A theoretical model of job retention for home health care nurses

The Hybrid Multiple-Criteria Decision-Making Model for Home Healthcare Nurses’ Job Satisfaction Evaluation and Improvement

Objectives: To investigate and evaluate the key factors related to job satisfaction performance of home healthcare nurses (HHNs).

Methods: A total of 31 HHNs from three community hospitals in Zhejiang province were invited to participate in the study. They completed a questionnaire survey based on the home healthcare nurse job satisfaction scale (HHNJS) from February to March 2022. Consistent fuzzy preference relation (CFPR) methods and important-performance analysis (IPA) were used to obtain the attribute weights and performance for HHNs job satisfaction.

Results: The results showed that the attributes of C₁₃, C₁₄, C₁₅, C₂₃, C₂₄, C₄₂, C₅₁, and C₅₂ were key factors influencing HHNs job satisfaction.

Conclusion: The hybrid multiple-criteria decision-making (MCDM) model can help home-healthcare-agency administrators better understand the key factors related to HHNs job satisfaction and establish reasonable improvement strategies.

The development and validation of the Japanese version of job satisfaction scale: a cross-sectional study on home healthcare nurses

Objective

A reliable and valid tool is required to assess home healthcare nurses’ job satisfaction for evaluating and improving the work environment and clinical practice of home healthcare. This study aimed to develop and examine the Japanese version of the Home Healthcare Nurses’ Job Satisfaction Scale (HHNJS-J). The Home Healthcare Nurses’ Job Satisfaction Scale (HHNJS) was translated into Japanese; a backward translation was performed until equivalence between the original and the backward-translated HHNJS was confirmed. Subsequently, a mail survey was conducted among 409 home healthcare nurses from 154 home healthcare agencies in Japan. We evaluated construct validity through Confirmatory Factor Analysis (CFA), and criterion-related validity and internal consistency were also tested.

Results

The CFA revealed a second-order seven-factor structure and adequate internal consistency, although, the fit of the data to the factor structure was moderate. As per the goodness-of-fit indices of the final model of the CFA, the comparative fit index was 0.89 and root mean square error of approximation was 0.06. This newly translated scale can be used to assess the job satisfaction of home healthcare nurses within Japan. The HHNJS-J evaluated acceptable reliability and validity among Japanese home healthcare nurses and had application in clinical practice in Japan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-022-06092-2.

The Role of Schedule Volatility in Home Health Nursing Turnover

Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Using novel administrative data from one of the largest home health care organizations in the United States, this study examined turnover among home health nurses, focusing on the role of schedule volatility. We estimated separation rates among full-time and part-time registered nurses and licensed practical nurses and used daily visit logs to estimate schedule volatility, which was defined as the coefficient of variation of the number of daily visits in the prior four weeks. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. These results suggest that reducing schedule volatility for full-time nurses could mitigate nursing turnover in home health care.

Relationship Between Self-Acceptance and Intention to Stay at Work Among Clinical Nurses in China: A Cross-Sectional Online Survey

BACKGROUND

During the pandemic and with the growing shortage of nurses, the problem of how to retain existing nurses was of paramount importance. However, there is limited evidence on the relationship between nurses' self-acceptance and intention to stay.

OBJECTIVES

This study aimed to investigate the factors influencing nurses' intention to stay at work, and explore the relationship between self-acceptance and their intention to stay.

METHODS

Convenience sampling was conducted to select nurses who worked in a clinical environment during June 2020, in hospitals in Shandong Province, China. Self-designed basic information and two questionnaires, namely, the "self-acceptance questionnaire" and "intention to stay" were adopted. Mean, median, related analysis, and regression analysis were adopted to describe the relationship of self-acceptance and intention to stay on part of Chinese nurses.

RESULTS

A total of 1,015 clinical nurses participated in the survey. The mean score of intention to stay among participants was 22.00. The multiple regression analysis revealed various factors, such as age, family support the work, interest in work, job suitability, type of employment, professional level, weekly working hours, working department and self-acceptance influenced the nurse's intention to stay (β range from -1.506 to 2.249).

CONCLUSION

Our findings identified several factors that are significantly related to and impact the level of intention to stay among clinical nurses.

The relationship between resilience and intent to stay among Chinese nurses to support Wuhan in managing COVID-19: The serial mediation effect of post-traumatic growth and perceived professional benefits

Aim

To explore the mediating role of post‐traumatic growth and perceived professional benefits between resilience and intent to stay among Chinese nurses to support Wuhan in managing COVID‐19.

Design

A cross‐sectional questionnaire survey.

Methods

In May 2020, the study recruited a convenience sample of 200 Chinese nurses to support Wuhan in managing COVID‐19. A set of self‐rating questionnaires was used to measure resilience, post‐traumatic growth, perceived professional benefits and intent to stay. Structural equation modelling was performed with 5,000 bootstrap samples using AMOS 23.0.

