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Bruno F, Nizzer S, Moreira NA, Martin T, King EC, McKay SM. Developing and Retaining Homecare Nurses Through Employer-Based Tuition Assistance Programs: A Mixed Methods Study. J Community Health Nurs 2024; 41:175-188. [PMID: 38391137 DOI: 10.1080/07370016.2024.2314077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE This study describes how an employer-based tuition-assistance program for homecare workers at one Canadian homecare organization enabled nursing career advancement and retention. DESIGN A convergent parallel mixed-methods design. METHODS We reviewed existing administrative data and concurrently conducted semi-structured interviews. Descriptive statistics were used on quantitative data and qualitative data was analyzed using thematic analysis. A joint data display was developed to integrate findings from both quantitative and qualitative data together. FINDINGS Tuition assistance reduced financial barriers to career advancement; 83% of recipients remained with their employer for at least 1-year post-studies but only 29% experienced career advancement. Psychosocial supports, career navigation and coaching to ease the licensing and role transition processes were identified as opportunities to support learners. CONCLUSION Employer-based tuition assistance programs are impactful in helping to develop skilled employees. Practical enhancements to further support career transitions may maximize retention to address urgent homecare staffing challenges. CLINICAL EVIDENCE Employer-based tuition assistance can be a useful strategy to support nursing career growth and staff retention.
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Affiliation(s)
- Frances Bruno
- Research and Innovation, VHA Home HealthCare, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Sonia Nizzer
- Research and Innovation, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Nicole A Moreira
- Research and Innovation, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Tonya Martin
- Research and Innovation, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Emily C King
- Research and Innovation, VHA Home HealthCare, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sandra M McKay
- Research and Innovation, VHA Home HealthCare, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Canada
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Chen Y, Zhou X, Bai X, Liu B, Chen F, Chang L, Liu H. A systematic review and meta-analysis of the effectiveness of social support on turnover intention in clinical nurses. Front Public Health 2024; 12:1393024. [PMID: 38903567 PMCID: PMC11187297 DOI: 10.3389/fpubh.2024.1393024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
Background Nurse turnover has become a salient issue in healthcare system worldwide and seriously compromises patient outcomes. Social support is considered an effective contributor to alleviate nurse turnover intention (TI). However, the degree of correlation between social support and nurse TI remains elusive. Aims This study aims to evaluate the strength of the effectiveness of social support on TI among nurses as well as its potential moderators. Design This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methods To obtained qualified studies, two researchers searched Embase, PubMed, Web of science, CINAHL, CNKI, WanFang, and Chinese Medical Journal Full Text Database from inception to January 6, 2024. Meta-analysis, publication bias, and sensitivity analysis were carried out on the included studies using CMA 3.0 software, and the moderating effect was verified through meta-analysis of variance (ANOVA). Results A total of 38 studies were obtained, involving 63,989 clinical nurses. The comprehensive effect size of the random effect model showed a significant medium negative correlation between social support and TI among nurses (p < 0.001). The sample size and TI measurement tools significantly moderated the correlation between social support and TI (p < 0.050). However, nurse department, gender, data collection time, and social support measurement tools did not moderate the correlation between the two variables. Conclusion Social support is negatively associated with TI in nurses. Nursing administrators and the medical community should fully recognize the importance of social support for nurses and take corresponding measures to enhance it, thereby reducing TI and ensuring the stability of the nursing team.
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Affiliation(s)
- Yan Chen
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiang Zhou
- School of Sociology and Political Science, Shanghai University, Shanghai, China
| | - Xue Bai
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Beibei Liu
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Fengzhi Chen
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lixia Chang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongli Liu
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Maniscalco L, Enea M, de Vries N, Mazzucco W, Boone A, Lavreysen O, Baranski K, Miceli S, Savatteri A, Fruscione S, Kowalska M, de Winter P, Szemik S, Godderis L, Matranga D. Intention to leave, depersonalisation and job satisfaction in physicians and nurses: a cross-sectional study in Europe. Sci Rep 2024; 14:2312. [PMID: 38282043 PMCID: PMC10822871 DOI: 10.1038/s41598-024-52887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/24/2024] [Indexed: 01/30/2024] Open
Abstract
The European healthcare sector faces a significant shortage of healthcare workers. Assessing the prevalence of this issue and understanding its direct and indirect determinants are essential for formulating effective recruitment programs and enhancing job retention strategies for physicians and nurses. A multicentric cross-sectional study was conducted, involving 381 physicians and 1351 nurses recruited from eight European hospitals in Belgium, the Netherlands, Italy, and Poland. The study focused on assessing turnover intentions among healthcare workers based on the Job Demands-Resources model, using an online questionnaire. Structural equation models were employed to test the data collection questionnaires' construct validity and internal consistency. The turnover intention was assessed by agreement with the intention to leave either the hospital or the profession. Among physicians, 17% expressed an intention to leave the hospital, while 9% intended to leave the profession. For nurses, the figures were 8.9% and 13.6%, respectively. The internal consistency of the questionnaires exceeded 0.90 for both categories of health workers. Depersonalization and job dissatisfaction were identified as direct determinants of turnover intention, with work engagement being particularly relevant for nurses. We found a higher intention to leave the hospital among physicians, while nurses were more prone to leave their profession. To mitigate turnover intentions, it is recommended to focus on improving job satisfaction, work engagement and fostering a positive working climate, thereby addressing depersonalisation and promoting job retention.
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Affiliation(s)
- L Maniscalco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - M Enea
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - N de Vries
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - W Mazzucco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - A Boone
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven (University of Leuven), Leuven, Belgium
| | - O Lavreysen
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven (University of Leuven), Leuven, Belgium
| | - K Baranski
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - S Miceli
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - A Savatteri
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - S Fruscione
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - M Kowalska
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - P de Winter
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
- Leuven Child and Health Institute, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - S Szemik
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - L Godderis
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven (University of Leuven), Leuven, Belgium
| | - D Matranga
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
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Wu F, Lao Y, Feng Y, Zhu J, Zhang Y, Li L. Worldwide prevalence and associated factors of nursing staff turnover: A systematic review and meta-analysis. Nurs Open 2024; 11:e2097. [PMID: 38268271 PMCID: PMC10802134 DOI: 10.1002/nop2.2097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/10/2022] [Accepted: 12/25/2023] [Indexed: 01/26/2024] Open
Abstract
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).
