarding the possibilities for self-realization in their jobs and the concrete realities of work; and 2- a job situation that limited the possibilities to self-realize in other spheres of their lives.

Nurses' practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country, multilevel study

BACKGROUND

Nursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied.

OBJECTIVE

The aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction.

DESIGN

Multilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied.

RESULTS

Regarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied.

CONCLUSIONS

We conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries.

Testing a theoretical model of clinical nurses' intent to stay

BACKGROUND

Published theoretical models of nurses' intent to stay (ITS) report inconsistent outcomes, and not all hypothesized models have been adequately tested. Research has focused on cognitive rather than emotional determinants of nurses' ITS.

PURPOSE

The aim of this study was to empirically verify a complex theoretical model of nurses' ITS that includes both affective and cognitive determinants and to explore the influence of relational leadership on staff nurses' ITS.

METHODOLOGY

The study was a correlational, mixed-method, nonexperimental design. A subsample of the Quality Work Environment Study survey data 2009 (n = 415 nurses) was used to test our theoretical model of clinical nurses' ITS as a structural equation model.

RESULTS

The model explained 63% of variance in ITS. Organizational commitment, empowerment, and desire to stay were the model concepts with the strongest effects on nurses' ITS. Leadership practices indirectly influenced ITS.

PRACTICE IMPLICATIONS

How nurses evaluate and respond to their work environment is both an emotional and rational process. Health care organizations need to be cognizant of the influence that nurses' feelings and views of their work setting have on their intention decisions and integrate that knowledge into the development of retention strategies. Leadership practices play an important role in staff nurses' perceptions of the workplace. Identifying the mechanisms by which leadership influences staff nurses' intentions to stay presents additional focus areas for developing retention strategies.

Predictors of the Intention to Resign Among Home-Visiting Nurses in Japan

Multivariate analysis was used to identify predictors of intention to resign in home-visiting nurses working for home-visit nursing agencies (VNAs) in Japan. Of the 214 participants, 56 (26.2%) intended to resign. Results showed that low job satisfaction (odds ratio [OR] = 2.24; 95% confidence interval [CI] = [1.49, 3.63]), working for a hospital-affiliated home-visit nursing agency (OR = 6.48; 95% CI = [1.84, 27.63]), and small allocation of service users per nurse (OR = 1.16, 95% CI [1.03, 1.34]) were significantly related to the intention to resign. Overall, approximately 30% of the nurses intended to resign. To prevent this, the number of service users assigned to a nurse should be flexible and measures should be taken to increase nurses’ job satisfaction. As autonomous organizations, hospital-affiliated home-visit nursing agencies should provide environments that encourage nurses to continue working.

Ethical climate and nurse competence – newly graduated nurses' perceptions

Background:

Nursing practice takes place in a social framework, in which environmental elements and interpersonal relations interact. Ethical climate of the work unit is an important element affecting nurses’ professional and ethical practice. Nevertheless, whatever the environmental circumstances, nurses are expected to be professionally competent providing high-quality care ethically and clinically.

Aim:

This study examined newly graduated nurses’ perception of the ethical climate of their work environment and its association with their self-assessed professional competence, turnover intentions and job satisfaction.

Method:

Descriptive, cross-sectional, correlational research design was applied. Participants consisted of 318 newly graduated nurses. Data were collected electronically and analysed statistically.

Ethical considerations:

Ethical approval and permissions to use instruments and conduct the study were obtained according to required procedures. Data were rendered anonymous to protect participant confidentiality. Completing the questionnaire was interpreted as consent to participate.

Findings:

Nurses’ overall perception of the ethical climate was positive. More positive perceptions related to peers, patients and physicians, and less positive to hospitals and managers. Strong associations were found between perceived ethical climate and self-assessed competence, turnover intentions in terms of changing job, and job satisfaction in terms of quality of care. Nurses at a higher competence level with positive views of job satisfaction and low turnover intentions perceived the climate significantly more positively.

Conclusion:

Nursing management responsible for and having the power to implement changes should understand their contribution in ethical leadership, as well as the multidimensional nature of nurses’ work environment and the interaction between work-related factors in planning developmental measures. Future research should focus on issues in nurse managers’ ethical leadership in creating ethical work environments. There is also a need for knowledge of newly graduated nurses’ views of factors which act as enhancers or barriers to positive ethical climates to develop. Interventions, continuing education courses, and discussions designed to promote positive ethical climates should be developed for managers, nurses, and multi-professional teams.