Results

The final model provided a good fit for the data. Resilience had the strongest direct effect on intent to stay. Perceived professional benefits partially mediated the association between resilience and intent to stay. Overall, the serial multiple mediations of post‐traumatic growth and perceived professional benefits in the relationship between resilience and intent to stay was statistically significant.

Exploring the relationships among professional quality of life, personal quality of life and resignation in the nursing profession

AIM

To explore the relationships between nurses' quality of life, personal quality of life, intention to stay (ITS) and resign and factors related to resignation.

DESIGN

Prospective cohort design.

METHODS

The participants were recruited from three different levels of hospital in central Taiwan. The survey instruments were structured questionnaires including demographics, Professional Quality of Life Scale, Short Form Health Survey (SF-36) and the Scale of ITS. The survey data were collected from December 2017-August 2018. Data on nurses' resignation were collected from the hospital systems 3 months after the survey. Descriptive analysis and multiple logistic regression were used to analyse the factors predicting participants' resignation.

RESULTS

Five hundred and fifty-three participants were recruited. Forty-nine out of 553 participants resigned (8.9%). Higher scores in compassion satisfaction were related to a greater ITS (p < .05). Employment units, burnout and ITS were the predictors for resignation (p < .05). We also found that compassion satisfaction moderated the relationship between ITS and resignation.

CONCLUSION

Compassion satisfaction of nursing professionals strengthened the effect of ITS on resignation. Programmes to reinforce satisfaction and stress management could be strategies for increasing nurses' professional quality of life and retention in clinical practice.

IMPACT

The study was the first to explore the relationships between professionals' quality of life, personal quality of life, ITS and resign. The study showed that compassion satisfaction increased the effect between ITS and resignation. Sense of achievement and satisfaction were the most important factors influencing nurses to stay in clinical practice. It is important to enhance nurse compassion satisfaction in nursing career, their job identity and gratification. The effective supportive environment and self-reflection may enhance compassion satisfaction, ameliorate nurse retention and improve the quality of care.

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

PURPOSE

Pediatric nurses are at high risk for turnover. Turnover intention strongly predicts the actual voluntary turnover. Currently, no nationwide study has examined turnover intention among pediatric nurses in mainland China since the universal two-child policy implementation. Related factors associated with pediatric nurse turnover intention have not yet been identified. This study aims to understand factors related to turnover intention among pediatric nurses in mainland China.

DESIGN AND METHODS

A cross-sectional on-line questionnaire survey was conducted among 6673 pediatric nurses across mainland China. Structural equation modeling (SEM) was used to examine the relationships between job satisfaction, work stress, job burnout, organizational commitment, work-family support and turnover intention.

RESULTS

Six hundred and sixty-three (9.93%) nurses reported high turnover intention. Work stress and job burnout were directly and indirectly associated with turnover intention positively. Job satisfaction was related to turnover intention negatively with both direct effect and indirect effect through the mediations of job burnout and organizational commitment. Organizational commitment had a negative direct effect on turnover intention. Work-family support had indirect effects on turnover intention through the mediating role of burnout, job satisfaction, and organizational commitment.

CONCLUSION

Turnover intention among pediatric nurses was associated with job satisfaction, work stress, job burnout, organizational commitment and work-family support.

PRACTICE IMPLICATIONS

Attention to pediatric nurses' job burnout and work stress is important to improve job satisfaction and organizational commitment and to provide them with support in order to alleviate the turnover intention.

Evolution of Job Satisfaction and Burnout Levels of Emergency Department Professionals during a Period of Economic Recession

Satisfaction at work has been found to be a predictive factor of permanency. On the other hand, burnout has been associated with financial loss. The purpose of this study was to analyse the levels of satisfaction and burnout of professionals in a hospital emergency department and make a comparison with results from the same service during the economic recession in 2012. An analytical, cross-sectional and descriptive study was undertaken during two time periods into the levels of satisfaction and burnout of the professionals of an emergency department. Consequently, 146 replies were received. The percentage of professionals who considered their salary to be unsatisfactory in 2012 diminished in comparison with 2018 (p = 0.034), while job stability was considered more satisfactory in 2018 (p = 0.039) and the timetable in 2018 as more unsatisfactory (p = 0.009). With regards to burnout, it was observed that in 2018 the score for depersonalisation had fallen (p = 0.029) in comparison with 2012. An improvement in the level of satisfaction is observed in 2018, and more positive scores have also been found in the depersonalisation subscale in 2018. An inverse association was observed between depersonalisation in 2018 and overall satisfaction.