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Affiliation(s)
- Feixia Wu
- Hangzhou Hospital of Traditional Chinese MedicineHangzhouChina
| | - Yuewen Lao
- Sir Run Run Shaw Hospital, Zhejiang University School of MedicineHangzhouChina
| | - Ying Feng
- Hangzhou Hospital of Traditional Chinese MedicineHangzhouChina
| | - Jiaqing Zhu
- Hangzhou Hospital of Traditional Chinese MedicineHangzhouChina
| | - Yating Zhang
- Hangzhou Hospital of Traditional Chinese MedicineHangzhouChina
| | - Liuyan Li
- Hangzhou Hospital of Traditional Chinese MedicineHangzhouChina
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Bae SH, Kim S, Myung H. Mediating effects of workgroup processes on the relationship between nurse turnover and nurse outcomes in hospitals. Front Public Health 2023; 11:1255983. [PMID: 38074708 PMCID: PMC10701376 DOI: 10.3389/fpubh.2023.1255983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background Nurse turnover is often considered to be an outcome, and few studies have investigated its consequences in nursing care. The underlying mechanism of the nurse turnover-nurse outcome relationship has not been empirically investigated. Therefore, this study examines workgroup processes and nurse outcomes as the consequences of nurse turnover and the mediating effect of workgroup processes on the nurse turnover-nurse outcomes relationship. Methods A cross-sectional design was adopted to investigate the data collected from 264 staff nurses. Furthermore, six-month turnover rates, workgroup processes (nurse-nurse collaboration, team cohesion), and nurse outcomes (job satisfaction, intent to leave) were utilized in the multivariate regression models. Results Overall, 53 (24.4%) nurses had worked in nursing units with a zero six-month turnover rate. The average mean six-month turnover rate was 15.5%. Nurse turnover adversely affected nurses' job satisfaction and several subscales of team cohesion including task cohesion and social cohesion. Team cohesion partially mediated the relationship between nurse turnover and job satisfaction. Conclusion Nurse turnover decreased job satisfaction and team cohesion, and team cohesion partially mediated the nurse turnover-nurse outcomes relationship. These findings provide evidence supporting the significant adverse effects of nurse turnover and suggest the potential role of workgroup processes in explaining the underlying mechanism of the relationship between nurse turnover and nurse outcomes. Implications for nursing and health policy Healthcare organizations must create a positive work environment to reduce nurse turnover. Further, states and countries should try to develop and establish nursing and health policies to prevent turnover.
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Affiliation(s)
- Sung-Heui Bae
- College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
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Brune S, Killam L, Camargo-Plazas P. Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper. Issues Ment Health Nurs 2023; 44:437-452. [PMID: 37167098 DOI: 10.1080/01612840.2023.2205502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.
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Affiliation(s)
- Sara Brune
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- Nursing (BSN) Program, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Laura Killam
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- School of Health Sciences and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
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Alenazy FS, Dettrick Z, Keogh S. The relationship between practice environment, job satisfaction and intention to leave in critical care nurses. Nurs Crit Care 2023; 28:167-176. [PMID: 34882918 DOI: 10.1111/nicc.12737] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent studies in the Kingdom of Saudi Arabia (KSA) have shown that the increasing nursing turnover in the health care industry has become a great source of concern. The overdependence on the supply of expatriate nurses (74%) and coronavirus disease 2019 (COVID-19) travel restrictions have exacerbated this staffing issue. AIMS To examine the relationship between perception of nursing practice environment (NPE), job satisfaction and intention to leave (ITL) among critical care nurses working in the state of Ha'il in KSA. DESIGN Cross-sectional correlational (observational) design. METHODS Data were collected via electronic online survey distributed to registered critical care nurses working in King Khalid Hospital (KKH), Ha'il, KSA, between July and August 2020. Participant demographics and key variables data related to NPE, job satisfaction and ITL respectively were collected from the participants using existing and validated questionnaires. Descriptive statistics and correlational analysis and multivariable analyses were conducted. RESULTS A response rate of 98% was achieved (152/160) for the study. Findings showed that the NPE was largely favourable (M = 2.89, SD = 0.44); however, nurse participation in hospital affairs (M = 2.83, SD = 0.47) and staffing and resource adequacy (M = 2.88, SD = 0.47) scored lowest. NPE was found to be significantly correlated with job satisfaction (rs = .287, P < .01). A significant negative relationship was found between NPE and ITL (rs = -0.277**, P < .01). However, job satisfaction was associated with ITL (rs = -.007, P = .930). CONCLUSIONS Maintaining a healthy work environment and job satisfaction levels in critical care units is key to improving, recruitment and retention of nursing staff. RELEVANCE TO CLINICAL PRACTICE Critical care and hospital leaders should implement programs that enhance the quality of the practice environment. This will improve nurse participation in unit and hospital affairs, job satisfaction and intention to stay.
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Affiliation(s)
- Faisal S Alenazy
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Nursing, ICU/Critical Care, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
| | - Zoe Dettrick
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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8
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Xu G, Zeng X, Wu X. Global prevalence of turnover intention among intensive care nurses: A meta-analysis. Nurs Crit Care 2023; 28:159-166. [PMID: 34261191 DOI: 10.1111/nicc.12679] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Nurse turnover is considered a major cause of nurse shortage, representing problems for health care systems in terms of both quality and cost of care for patients, and intention to leave is the strongest practical predictor variable of actual turnover. AIM This systematic review and meta-analysis aims at exploring the global prevalence of turnover intention in intensive care nurses. DESIGN This was a systematic literature review. METHODS A systematic review of empirical quantitative studies on turnover intention in nurses of intensive care units (ICUs), published in English till March 2021, was conducted. The databases PubMed, Embase, ISI Web of Knowledge, and CINAHL were searched. Eligible studies were observational or descriptive studies that reported the prevalence of turnover intention among nurses in all types of ICUs. The quality of studies was assessed using a modified Newcastle-Ottawa Scale. A random effect meta-analysis was conducted to estimate the pooled prevalence of turnover intention among ICU nurses. RESULTS We identified 18 cross-sectional studies investigating a total of 23 140 intensive care nurses from 23 countries. The intention to leave rate was ranged from 3.0% to 75.0%. The pooled prevalence of turnover intention was 27.7% (95% confidence interval: 21.6%-34.3%). CONCLUSIONS This meta-analysis showed that more than 27% of the intensive care nurses had the intention to leave worldwide. In the current context of nursing shortage, efforts should be made to improve conditions for this important group of care providers. RELEVANCE TO CLINICAL PRACTICE The prevalence of turnover intention is relatively high among intensive care nurses. Nurse managers should take this intention seriously, as the intention to leave may lead to an actual decision to leave the profession.
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Affiliation(s)
- Guoilian Xu
- Department of teaching management, Department of nursing, Jiangxi College of Traditional Chinese Medicine, Fuzhou, JiangXi, China
| | - Xiaoying Zeng
- Department of nursing, Jiangxi College of Traditional Chinese Medicine, FuZhou, JiangXi, China
| | - Xiaohua Wu
- Operating room of Nanfeng Hospital of traditional Chinese Medicine, FuZhou, JiangXi, China
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9
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Bae SH. Comprehensive assessment of factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals: a systematic review. BMC Nurs 2023; 22:31. [PMID: 36739408 PMCID: PMC9899133 DOI: 10.1186/s12912-023-01190-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/24/2023] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the demand for nursing care increased, making the retention of nurses even more important. Among staff nurses, it is reported that the turnover rate of newly licensed registered nurses is higher. However, no systematic reviews have focused on the factors that influence newly licensed registered nurses' turnover. Additionally, because newly licensed registered nurses are a major source of the supply of nurses, it is critical to retain them to meet patient needs. Therefore, this study aimed to systematically synthesize the factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals. METHODS CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS, and Web of Science were searched for studies published between January 2000 and June 2021. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Ten articles from 9029 were included in this review. All studies used a longitudinal design. The annual turnover rates of newly licensed registered nurses ranged from 12 to 25%. Health status, including sleep and healthy lifestyles, were significant factors affecting turnover. Most studies focused on work environment factors, and emotional exhaustion, job satisfaction, peer support, and intent to leave, were significantly associated with newly licensed registered nurses' turnover. Small hospitals located in nonmetropolitan areas were at risk of high turnover of newly licensed registered nurses. CONCLUSIONS Turnover is inevitable in the process of employment, but high turnover can be prevented. Through reviewing ten articles, significant contributing factors for newly licensed registered nurses' turnover included personal factors of health status; work environment factors of physical exhaustion, emotional exhaustion, depersonalization, occupational injuries, income, intent to stay, job satisfaction, and peer support; and hospital factors of hospital size, location, and unionization. Most existing studies focus on work environment factors, which reflects the significance of fostering healthy work conditions to prevent high turnover. These findings can be used to develop strategies and policies for work environment to reduce high turnover of newly licensed registered nurses, and support high-risk groups, such as small hospitals located in nonmetropolitan areas with high levels of nurses' turnover.