Caring for Critically Ill Patients: Clinicians' Empathy Promotes Job Satisfaction and Does Not Predict Moral Distress

Background

Several studies have highlighted the benefits of empathy in healthcare settings. A correlation between clinicians' empathy and patients' adherence and satisfaction, as well as the ability for the clinician to accurately assess family members' needs, has been found. However, empathy is often seen by clinicians as a risk factor for their wellbeing. This study aims to assess whether the level of empathy of clinicians working in critical care settings may expose them to moral distress, poor job satisfaction, and intention to quit their job.

Methods

Italian clinicians who attended the 2016 "Smart Meeting Anesthesia Resuscitation in Intensive Care" completed the Empathy Quotient questionnaire, the Moral Distress Scale-Revised, and two questions assessing job satisfaction and intention to quit the job. Multiple linear and logistic regressions were performed to determine if clinicians' empathy influences moral distress, job satisfaction, and intention to quit. Age, gender, and profession were used as control variables.

Results

Out of 927 questionnaires distributed, 216 were returned (23% response rate) and 210 were used in the analyses. Respondents were 56% physicians, 24% nurses, and 20% residents. Over half of the clinicians (58%) were female. Empathy resulted the only significant predictor of job satisfaction (β = 0.193; p < 0.05). None of the variables included in the model predicted moral distress.

Conclusion

Empathy determined neither moral distress nor intention to quit. Findings suggest that empathy is not a risk factor for critical care clinicians in developing moral distress and the intention to quit their job. On the contrary, empathy was found to enhance clinicians' job satisfaction.

Attributable Delay of Discharge for Children with Long-Term Mechanical Ventilation

OBJECTIVE

To assess the reasons for discharge delays for children with long-term mechanical ventilation.

STUDY DESIGN

Charts of children (0-18 years of age) with a new tracheostomy in the Pulmonary Habilitation Program at the Ann and Robert H. Lurie Children's Hospital of Chicago were retrospectively reviewed for demographic information, medical diagnoses, medical stability, discharge to home, reasons for discharge delay, and hours of staffed home nursing. All patients were discharged on mechanical ventilation. Discharge delay was defined as >10 days after medical stability. Hospital charges were analyzed and excess charges quantified beginning with the date of delay. Descriptive statistics and Pearson χ² tests were used to compare nursing hours and demographics.

RESULTS

Of 72 patients, 55% were male with mean age 1.8 years (SD 3.8) at tracheostomy placement. The most common long-term mechanical ventilation indication was chronic lung disease (n = 47, 65%); 54% had discharge delays, the majority were primarily due to lack of home nursing (62%), followed by delay of caregiver training (18%), caregiver health and social issues (8%), and delay in a transitional care facility bed (8%). Of the 39 delayed patients, 10% ($13 217 889) of hospital charges occurred during excess days with a median of $186 061 (IQR $117 661-$386 905) per patient.

CONCLUSIONS

Over one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing. This case series provides further evidence that limited availability of home nursing impedes efficient discharge and prolongs hospitalizations.

Quantitative thresholds based decision support approach for the home health care scheduling and routing problem

In the domain of Home Health Care (HHC), precise decisions regarding patient's selection, staffing level, and scheduling of health care staff have a significant impact on the efficiency and effectiveness of the HHC system. However, decentralized planning, the absence of well defined decision rules, delayed decisions and lack of interactive tools typically lead towards low satisfaction level among all the stakeholders of the HHC system. In order to address these issues, we propose an integrated three phase decision support methodology for the HHC system. More specifically, the proposed methodology exploits the structure of the HHC problem and logistic regression based approaches to identify the decision rules for patient acceptance, staff hiring, and staff utilization. In the first phase, a mathematical model is constructed for the HHC scheduling and routing problem using Mixed-Integer Linear Programming (MILP). The mathematical model is solved with the MILP solver CPLEX and a Variable Neighbourhood Search (VNS) based method is used to find the heuristic solution for the HHC problem. The model considers the planning concerns related to compatibility, time restrictions, distance, and cost. In the second phase, Bender's method and Receiver Operating Characteristic (ROC) curves are implemented to identify the thresholds based on the CPLEX and VNS solution. While the third phase creates a fresh solution for the HHC problem with a new data set and validates the thresholds predicted in the second phase. The effectiveness of these thresholds is evaluated by utilizing performance measures of the widely-used confusion matrix. The evaluation of the thresholds shows that the ROC curves based thresholds of the first two parameters achieved 67% to 71% accuracy against the two considered solution methods. While the Bender's method based thresholds for the same parameters attained more than 70% accuracy in cases where probability value is small (p ≤ 0.5). The promising results indicate that the proposed methodology is applicable to define the decision rules for the HHC problem and beneficial to all the concerned stakeholders in making relevant decisions.

Factors associated with patient information sharing among home-visiting nurses in Japan: a cross-sectional study

Background

Home-visiting nurses are expected to enhance their ability to provide adequate nursing care in a relatively isolated work environment. However, the isolated work environment leads to less opportunity to share patient information. We investigated factors relevant to better patient information sharing among home-visiting nurses, which would contribute to the improved care performance of these nurses.

Methods

A cross-sectional study with anonymous self-administered questionnaire was conducted between June 2015 and September 2015 in two districts of Japan. Home-visiting nurses who were working at home health care agencies were recruited. The questionnaires consisted of items on demographic data, job-related variables, communication in the workplace, the current state of patient information sharing, opportunities (or measures) of patient information sharing in the workplace, and job satisfaction. Descriptive analyses were performed on all variables, using the Chi-square test, Fisher’s exact test, or Mann-Whitney U-test. Logistic regression analyses were conducted to identify the factors associated with better information sharing, adjusting the years of home-visiting nursing experience as the control variable.

Results

Of 762 anonymous self-administered questionnaires were mailed, data from 482 participants who consented to this study and had no missing answer were analyzed. Of the total, 77.2% shared the patients’ information. Having a friendly adviser (OR = 2.51, 95% CI = 1.14–5.55, p = 0.023), attending some conferences (OR = 2.32, 95% CI = 1.12–4.82, p = 0.024), joining workshops (OR = 1.89, 95% CI = 1.15–3.10, p = 0.012), and years of home-visiting nursing experience (OR = 1.27, 95% CI = 1.03–1.57, p = 0.025) were significantly associated with sufficient sharing of the information. Nurses sufficiently sharing the information were well satisfied with their job (OR = 5.38, 95% CI =3.19–9.09, p < 0.001) and highly preferred a career in home-visiting nursing care (OR = 5.62, 95% CI =3.41–9.27, p < 0.001).

Conclusions

The results suggested that having opportunities to discuss face-to-face such as at conferences and workshops as well as promoting good relationships among colleagues in the workplace will contribute to better information sharing among home-visiting nurses. Home-visiting nurses with less years of experience need to be supported in order to share the information sufficiently. Additionally, sufficient information sharing was also associated with job satisfaction and preference for home-visiting nursing care, which might lead to job retention for home-visiting nurses.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3924-5) contains supplementary material, which is available to authorized users.

Attractiveness of working in home care: An online focus group study among nurses

Many western countries are experiencing a substantial shortage of home-care nurses due to the increasing numbers of care-dependent people living at home. In-depth knowledge is needed about what home-care nurses find attractive about their work in order to make recommendations for the recruitment and retention of home-care nursing staff. The aims of this explorative, qualitative study were to gain in-depth knowledge about which aspects home-care nurses find attractive about their work and to explore whether these aspects vary for home-care nurses with different levels of education. Discussions were conducted with six online focus groups in 2016 with a total of 38 Dutch home-care nurses. The transcripts were analysed using the principles of thematic analysis. The findings showed that home-care nurses find it attractive that they are a "linchpin", in the sense of being the leading professional and with the patient as the centre of care. Home-care nurses also find having autonomy attractive: autonomy over decision-making about care, freedom in work scheduling and working in a self-directed team. Variety in patient situations and activities also makes their work attractive. Home-care nurses with a bachelor's degree did not differ much in what they found attractive aspects from those with an associate degree (a nursing qualification after completing senior secondary vocational education). It is concluded that autonomy, variety and being a "linchpin" are the attractive aspects of working in home care. To help recruit and retain home-care nursing staff, these attractive aspects should be emphasised in nursing education and practice, in recruitment programmes and in publicity material.

Job satisfaction, work environment and successful ageing: Determinants of delaying retirement among acute care nurses

AIM

To determine the relationships between job satisfaction, work environment and successful ageing and how these factors relate to Registered Nurses' intent to retire.

BACKGROUND

Although little studied, retention of older nurses by delaying early retirement, before age 65, is an important topic for research. Qualitative and quantitative studies have indicated that job satisfaction work environment and successful ageing are key motivators in acute care Registered Nurses retention and/or delaying retirement. This study was designed to provide information to administrators and policy makers about retaining older, experienced RNs longer and more productively.

DESIGN

This was a correlational, descriptive, cross-sectional study.

METHODS

An online survey of acute care Registered Nurses (N = 2,789) aged 40 years or older working in Florida was conducted from September - October 2013. Participants completed items related to job satisfaction, work environment, successful ageing and individual characteristics. Hypotheses derived from the modified Ellenbecker's Job Retention Model were tested using regression analysis.

RESULTS

Job satisfaction scores were high. Highest satisfaction was with scheduling issues and co-workers; lowest with advancement opportunities. Successful ageing scores were also high with 81% reporting excellent or good health. Work environment explained 55% of the variance in job satisfaction. Years to retirement were significantly associated with successful ageing (p < .001), age (p < .001) and income (p < .010).