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Affiliation(s)
- Sung-Heui Bae
- grid.255649.90000 0001 2171 7754College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Helen Hall #204, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760 Republic of Korea
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10
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Smama’h Y, Eshah NF, Al-Oweidat IA, Rayan A, Nashwan AJ. The Impact of Leadership Styles of Nurse Managers on Nurses' Motivation and Turnover Intention Among Jordanian Nurses. J Healthc Leadersh 2023; 15:19-29. [PMID: 36718174 PMCID: PMC9884098 DOI: 10.2147/jhl.s394601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
Aim The purpose of this study is to examine the relationship between leadership styles of nurse managers, nurses' motivation, and turnover intentions among Jordanian nurses. Design A descriptive correlational cross-sectional study using a self-administered questionnaire was conducted. Methods A convenience sampling technique was utilized to select the required .sample A sample of 170 registered nurses working at private hospitals in Jordan was surveyed. Moreover, a questionnaire of Path-Goal Leadership, Multidimensional Work Motivation Scale, and Turnover Intention Scale was used to assess leadership styles of nurse managers, nurses' motivation and turnover intention among the participants. Descriptive and inferential tests were used to ask the research questions. Results The participants perceived the supportive leadership style as the highest (M = 24.4, SD = 4.66). The mean work motivation among participants was 87.12, and the mean turnover intention was 22.01. Nurses' motivation has a positive correlation with all leadership styles. Years of experience predict the nurses' work motivation. Among the leadership styles; two of them significantly predict nurses' work motivation (supportive style) p < 0.001, and (achievement-oriented style) p < 0.001. Finally, the highest correlation coefficient was noticed between work motivation and achievement-oriented style (r = 0.46, p < 0.001) by moderate positive correlation, and the lowest correlation coefficient was between work motivation and directive style (r = 0.29, p < 0.001), whereas the results revealed that turnover intention was not significantly correlated with any of the leadership styles. Conclusion The results present a unique theoretical underpinning that highlights the factors that affect nurses' turnover intention. So, these findings could be used as guide for policy makers to establish organizational policies toward satisfying nurses' motivation and quality of life to enhance their retention. Besides, enriching the factors that may enhance nurses' motivation and reduce their turnover intention.
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Affiliation(s)
| | | | | | - Ahmad Rayan
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Abdulqadir J Nashwan
- Department of Nursing, Hamad Medical Corporation (HMC), Doha, Qatar,Correspondence: Abdulqadir J Nashwan, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar, Tel +974 40240487; +974 66473549, Email
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11
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de Vries N, Boone A, Godderis L, Bouman J, Szemik S, Matranga D, de Winter P. The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231159318. [PMID: 36912131 PMCID: PMC10014988 DOI: 10.1177/00469580231159318] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.
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Affiliation(s)
- Neeltje de Vries
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands.,Department of Science, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Anke Boone
- Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health, KU Leuven, Leuven, Belgium.,IDEWE, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - José Bouman
- Department of Science, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
| | - Szymon Szemik
- Department of Epidemiology, School of Medinie in Kotawice, Medical University of Silesia, Katowice, Poland
| | - Domenica Matranga
- University of Palermo, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy
| | - Peter de Winter
- Department of Science, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands.,Leuven Child and Health Institute, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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12
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Bae SH. Association of Work Schedules With Nurse Turnover: A Cross-Sectional National Study. Int J Public Health 2023; 68:1605732. [PMID: 37168137 PMCID: PMC10164927 DOI: 10.3389/ijph.2023.1605732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/29/2023] [Indexed: 05/13/2023] Open
Abstract
Objective: To examine the relationship of work schedules with nurse turnover across various work settings. Methods: A cross-sectional study design was used with data collected from 17,046 nurses who participated in the 2018 National Sample Survey of Registered Nurses in the U.S. Multivariate logistic regression was used to examine the effects of work hours and overtime on nurse turnover. Results: Longer weekly work hours increased nurse turnover (OR = 1.104, 95% confidence interval [CI] = 1.006-1.023). A non-linear relationship was observed between overtime and turnover. Compared with nurses with no overtime, the turnover for nurses working 1-11 h overtime per week decreased (OR = 0.893, 95% CI = 0.798-0.999). When nurses worked ≥12 h, turnover increased (OR = 1.260, 95% CI = 1.028-1.545). Earning from the primary nursing position decreased turnover among nurses working in hospitals, other inpatient settings, and clinics. Job satisfaction decreased turnover. Conclusion: To prevent nurse turnover, it is important to monitor and regulate nurses' working hours at institutional and government levels. Government support and policy implementations can help prevent turnover.
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Leadership styles and their outcomes: a study of a Nigerian hospital middle management nurses. Leadersh Health Serv (Bradf Engl) 2022. [DOI: 10.1108/lhs-05-2022-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose
This study was conducted to identify and explore the leadership styles and the leadership outcomes of the middle management nurses in a large tertiary hospital in Ibadan, the capital of Oyo state of Nigeria. This study aims to explore and describe the perception of staff nurses (SNs) about their nurse managers’ (NMs) leadership styles, to investigate the leadership outcomes of NMs as perceived by their SNs and to investigate what are the best predictors of the leadership outcomes among the perceived leadership styles.
Design/methodology/approach
Thirty-six variables of the MLQ-5X were compressed into the nine psychological constructs, as proposed by Avolio and Bass (2004). Four items of each of the nine sub-scales were combined together, to form the independent variables. The nine items of the leadership outcomes were compressed into three composite variables as: the Leader’s perceived influence as being effective in leading the group variable, it has four items; the Leader’s perceived influence as being satisfactory to the group being led variable, it has two items; and lastly, the Leader’s perceived influence to encourage the staff.
Findings
When all the three leadership sub-scales were combined as one total leadership outcome, the regression analysis showed that four leadership constructs were the predictors of the leadership outcome, that is, idealized attribute (ß = 0.173, p = 0.011), intellectual stimulation (ß = 0.171, p = 0.016), individualized consideration (ß = 0.240, p = 0.001) and contingent reward (ß = 0.194, p = 0.006). The coefficients and the p-values of the remaining five leadership constructs are as shown in Table 1.
Research limitations/implications
This study has many limitations. One, the respondents were not randomly sampled, so the results cannot be generalized outside of UCH, Nigeria. It is also a one-time survey.
Practical implications
Managers who regularly practice transformational leadership (TFL) would be able to encourage their SNs to put in their best for the greater good of the organization. In this study, three sub-scales of the TFL, that is, idealized attribute, intellectual stimulation and individualized consideration were found to be strong predictors of leadership outcomes. Leaders who are able to treat their staff with care and concern for the individual, able to mentor, advise, coach and develop their staff are likely to also see improved staff satisfaction and extra effort in staff performance. This is especially necessary in sub-Saharan African countries, including Nigeria.
Social implications
It is therefore strongly recommended that middle management nurses in UCH should continue to strive and improve on their TFL skills as well as their contingent reward styles of leadership. Vesterinen et al. (2012) said that NMs who can observe their own behaviour and its effects on employees can adjust to a better leadership style. In particular, individualized consideration skills such as coaching, mentoring, advising, developing and showing concern for the individual needs of their staff would encourage SNs to put in extra effort and be more satisfied with their leaders.
Originality/value
To the best of the author’s knowledge, this is his original research work and it has never been published elsewhere. The whole work was however submitted for a PhD thesis to the University of Salford.
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Orton DG. Team Lavender Supports Healthcare Workers: "Our Spiritual, Emotional and Mental Health Matters". THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2022; 76:162-170. [PMID: 35712919 DOI: 10.1177/15423050221106423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Team Lavender, a coordinated response team addresses the spiritual, emotional, and psychological needs of healthcare workers following adverse events and accumulated stress, including Covid-19. Proven to be a valuable peer-to-peer support team in reducing stress levels. Team Lavender is modeled from Code Lavender in the United States. This article addresses the background to justify the need of Team Lavender, its' significance in a regional acute care setting, and justification for implementing Team Lavender.
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15
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Heistad A, Goldsworthy S, Reilly S, Perez G. How do intensive work environments affect nurses' absenteeism and turnover intent? Appl Nurs Res 2022; 66:151608. [DOI: 10.1016/j.apnr.2022.151608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/07/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
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16
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Sawada S, Takemura Y, Isobe T, Koyanagi H, Kida R. Perceived Impact of Nurse Turnover on the Organization: A Delphi study on Managers of nursing. J Nurs Manag 2022; 30:3168-3177. [PMID: 35815682 DOI: 10.1111/jonm.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify the aspects and items of nurse turnover impact on organizations as perceived by nursing management. BACKGROUND Turnover rate does not capture the extent to which an organization is affected by turnover. Another indicator is required to assess the control status of turnover impact. METHODS A Delphi study was conducted in 2021, where 2,670 managers of nursing at 712 hospitals were asked to complete three surveys. Factor analysis was conducted on these items for which a consensus was reached. RESULTS Overall, 232 managers who responded multiple times, including the third survey, were included in the analysis. Consensus was reached for 36 items affected by turnover and considered important for nursing management. Using exploratory factor analysis, the following six factors were extracted: quality of nursing care, physical and mental health of nursing staff, workload and working conditions of nursing staff, relationships among nursing staff members, sense of responsibility among nursing staff, and cost and benefit of hiring replacement personnel. CONCLUSIONS Six aspects consisting of 36 items were extracted. These aspects can be used to assess the impact of nurse turnover. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers can assess the status of the organization more appropriately by understanding these aspects.
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Affiliation(s)
- Sai Sawada
- Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukie Takemura
- Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tamaki Isobe
- Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroe Koyanagi
- Research Center for Implementation Nursing Science Initiative, School of Health Sciences, Fujita Health University
| | - Ryohei Kida
- Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Ki J, Choi-Kwon S. Health problems, turnover intention, and actual turnover among shift work female nurses: Analyzing data from a prospective longitudinal study. PLoS One 2022; 17:e0270958. [PMID: 35802575 PMCID: PMC9269367 DOI: 10.1371/journal.pone.0270958] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aims
This study investigated health problems, turnover intention, and actual turnover among shift work nurses. While turnover intention is often used as a proxy variable for turnover, the relationship between these variables requires clarification. This study tested for relevant associations using prospective longitudinal data with a time lag of 12 months. We also tested for associations between health problems (sleep disturbance, fatigue, and depression) and turnover intentions/turnover, with a focus on the mediating role of turnover intention.
Methods
This study conducted a secondary analysis of data from the Shift Work Nurses’ Health and Turnover project, which is a prospective longitudinal cohort study. We analyzed health problems, turnover intention, and actual turnover. The data were analyzed via descriptive statistics, the Pearson’s chi-squared test, independent t-test, univariable logistic regression, multiple logistic regression, and causal mediation.
Results
Participants included 491 shift work female nurses. Of these, 112 (22.8%) had turnover intention, while 38 (7.7%) left their jobs within the 12-month period of investigation. Of the 112 with turnover intention, 22 left their jobs (OR 5.68. 95% CI 2.84–11.36). The logistic regression analysis showed that sleep disturbance and fatigue were associated with turnover intentions and actual turnover, while depression was only associated with turnover intention. The causal mediation analysis showed that turnover intention mediated the relationship between health problems (sleep disturbance and fatigue) and actual turnover (sleep disturbance OR 1.31, 95%CI = 1.02–1.60; fatigue OR 2.11, 95%CI = 1.50–2.68); sleep disturbance had a natural direct effect on actual turnover (OR 2.66, 95%CI,2.07–3.21).
Conclusion
Turnover intention strongly predicted actual turnover. Sleep disturbances may result in turnover, even in cases without existing turnover intention. These findings highlight the need for early interventions aimed at preventing and alleviating sleep disturbances for shift work female nurses.
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Affiliation(s)
- Jison Ki
- The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Smi Choi-Kwon
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
- * E-mail:
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18
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An M, Heo S, Hwang YY, Kim J, Lee Y. Factors Affecting Turnover Intention among New Graduate Nurses: Focusing on Job Stress and Sleep Disturbance. Healthcare (Basel) 2022; 10:healthcare10061122. [PMID: 35742172 PMCID: PMC9223151 DOI: 10.3390/healthcare10061122] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Minjeong An
- College of Nursing, Chonnam National University, Gwangju 61469, Korea;
| | - Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA 30341, USA;
| | | | - JinShil Kim
- College of Nursing, Gachon University, Incheon 21936, Korea;
| | - Yeonhu Lee
- Department of Trauma Ward, Chonnam National University Hospital, Gwangju 61469, Korea
- Correspondence: ; Tel.: +82-10-9405-7399
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Bae SH. Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review. Int Nurs Rev 2022; 69:392-404. [PMID: 35654041 PMCID: PMC9545246 DOI: 10.1111/inr.12769] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/16/2022] [Indexed: 11/29/2022]
Abstract
AIM To examine and synthesize the noneconomic and economic impacts of nurse turnover in acute hospitals. BACKGROUND Nurse turnover occurs when nurses leave their jobs or the profession and is a major concern for the healthcare industry. Many studies have investigated the determinants of nurse turnover. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was utilized in the current review. Article search was conducted in June 2021. Research articles published since January 2000 were included. Eight databases (e.g., CINAHL, PubMed, PsycINFO, and Web of Science) were used. The following eligibility criteria were applied for inclusion: Articles that (1) were nonexperimental quantitative studies, (2) examined the impact of actual nurse turnover in acute hospitals, (3) were a peer-reviewed original research article, and (4) were written in English or Korean. RESULTS Among 9,041 searched articles, 16 were included in the review. Seven studies investigated the association of nurse turnover with processes and outcomes (workgroup processes, nurse staffing, nurse outcomes, and patient outcomes), and partially supported the negative impact of turnover. Nine studies found that nurse turnover is very costly. CONCLUSION Most studies investigated the turnover cost, which is costly. The negative noneconomic impact of nurse turnover was partially supported. IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY To prevent the adverse noneconomic and economic impacts of nurse turnover and retain nurses, healthcare organizations, nurse managers, and hospital staff nurses need to develop and implement prevention strategies and policies to address nurse turnover. Efforts to address nurse turnover can increase hospital competency to improve the quality of nursing care services and patient safety.