CONCLUSIONS

This study provides quantitative evidence that environment and successful ageing are important areas that have an impact on job satisfaction and delay of retirement in older nurses and further studies in these areas are warranted to expand on this knowledge.

Factors Associated With Stability of Health Nursing Services for Children With Medical Complexity

The objectives of our study are to: (1) identify the factors associated with lack of stable home healthcare nursing services for children with medical complexity, and (2) describe the implications of unstable home healthcare nursing for children, caregivers, nurses, and home healthcare agencies. We collected qualitative data in 20 semistructured in-depth interviews (15 English, 5 Spanish) with 26 primary caregivers of children with medical complexity, and 4 focus groups of 18 home healthcare nurses inquiring about their experiences about home healthcare nursing services for children with medical complexity. During an iterative analysis process, we identified recurrent themes related to stability of home healthcare nursing. Lack of stability in home healthcare nursing was common. These include: (1) not finding nurses to cover shifts, (2) nurse turnover, (3) nurses calling out frequently, and (4) nurses being fired by caregivers. Reasons for lack of stability of home healthcare nursing services were multifactorial and included: nurse-level, child-level, caregiver-level, residence-level, agency-level, and system-level factors. Lack of stable home healthcare nursing affected the well-being of children with medical complexity, and contributed to substantial caregiver burden. There were negative implications of unstable home healthcare services for nurses and home healthcare agencies as well. Lack of stable home healthcare nursing services is a major problem in the home care of children with medical complexity. Although some of the factors for unstable home healthcare nursing services are not modifiable, there are others that are potentially modifiable. Ensuring stable home healthcare nursing services will likely improve care of children and reduce caregiver burden.

Do Changing Labor Market Conditions Affect the Length of Stay for Chronic Respiratory Failure Hospitalizations?

The availability of home care nurses is widely seen as a cause for delayed discharge from inpatient care. However, there is a paucity of data to support or refute this hypothesis. If availability is driven by labor market conditions, the relative availability should vary over time with changing labor market conditions. The purpose of this study was to determine whether the length of stay for pediatric patients bound for home care was correlated with the local unemployment rate. We found that a 1-percentage-point (or marginal) increase in the unemployment rate was associated with a 2.3-day decrease in the length of stay for chronic respiratory failure hospitalizations. This suggests that labor market conditions result in delayed discharge for chronic respiratory failure patients.

An analysis of the relationship between burnout, socio-demographic and workplace factors and job satisfaction among emergency department health professionals

INTRODUCTION

Burnout among emergency medical practitioners and personnel negatively affects career satisfaction and job performance and can lead to mental health issues, including anxiety, depression, and suicide.

PURPOSE

This study investigated the relationship between the perceptions of burnout and job satisfaction of those working in two different hospital's emergency departments assessing the effect of burnout dimensions and additional factors (age, position, marital status, annual income, employment type, gender, patient encounters, and household economic well-being) on job satisfaction. This study addresses a gap in the literature of the relationships between a) burnout and job satisfaction of emergency department's health care personnel (physicians, nurses, technicians) and b) the factors that are associated with emergency department employees' job satisfaction.

METHOD

A cross-sectional survey of two hundred and fifty participants was interviewed, using validated instruments (the Maslach Burnout Scale and the Minnesota Satisfaction Questionnaire). Participants include 38 physicians, 89 nurses, and 84 medical technicians, and 39 information technicians. The Maslach Burnout Inventory Scale, which assesses emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), and the Minnesota Satisfaction Questionnaire (MSQ), which assesses intrinsic satisfaction (IS), extrinsic satisfaction (ES) and overall satisfaction (OS), were used for data collection.

RESULTS

Study findings indicate that significant relationship exists between burnout and job satisfaction; annual income and household economic-well-being had a positive association with job satisfaction, whereas gender, age, education, marital status had no significant effect on any form of satisfaction. Moreover, this study reveals that emotional exhaustion (EE) is a significant predictor of all three dimensions of job satisfaction while depersonalization (DP) had no significant showing.

CONCLUSION

Results of this study suggest that it is not yet clear which factors are salient contributors in demonstrating the relationship between burnout and job satisfaction. This study may draw attention to a better understanding of this relationship will help enable health care administrators to design and implement tools to help increase job satisfaction and decrease burnout as a combined goal rather than treat each issue separately.

Choosing Home Health as a Specialty and Successfully Transitioning Into Home Health Nursing Practice

This article describes components of a qualitative research study that investigated the process of how acute care nurses successfully transition into home health nursing practice. The sequences of activities in choosing home health as a specialty to practice and the phases of successful transition from acute care practice to home health practice are described. The sequence of activities and phases of successful transition were developed and grounded in the practice of 14 home health nurses. Implications for home health nursing practice, administration, and education are discussed.