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Affiliation(s)
- Sung-Heui Bae
- Associate Professor, College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Republic of Korea
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20
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Abstract
The health of nurses impacts the care of patients in healthcare settings today both inside and outside of hospitals. Many papers are written about nurses' burnout, depression, poor physical and mental health, weight gain, unhealthy eating patterns, back injury, moral negativity, and lack of job satisfaction. However, little attention has been paid to self-care in nurses. The goal of this paper is to discuss the importance of nurses caring for themselves as they work under stressful conditions regularly. Job satisfaction is necessary for nurses to have a healthy work-life balance and a desire to go to work. There are evidence-based interventions that can make a difference in a nurse's quality of life that can be implemented independently or within the work setting. Suggestions made by researchers include working less than 40 hr/week in a clinical setting, working a consistent time of day without rotations, expressing emotions, taking time to exercise, participating in a support group, and incorporating a place designated as a sanctuary in the clinical setting. Personal ways to improve health include preparing healthy meals before working a shift, getting proper sleep, utilizing cognitive behavioral therapy, participating in mindfulness training, and practicing stress reduction techniques.
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21
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Roth C, Wensing M, Breckner A, Mahler C, Krug K, Berger S. Keeping nurses in nursing: a qualitative study of German nurses' perceptions of push and pull factors to leave or stay in the profession. BMC Nurs 2022; 21:48. [PMID: 35193561 PMCID: PMC8863506 DOI: 10.1186/s12912-022-00822-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/08/2022] [Indexed: 12/20/2022] Open
Abstract
Background The increasing nursing shortages worldwide has focused attention on the need to find more effective ways to recruit and retain nurses. The aim of this study was to gain understanding of factors that keep German nurses in nursing and explore their perceptions of factors that contribute to nurses leaving or staying in the profession. Methods An explorative qualitative study was undertaken at four different hospitals (two university hospitals and two public hospitals) in Baden-Wuerttemberg, a state in South Germany. Semi-structured face-to-face or telephone interviews were conducted with 21 state-qualified nurses who had graduated from a German nursing program. Each interview was pseudonymized and transcribed. Transcripts were coded according to Qualitative Content Analysis with data structured into themes and subthemes. The study was reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist for qualitative research. Results Two themes emerged from the analysis and each theme had several subthemes: a) PUSH FACTORS i.e. factors that may push nurses to consider leaving the profession included limited career prospects, generational barriers, poor public image of nursing, and workplace pressures; b) PULL FACTORS i.e. factors that nurses wished for and could keep them in the profession included professional pride, improved remuneration, recognition of nursing, professionalisation, and improving the image of nursing as a profession. Conclusion The decision to leave or stay in nursing is influenced by a complex range of dynamic push and pull factors. Nurse Managers responsible for stabilizing the workforce and maintaining their health system will continue to have to navigate challenges until working conditions, appropriate wages and career development opportunities are addressed. A key to tackling nursing shortages may be focusing on pull factors and nurse managers listening in particular to the perspectives of junior nurses directly involved in patient care, as giving them opportunity to further develop professionally, reinforcing a strong and supportive workplace relationships, paying an appropriate salary, and improving the public image of nursing profession. Registration number The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register (DRKS00017465).
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Affiliation(s)
- Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany.
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Cornelia Mahler
- Department of Nursing Science, University Hospital Tuebingen, Hoppe-Seyler-Str. 9, 72076, Tuebingen, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Sarah Berger
- Centre for Postgraduate Nursing Studies, University of Otago-Christchurch Campus, 2 Riccarton Ave, Christchurch, 9140, New Zealand
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22
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Taylor-Clark TM, Swiger PA, Anusiewicz CV, Loan LA, Olds DM, Breckenridge-Sproat ST, Raju D, Patrician PA. Identifying Potentially Preventable Reasons Nurses Intend to Leave a Job. J Nurs Adm 2022; 52:73-80. [PMID: 35025828 PMCID: PMC9008872 DOI: 10.1097/nna.0000000000001106] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to describe the relationships between intent to leave, reasons nurses intend to leave, and the nursing work environment in military hospitals. BACKGROUND Intention to leave is a precursor of nurse turnover. The reasons nurses intend to leave may be influenced by leader interventions and potentially preventable. METHODS This descriptive, correlational secondary analysis included 724 nurse survey responses from 23 US Army hospitals. Bivariate correlations and predictive modeling techniques were used. RESULTS Forty-nine percent of nurses indicated they intended to leave, 44% for potentially preventable reasons. Dissatisfaction with management and the nursing work environment were the top potentially preventable reasons to leave. Nurses who intended to leave for potentially preventable reasons scored aspects of the nursing work environment significantly lower than those intending to leave for nonpreventable reasons. CONCLUSIONS Identifying potentially preventable reasons in conjunction with intent to leave can provide leaders opportunities to intervene and influence turnover intention.
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Affiliation(s)
- Tanekkia M Taylor-Clark
- Author Affiliations: US Army Nurse Corps Officer (Dr Taylor-Clark), Associate Professor and Executive DNP Pathway Director (Dr Loan), and Professor and Rachel Z. Booth Endowed Chair (Dr Patrician), School of Nursing, University of Alabama at Birmingham; Deputy Chief (Dr Swiger), Center for Nursing Science and Clinical Inquiry, US Army, Landstuhl, Germany; Postdoctoral Fellow (Dr Anusiewicz), School of Nursing, University of Pennsylvania, Philadelphia; Research Assistant Professor (Dr Olds), School of Nursing, The University of Kansas; Consultant (Dr Breckenridge-Sproat), US Army Retired, Santa Fe, New Mexico; and Statistician (Dr Raju), Vidence, LLC, Boca Raton, Florida
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Boamah SA, Hamadi HY, Havaei F, Smith H, Webb F. Striking a Balance between Work and Play: The Effects of Work-Life Interference and Burnout on Faculty Turnover Intentions and Career Satisfaction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:809. [PMID: 35055630 PMCID: PMC8775585 DOI: 10.3390/ijerph19020809] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The interactions between work and personal life are important for ensuring well-being, especially during COVID-19 where the lines between work and home are blurred. Work-life interference/imbalance can result in work-related burnout, which has been shown to have negative effects on faculty members' physical and psychological health. Although our understanding of burnout has advanced considerably in recent years, little is known about the effects of burnout on nursing faculty turnover intentions and career satisfaction. OBJECTIVE To test a hypothesized model examining the effects of work-life interference on nursing faculty burnout (emotional exhaustion and cynicism), turnover intentions and, ultimately, career satisfaction. DESIGN A predictive cross-sectional design was used. SETTINGS An online national survey of nursing faculty members was administered throughout Canada in summer 2021. PARTICIPANTS Nursing faculty who held full-time or part-time positions in Canadian academic settings were invited via email to participate in the study. METHODS Data were collected from an anonymous survey housed on Qualtrics. Descriptive statistics and reliability estimates were computed. The hypothesized model was tested using structural equation modeling. RESULTS Data suggest that work-life interference significantly increases burnout which contributes to both higher turnover intentions and lower career satisfaction. Turnover intentions, in turn, decrease career satisfaction. CONCLUSIONS The findings add to the growing body of literature linking burnout to turnover and dissatisfaction, highlighting key antecedents and/or drivers of burnout among nurse academics. These results provide suggestions for suitable areas for the development of interventions and policies within the organizational structure to reduce the risk of burnout during and post-COVID-19 and improve faculty retention.
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Affiliation(s)
- Sheila A. Boamah
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Hanadi Y. Hamadi
- Department of Health Administration, Brooks College of Health (Building 39), University of North Florida, Jacksonville, FL 32224, USA; (H.Y.H.); (H.S.)
| | - Farinaz Havaei
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Hailey Smith
- Department of Health Administration, Brooks College of Health (Building 39), University of North Florida, Jacksonville, FL 32224, USA; (H.Y.H.); (H.S.)
| | - Fern Webb
- Department of Surgery-Jacksonville, Center for Health Equity & Engagement Research, Urban Health Alliance of Jacksonville, College of Medicine, University of Florida, Jacksonville, FL 32209, USA;
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Intention to Stay in Specialist Trauma Nurses: Relationship With Role Conflict, Stress, and Organizational Support. J Trauma Nurs 2022; 29:21-28. [PMID: 35007247 DOI: 10.1097/jtn.0000000000000628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Specialist trauma nurses contribute to shortening hospital stay, lowering intensive care unit readmission rates, and improving treatment outcomes through early detection and management of health problems in trauma patients. However, Korean specialist trauma nurses have a higher turnover rate than other nurses due to negative factors like unclear job descriptions and inconsistent job activities. OBJECTIVE This study aimed to examine the levels of and relationships among role conflict, occupational stress, perceived organizational support, and intent to stay in Korean specialist trauma nurses. METHODS We enrolled 53 specialist trauma nurses from eight regional trauma centers in Korea. Data on role conflict, occupational stress, perceived organizational support, and intent to stay were collected using a structured questionnaire. Mann-Whitney U test, Kruskal-Wallis test, and Bonferroni post hoc tests were conducted to examine differences in intent to stay. Spearman's correlation coefficients were used to examine correlations between the key variables. RESULTS High intent to stay was associated with periodic job training, job satisfaction, and perceived high workload. Role conflict was positively correlated with occupational stress, whereas both were negatively correlated with perceived organizational support. Intent to stay was negatively correlated with occupational stress and positively correlated with perceived organizational support. CONCLUSIONS Effective improvement measures that lower occupational stress and increase perceived organizational support will help maintain the positions of specialist trauma nurses. These results highlight the need to specify the scope of practice and implement practical measures like career development programs that enhance professional nursing competencies to retain specialist trauma nurses.
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Hwang J, Song EK, Ko S. Relationships among basic psychological needs, organizational commitment, perceived authentic leadership, and turnover intention in Korean nurses: A cross-sectional study. J Nurs Manag 2022; 30:2176-2184. [PMID: 34996129 DOI: 10.1111/jonm.13546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/25/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
AIM This study determined the relationships of satisfaction and frustration with basic psychological needs, organizational commitment, perceived authentic leadership, and turnover intention in nurses in South Korea. BACKGROUND Minimizing nurse turnover is essential for improving the quality of nursing care and patient safety. METHODS This was a cross-sectional, correlational pilot study of 216 nurses at a university hospital in South Korea. Data were collected with a self-report questionnaire, from September 1 to 15, 2020. Collected data were analyzed using SPSS 24.0. RESULTS Multiple regression analysis revealed that clinical experience (3 to 5 years, β=2.35, p=.019; 5 to 10 years, β=2.23, p=.026), subjective workload (severe, β= 2.10, p=.036; extreme, β=2.84, p=.005), psychological needs frustration (β=0.35, p<.001), organizational commitment (β=-0.17, p=.011), and perceived authentic nurse leadership (β=-0.14, p=.030) were found to have significant effects on nurses' turnover intention. CONCLUSIONS A strategy is needed for efficient nursing staffing management and reduction of nurses' turnover intentions. IMPLICATIONS FOR NURSING MANAGEMENT This study offers a new approach to reducing nurses' turnover. The results suggest that it is necessary to create a transparent work environment based on authentic leadership and consider individual frustrations with regard to basic psychological needs and organizational commitments.
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Affiliation(s)
- Jina Hwang
- Ulsan University Hospital, Ulsan, South Korea
| | - Eun Kyeung Song
- Department of Nursing, University of Ulsan, Ulsan, South Korea
| | - Sangjin Ko
- Department of Nursing, University of Ulsan, Ulsan, South Korea
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Influence of Sleep Characteristic Changes on Nurses' Quality of Life during Their Transition to Practice: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010573. [PMID: 35010831 PMCID: PMC8744848 DOI: 10.3390/ijerph19010573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/22/2021] [Accepted: 12/31/2021] [Indexed: 12/13/2022]
Abstract
Aim: To explore the effect of changes in sleep characteristics on changes in quality of life during the transition period of new graduate nurses. Background: Sleep problems among nurses are associated with negative physical and psychological consequences. Methods: This prospective cohort study was conducted at a tertiary hospital in South Korea. Participants included 88 newly graduated nurses. Data were collected twice, prior to shift work and after 4 months of working as a nurse, via online structured self-report questionnaires created using Survey Monkey from March 2018 to February 2020. A generalized linear mixed model was used to analyze the influence of changes in sleep characteristics on quality of life. Results: A generalized linear mixed model showed that changes in the subjective quality of sleep, subjective health perception, and daytime dysfunction influenced quality of life changes during the transition. This implies that deterioration already existed. From their undergraduate period to four months after they began working as nurses, a significant decrease was observed in the quality of sleep. Participants’ quality of life significantly decreased. Conclusions: Changes in the quality of life of new graduate nurses may show deterioration with a significant drop in subjective sleep quality. Institutions should improve existing work adaptation programs provided during new graduate nurses’ transition to practice by including information on changes in nurses’ health caused by changes in sleep characteristics and sleep quality.
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Adams R, Ryan T, Wood E. Understanding the factors that affect retention within the mental health nursing workforce: a systematic review and thematic synthesis. Int J Ment Health Nurs 2021; 30:1476-1497. [PMID: 34184394 DOI: 10.1111/inm.12904] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 12/19/2022]
Abstract
There are over 41 000 vacant nursing posts across the United Kingdom's National Health Service (NHS), with more people leaving the profession that joining it. Despite mental health being acknowledged as a priority area, some of the most significant staff shortages are occurring within mental health services. Urgent action is needed to retain the mental health nurses (MHNs) currently in post to ensure the profession is fit for purpose and aid future recruitment efforts. This review set out to identify the individual factors that affect the retention of MHNs. A systematic search of six databases was conducted (CINAHL, PsychINFO, MEDLINE, Web of Science (Core collection), EMBASE and the British Nursing Index). Studies were systematically screened for inclusion based on predetermined eligibility criteria. The studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). Findings were synthesized using Thematic Synthesis. A total of 23 studies consisting of a range of study designs were included in the review. Four key themes emerged from the synthesis: Individual characteristics, Working within mental health services, Training and skills and Work environment. The findings from this review suggest that MHNs encounter some factors unique to working in mental health services, which suggests that retention strategies should be specific to each nursing speciality. Beyond nursing speciality, the factors identified vary between clinical settings in mental health due to the differences in work environments and services they provide. Future studies should now set out to explore what factors exist in which clinical settings to inform better tailored retention strategies to generate better outcomes.