How does collegial support increase retention of registered nurses in homecare nursing agencies? a qualitative study

Background

Collegial workplace support has been linked to higher registered nurse (RN) retention in various clinical settings. In Japan, homecare agencies experience high RN turnover. The purpose of this study was to develop a conceptual framework to describe how perceived support from colleagues affects RNs’ decision to remain in an agency.

Methods

A qualitative research method based on grounded theory was used. Participants were RNs with at least 4 years of experience at the same homecare agency. Participants were theoretically sampled via managers of 12 homecare nursing agencies. Semi-structured interviews and supplementary participant observations were conducted. Data were analyzed using a constant comparative technique, and the process of how workplace support affected participants’ decision to remain at their agency was clarified.

Results

In total, 26 RNs were interviewed, 23 of whom were observed in their practice setting. Participants’ perception of support from colleagues was framed as being “encouraged to grow in one’s own way”, which comprised practicing with protected autonomy in an insight-producing environment. Participants reported that they were able to practice with protected autonomy, receiving 1) mindful monitoring, 2) semi-independent responsibility, 3) help as needed, and 4) collegial empathy and validation. RNs also felt supported in an insight-producing environment by 1) enlightening dialogue, 2) being set for one’s next challenges, and 3) being able to grow at one’s own pace. Reportedly, these were defining characteristics in their decision to continue working in their agencies.

Conclusions

For RNs to willingly stay at a homecare nursing agency, it is essential that they are able to practice with protected autonomy in an insight-producing environment that encourages them to grow in their own way. Further research is needed to explore ways to create and enhance such environments to lower RN turnover.

Indicators of Job Satisfaction of Home Healthcare Nurses in the San Francisco Bay Area of California

The purpose of this study was to identify the factors that provide job satisfaction for home healthcare nurses and to determine if the nurses' educational level makes a difference in job satisfaction. Data were collected using Ellenbecker's (2004) 21-item Home Healthcare Nurses Job Satisfaction Scale. The study results indicated the majority of this population of home healthcare nurses was satisfied on all items, except in having the power to change agency policy. Educational level made no significant difference in job satisfaction. Recommendations include encouraging agencies to include clinicians in policy decision-making and management of patient care. Nursing education programs should ensure nurses graduate with the skills necessary for policy development and to make decisions that positively impact patient care.

Autonomous home-care nursing staff are more engaged in their work and less likely to consider leaving the healthcare sector: a questionnaire survey

BACKGROUND

The need for home care is rising in many Western European countries, due to the ageing population and governmental policies to substitute institutional care with home care. At the same time, a general shortage of qualified home-care staff exists or is expected in many countries. It is important to retain existing nursing staff in the healthcare sector to ensure a stable home-care workforce for the future. However, to date there has been little research about the job factors in home care that affect whether staff are considering leaving the healthcare sector.

OBJECTIVE

The main purpose of the study was to examine how home-care nursing staff's self-perceived autonomy relates to whether they have considered leaving the healthcare sector and to assess the possible mediating effect of work engagement.

DESIGN, SETTING AND PARTICIPANTS

The questionnaire-based, cross-sectional study involved 262 registered nurses and certified nursing assistants employed in Dutch home-care organisations (mean age of 51; 97% female). The respondents were members of the Dutch Nursing Staff Panel, a nationwide group of nursing staff members in various healthcare settings (67% response rate).

METHODS

The questionnaire included validated scales concerning self-perceived autonomy and work engagement and a measure for considering pursuing an occupation outside the healthcare sector. Logistic regression and mediation analyses were conducted to test associations between self-perceived autonomy, work engagement and considering leaving the healthcare sector.

RESULTS

Nursing staff members in home care who perceive more autonomy are more engaged in their work and less likely to have considered leaving the healthcare sector. The positive association between self-perceived autonomy and considering leaving, found among nursing staff members regardless of their level of education, is mediated by work engagement.

CONCLUSION

In developing strategies for retaining nursing staff in home care, employers and policy makers should target their efforts at enhancing nursing staff's autonomy, thereby improving their work engagement.

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.

Should I stay or should I go? The impact of working time and wages on retention in the health workforce

BACKGROUND

Turnover in the health workforce is a concern as it is costly and detrimental to organizational performance and quality of care. Most studies have focused on the influence of individual and organizational factors on an employee's intention to quit. Inspired by the observation that providing care is based on the duration of practices, tasks and processes (issues of time) rather than exchange values (wages), this paper focuses on the influence of working-time characteristics and wages on an employee's intention to stay.