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Affiliation(s)
- Rosie Adams
- Health Sciences School, The Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Tony Ryan
- Health Sciences School, The Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Emily Wood
- Health Sciences School, The Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
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Cengiz A, Yoder LH, Danesh V. A concept analysis of role ambiguity experienced by hospital nurses providing bedside nursing care. Nurs Health Sci 2021; 23:807-817. [PMID: 34689398 DOI: 10.1111/nhs.12888] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 01/16/2023]
Abstract
The concept of role ambiguity, despite its wide application in nursing research, lacks a clear definition and conceptualization, resulting in inconsistencies about how it is defined, operationalized, and applied in research. The purpose of this paper was to analyze and define the concept of role ambiguity among hospital nurses providing nursing care, using the concept analysis method developed by Walker and Avant. The three defining attributes of role ambiguity were lack of information (information deficiency), lack of clarity, and unpredictability. Antecedents included lack of clear role definitions, lack of education/training, communication problems, supervisory behaviors and support, organizational culture, practice environment conditions, experience, group cohesiveness, and preferred work setting. The consequences of role ambiguity included increased stress, lack of organizational commitment, job dissatisfaction, burnout, and increased intent to leave. This concept analysis provides a clear conceptual definition to better understand role ambiguity among hospital nurses along with implications for nurse leaders, educators, clinicians, and researchers to support nurses and guide future research. This paper further emphasizes the importance of nurse-manager relationships in reducing the experience of role ambiguity among hospital nurses.
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Affiliation(s)
- Adem Cengiz
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Linda H Yoder
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Valerie Danesh
- The University of Texas at Austin School of Nursing, Austin, Texas, USA.,Baylor Scott & White Health, Dallas, Texas, USA
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Individual and organizational factors of nurses' job satisfaction in long-term care: A systematic review. Int J Nurs Stud 2021; 123:104073. [PMID: 34536909 DOI: 10.1016/j.ijnurstu.2021.104073] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND In long-term care facilities, nurses' job satisfaction predicts staff turnover, which adversely affects resident outcomes. Thus, it is important to develop a comprehensive understanding of factors affecting nurses' job satisfaction in long-term care facilities. OBJECTIVES To analyze factors associated with job satisfaction among nurses in nursing homes from individual and organizational perspectives utilizing a deductive approach. DESIGN Systematic literature review SETTING: Nursing homes. PARTICIPANTS Registered nurses and licensed practical nurses in nursing homes. METHODS A systematic literature review of seven online databases (EMBASE, CINAHL, PsychINFO, MEDLINE, PubMed, Scopus, and Web of Science) to July 23, 2020 was conducted. Studies were included if they examined factors associated job satisfaction in the target population and setting. Decision rules on how to determine factors important to nurse job satisfaction were developed a priori. Two team members independently screened the publications for inclusion, extracted data, and assessed included publications for methodological quality; conflicts were resolved through a consensus process and consultation of the third senior team member when needed. RESULTS Twenty-eight studies were included. Of these, 20 studies were quantitative, 6 were qualitative, and 2 were mixed methods. Factors associated with job satisfaction were grouped into two categories: individual and organizational. Individual factors significantly associated with job satisfaction were age, health status, self-determination/autonomy, psychological empowerment, job involvement, work exhaustion, and work stress. Individual factors identified as not important or equivocal were gender and experience as a nurse/in aged care. No organizational factors were identified as important for nurses' job satisfaction. Facility ownership, supervisor/manager support, resources, staffing level, and social relationships were identified as equivocal or not important. Findings from qualitative studies identified relationship with residents as an important factor for job satisfaction. CONCLUSIONS/IMPLICATIONS Factors identified as important to nurses' job satisfaction differ from those reported among care aides in nursing homes and nurses employed in acute care settings, suggesting that there is a need for unique approaches to enhance nurses' job satisfaction in nursing homes.
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Kim SO, Moon SH. Factors Influencing Turnover Intention among Male Nurses in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189862. [PMID: 34574784 PMCID: PMC8470736 DOI: 10.3390/ijerph18189862] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
The study examined predictors of male nurse turnover intention in Korea using data collected from Korean hospitals. The results were obtained based on a secondary analysis of data previously collected from 306 male nurses in 16 regions of Korea from December 2014 to February 2015. Our findings suggest that male nurse turnover intention is predicted by (1) individual factors: single (B = 0.93, p = 0.008); (2) organizational factors: organizational commitment (B = -0.36, p < 0.001), job satisfaction (B = -0.27, p = 0.001), and job stress (B = 0.24, p < 0.001); and (3) social factors: hospital location in medium-categorized cities (B = 0.70, p = 0.012) and kinship responsibility (B = 0.13, p = 0.026). These factors accounted for 56.9% of the total variance. To lower the rate of turnover intention among male nurses, strategic interventions should be implemented based on the factors identified in this study.
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Affiliation(s)
- Su Ol Kim
- Department of Nursing, Kwangju Women’s University, Gwangju 62396, Korea;
| | - Sun-Hee Moon
- College of Nursing, Chonnam National University, Gwangju 61469, Korea
- Correspondence:
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Abstract
Virtually, no published research is available on the relationship between employing newly graduated nurses (NGNs) in the emergency department (ED) and the advancing of nursing practice and the optimization of patient care outcomes. Traditionally, nurses hired into these practice areas have required advanced skills in clinical assessment and experience with a variety of situations that were assumed to offer them a framework by which they could recognize and respond to potentially life-threatening changes in a patient's status. This qualitative study explored the issues of integrating NGNs into the ED. Findings clearly established the challenges to integrating NGNs into this practice context. The intersection of variables included a low level of clinical predictability accompanied by high acuity; an increased level of practitioner autonomy combined with high levels of risk when applying decision making to patient outcomes; and the potential for devolution of professional identity in the face of highly intense, morally conflicted, and socially nuanced care situations.
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Zaheer S, Ginsburg L, Wong HJ, Thomson K, Bain L, Wulffhart Z. Acute care nurses' perceptions of leadership, teamwork, turnover intention and patient safety - a mixed methods study. BMC Nurs 2021; 20:134. [PMID: 34330272 PMCID: PMC8323271 DOI: 10.1186/s12912-021-00652-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined. METHODS In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked 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 senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study's key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey). CONCLUSIONS The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.