METHODS

Using data from the WageIndicator web survey (N = 5,323), three logistic regression models were used to estimate health care employee's intention to stay for Belgium, Germany and the Netherlands. The first model includes working-time characteristics controlling for a set of sociodemographic variables, job categories, promotion and organization-related characteristics. The second model tests the impact of wage-related characteristics. The third model includes both working-time- and wage-related aspects.

RESULTS

Model 1 reveals that working-time-related factors significantly affect intention to stay across all countries. In particular, working part-time hours, overtime and a long commuting time decrease the intention to stay with the same employer. The analysis also shows that job dissatisfaction is a strong predictor for the intention to leave, next to being a woman, being moderately or well educated, and being promoted in the current organization. In Model 2, wage-related characteristics demonstrate that employees with a low wage or low wage satisfaction are less likely to express an intention to stay. The effect of wage satisfaction is not surprising; it confirms that besides a high wage, wage satisfaction is essential. When considering all factors in Model 3, all effects remain significant, indicating that attention to working and commuting times can complement attention to wages and wage satisfaction to increase employees' intention to stay. These findings hold for all three countries, for a variety of health occupations.

CONCLUSIONS

When following a policy of wage increases, attention to the issues of working time-including overtime hours, working part-time, and commuting time-and wage satisfaction are suitable strategies in managing health workforce retention.

Meanings over time of working as a nurse in elderly care

Background:

Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as “low status” in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time.

Aim:

The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs.

Method:

We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description.

Results:

The results show similarities and differences over time in the RNs’ reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities.

Conclusion:

An RN’s intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.

Deciding if Home Care Is Right for Me

As the location of health care delivery continues to shift from inpatient settings into the community understanding the experience of the home care workforce is important. Challenges related to recruitment and retention of nurses in home care has resulted in agencies hiring new graduate nurses. While Extensive research exists exploring experiences of new graduates in hospital settings, experiences of new graduates in home care are not well understood. Given the contextual differences between hospital and home care, research exploring new graduate nurses’ experiences in the home care sector is warranted. A phenomenological approach was used. “Deciding if home care is right for me” emerged as a way of understanding new graduate nurses’ experiences in home care.

Intervening conditions of hospital-based home care for people with severe mental illness

OBJECTIVE

This study discusses the intervening conditions of hospital-based home care (HBHC) for people with severe mental illness in Taiwan.

DESIGN AND SAMPLE

Grounded theory of the Strauss and Corbin approach was used. Participants were selected from six hospitals in Central Taiwan, including 21 clients, 19 caregivers, and 25 professionals.

MEASURES

Semi-structured one-on-one interviews were used to collect data. Data analysis consisted of three stages: open, axial, and selective coding. Data analysis, data collection, and sampling were conducted through the constant comparative analysis process.

RESULTS

Two categories were generated as positive and negative intervening conditions of HBHC services. Eight positive effects and nine negative effects were generated from the data.

CONCLUSIONS

Several positive and negative intervening conditions were found in this study to affect the delivery of HBHC. Government support and several limitations regarding HBHC services quality should be noticed and improved.

Job satisfaction in rural public health nurses

OBJECTIVE

The purpose of this study was to determine whether nurse managers and staff nurses in rural public health offices were satisfied with their jobs, whether managers were more satisfied than staff nurses, and whether their achieved educational level impacted their job satisfaction.

DESIGN

A nonexperimental comparative study was conducted of currently employed public health nurses (PHNs) to determine job satisfaction levels by using Stember's Web-based 80-question job satisfaction survey.

SAMPLE

The sample consisted of 88 PHNs employed as either managers or staff nurses in county public health office settings during April 2006.

RESULTS

In general, both nurse managers and staff nurses reported high job satisfaction. No significant differences existed between the composite job satisfaction scores of the managers and staff nurses. Significant differences existed between managers' and staff nurses' job satisfaction in the categories of "influence" and "interpersonal relationships" with managers less satisfied than staff nurses.

CONCLUSIONS

Both staff nurses and managers in public health were satisfied with their jobs. Managers attributed any sense of decreased job satisfaction in the areas of influence and interpersonal relationships. Further study is needed to determine what contributes to satisfaction of PHNs in order to promote positive work environments conducive to retention and recruitment.

The Correlates of Nursing Staff Turnover in Home and Hospice Agencies

Using data from the 2007 National Home and Hospice Care Survey, this study provides an update of nursing staff turnover at U.S. home health and hospice agencies and explores correlates of nursing staff turnover. Results show that the three-month turnover rates of registered nurses (RNs), licensed practice nurses (LPNs), home health aides (HHAs), and certified nursing assistants (CNAs) in 2007 were 10.2%, 14.3%, 12.5%, and 12.9%, respectively. A higher nurse staffing level reduced the odds of RN and HHA turnover; the availability of communication aids reduced the odds of LPN turnover. Moreover, among benefit programs, the provision of partial insurance for family reduced the odds of HHA turnover; dental or vision health insurance reduced the odds of RN turnover; mileage reimbursement or agency car reduced the odds of LPN turnover. The provision of a 401k plan and a paid-time-off program increased the odds of RN turnover. The study results suggest that high staffing levels and benefit programs (e.g., health insurance) may reduce the odds of experiencing nursing staff turnover. Initiatives to minimize nursing staff turnover should consider these factors.

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.

Job satisfaction among Iranian hospital-based practicing nurses: examining the influence of self-expectation, social interaction and organisational situations

AIM

The influence of self-expectation, social interaction, and organisational situation on job satisfaction among nurses is examined.

BACKGROUND

Understanding determinants and correlates of job satisfaction are important factors that help to reduce the problem of nurse attrition.

METHODS

Utilizing the Hybrid Model of concept development, job satisfaction was examined in three phases: (1) the theoretical phase, a working definition and the dimensions of job satisfaction were established; (2) the fieldwork phase, a qualitative semi-structured interview was employed to capture participants' perceptions of the concept; and (3) the analytical phase, the experiences of nurses were evaluated using the conceptual model.

RESULTS

The results indicate that personal beliefs, rather than social interaction or organisational situation, constitute the core of job satisfaction.

CONCLUSIONS

Despite the variety of dissatisfaction factors rooted in social interaction and organisational situation, participants achieved the highest job satisfaction when trusting in self-value systems and the spiritual value of their job objectives.

IMPLICATIONS

Intervention is needed to increase organisational and professional support for nurses. However, highlighting the sacred and spiritual value of the nursing profession, which is rooted in religious values and culture, provides additional reinforcement for enhancing the job satisfaction among this segment of health care providers.

The Psychological Reward Satisfaction Scale: developing and psychometric testing two refined subscales for nurses

AIM

This paper is a report of the development and psychometric testing of two refined subscales of the Psychological Reward Satisfaction Scale.

BACKGROUND

Besides financial and material rewards, nurses also value psychological rewards: supportive and positively evaluated outcomes of the relationship an employee develops with the supervisor. Satisfaction with these rewards influences employees' attitudes. Recently, the Psychological Reward Satisfaction Scale was developed to measure an employee's satisfaction with psychological rewards. However, this instrument needs refinement before it can be used with a nursing sample.

METHOD

We conducted a pilot study to test the reliability of the refined subscales. Forty nurses completed an online survey twice, with a time interval of 2 weeks. Afterwards, we gathered survey data with a larger sample of 337 nurses to examine the two subscales and their influence on turnover intention and the turnover antecedents job satisfaction and organizational commitment (measured by validated scales) in more detail. Data collection took place in Belgium in 2006.

RESULTS

The two refined subscales each contained four items. A series of hierarchical regression analyses suggested that satisfaction with psychological rewards from the head nurse has a statistically significant influence on nurses' turnover intention, job satisfaction and affective commitment, whereas pay satisfaction has not. Satisfaction with psychological rewards from the physicians only explained nurses' affective commitment.

CONCLUSION

When trying to motivate nurses through rewarding them, hospital managers should not only concentrate on financial rewards, but also pay attention to psychological rewards.

A resource-based perspective on retention strategies for nurse epidemiologists

AIM

This paper is a report of a study to evaluate the intent of epidemiologists to remain in their chosen career and identify the variables that contributed to or predicted their intent to stay.

BACKGROUND

Recently, emerging new infections, such as severe acute respiratory syndrome or bird flu, have placed significant occupational and psychological stress on epidemiologists, especially in South-East Asia, resulting in a high intent to change their career. In the light of possible staff shortages, retention strategies for epidemiologists have gained importance.

METHODS

A self-administered questionnaire survey and stratified sampling were used to collect data from 351 epidemiologists including nurse epidemiologists in Taiwan in 2005; response rate was 70.6%. Correlation analysis and hierarchical multiple regression analysis were used to examine relationships among occupational stress, psychological stress, human resources and intent to stay in their career.

RESULTS

Occupational stress, psychological stress and human resources had an impact on epidemiologists' intent to stay in their career. Results show that the relationship between occupational stress (operation and personal safety hazard) and intent to stay could be influenced by organizational capital, and the relationship between emotional distress and intent to stay could be influenced by a broad spectrum of human resources (organizational, social and human capital).

CONCLUSION

The severe acute respiratory syndrome epidemic raised worldwide attention and challenged epidemiologists' intent to stay. Results indicate that human resources play an important role in this issue. Managers should enhance human resources in organizations as much as possible to attenuate epidemiologists' stress, which may, in turn, strengthen their intent to stay.