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Affiliation(s)
- Shahram Zaheer
- School of Health Policy and Management, York University, Toronto, Canada. .,Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Canada
| | - Hannah J Wong
- School of Health Policy and Management, York University, Toronto, Canada
| | - Kelly Thomson
- School of Administrative Studies, York University, Toronto, Canada
| | - Lorna Bain
- Interprofessional Collaboration and Education, Southlake Regional Health Centre, Newmarket, Canada.,University of Toronto, Toronto, Canada
| | - Zaev Wulffhart
- University of Toronto, Toronto, Canada.,Regional Cardiac Care Program, Southlake Regional Health Centre, Newmarket, Canada
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Park SY, Kim H, Ma C. Factors associated with difficulty in adapting and intent to leave among new graduate nurses in South Korea. Health Care Manage Rev 2021; 47:168-178. [PMID: 34319282 DOI: 10.1097/hmr.0000000000000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND New graduate nurses experience difficulty in adapting to a new environment, which affects intent to leave. However, data on the factors contributing to difficulty in adapting and intent to leave among new graduate nurses are insufficient. PURPOSE The aim of the study was to explore and compare factors associated with difficulty in adapting and the intent to leave among new graduate nurses in South Korea. METHODOLOGY This cross-sectional study used secondary data analysis. Primary data were obtained from the 2015-2016 Korean National Graduates Occupational Mobility Survey. Descriptive statistics, independent t tests, and chi-square statistics with weighted samples besides multivariate logistic regression analyses were conducted (N = 467). RESULTS Roughly 46% of nurses reported difficulty adapting, and 16% expressed their intent to leave. The factors linked to difficulty in adapting were working at large hospitals with rotating shifts, low person-job fit, and low satisfaction with personal competency; intent to leave was associated with high monthly salary and low satisfaction with the workplace (all ps < .05). Difficulty in adapting did not equate to their intent to leave. CONCLUSIONS There were high rates of difficulty in adapting and intent to leave among new graduate nurses. Although different factors were associated with difficulty adapting and intent to leave, workplace condition is a common factor. PRACTICE IMPLICATIONS Different strategies are needed to improve adaptation and intention of leaving among new graduate nurses. For better adaptation, developing training programs enhancing professional competency with a sufficient training period is required. In addition, providing staff and resources to reduce the intent to leave is crucial.
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Affiliation(s)
- Sun-Young Park
- Sun-young Park, MSN, RN, is Doctoral Student, College of Nursing, Yonsei University, and Associate Research Fellow, Division of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, South Korea. Heejung Kim, PhD, RN, is Associate Professor, College of Nursing, Yonsei University, and Principal Researcher, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea. E-mail: . Chenjuan Ma, PhD, MSN, RN, is Assistant Professor, Rory Meyers College of Nursing, New York University, New York
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Lavoie-Tremblay M, Sanzone L, Aubé T, Paquet M. Sources of Stress and Coping Strategies Among Undergraduate Nursing Students Across All Years. Can J Nurs Res 2021; 54:261-271. [PMID: 34192949 PMCID: PMC9379378 DOI: 10.1177/08445621211028076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Undergraduate nursing students experience high levels of stress
during their programs. The literature on their stress is
extensive, however, what is less well-known are the specific
sources of stresses for students in different years of
study. Purpose The aim of this study is to understand nursing students’ sources of
stress and coping strategies in each year of study. Method A transversal descriptive qualitative study was used. A sample of
26 undergraduate students attending a university in Montreal,
Canada were recruited and participated in a semi-structured
interview. Data were analysed using inductive thematic
analysis. Results The sources of stress differed according to year of study and
related significantly to the specific novelty of that year. For
first-year students, their stress was related to their academic
courses. High clinical performance expectations and a lack of
time for their personal lives was a main source of stress for
second-year students. The prospect of graduating and
transitioning into the work environment caused stress for
students in their final year. Students across all years of study
utilized similar coping strategies. Conclusion The findings suggest that interventions can be developed to address
the sources of stress experienced by nursing students in each
year of study.
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Affiliation(s)
| | - Lia Sanzone
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Thalia Aubé
- Department of Psychology, University of Montreal, Québec, Canada
| | - Maxime Paquet
- Department of Psychology, University of Montreal, Québec, Canada
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Gohar B, Larivière M, Lightfoot N, Wenghofer E, Larivière C, Nowrouzi-Kia B. Understanding sickness absence in nurses and personal support workers: Insights from frontline staff and key informants in Northeastern Ontario. Work 2021; 66:755-766. [PMID: 32925137 DOI: 10.3233/wor-203222] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nurses and personal support workers (PSWs) have high sickness absence rates in Canada. Whilst the evidence-based literature helped to identify the variables related to sickness absenteeism, understanding "why" remains unknown. This information could benefit the healthcare sector in northeastern Ontario and in locations where healthcare is one of the largest employment sectors and where nursing staff have high absence and turnover rates. OBJECTIVE To identify and understand the factors associated with sickness absence among nurses and PSWs through several experiences while investigating if there are northern-related reasons to explain the high rates of sickness absence. METHODS In this descriptive qualitative study, focus group sessions took place with registered nurses (n = 6), registered practical nurses (n = 4), PSWs (n = 8), and key informants who specialize in occupational health and nursing unions (n = 5). Focus group sessions were transcribed verbatim followed by inductive thematic analysis. RESULTS Four main themes emerged, which were occupational/organizational challenges, physical health, emotional toll on mental well-being, and northern-related challenges. Descriptions of why such factors lead to sickness absence were addressed with staff shortage serving as an underlying factor. CONCLUSION Despite the complexity of the manifestations of sickness absence, work support and timely debriefing could reduce sickness absence and by extension, staff shortage.
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Affiliation(s)
- Basem Gohar
- Department of Psychology, University of Guelph, Guelph, Canada.,Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, Canada
| | - Michel Larivière
- School of Human Kinetics, Northern Ontario School of Medicine & Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, Canada
| | - Nancy Lightfoot
- School of Rural and Northern Health & Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, Canada
| | - Elizabeth Wenghofer
- School of Rural and Northern Health & Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, Canada
| | - Céline Larivière
- School of Human Kinetics, Northern Ontario School of Medicine & Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Centre for Research in Occupational Safety and Health, Laurentian University, Sudbury, Canada
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36
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Nowrouzi-Kia B, Fox MT, Sidani S, Dahlke S, Tregunno D. The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada. Can J Nurs Res 2021; 54:112-120. [PMID: 34042538 PMCID: PMC9109589 DOI: 10.1177/08445621211014421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives The study aimed to describe and compare nurses’ perceptions of role conflict
by professional designation [registered nurse (RN) vs registered practical
nurse (RPN)] in three primary areas of practice (emergency department,
medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a
random sample of RNs and RPNs working as staff nurses in acute care
hospitals in Ontario, Canada. Role conflict was measured by the Role
Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s
eligibility criteria and provided complete data. In general, RN and RPN mean
total scale scores on role conflict hovered around the scale’s mid-point
(2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the
emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and
surgical unit (2.90 vs 2.72). Where statistically significant differences
were found, the effect sizes were negligible to medium in magnitude with the
largest differences noted between RNs and RPNs working in the emergency
department. Conclusions The results suggest the need to implement strategies that diminish role
conflict for both RNs and RPNs.
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Affiliation(s)
- Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary T Fox
- York University Centre for Aging Research and Education, School of Nursing, York University, Toronto, Ontario, Canada
| | - Souraya Sidani
- School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Havaei F, Ma A, Leiter M, Gear A. Describing the Mental Health State of Nurses in British Columbia: A Province-Wide Survey Study. ACTA ACUST UNITED AC 2021; 16:31-45. [PMID: 34129477 DOI: 10.12927/hcpol.2021.26500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A cross-sectional province-wide survey study of 3,978 British Columbia (BC) nurses was conducted to explore the mental health state of the nursing workforce in BC. About one third of nurses reported depression and anxiety; about half reported symptoms of post-traumatic stress disorder and at least one third reported high levels of one or more dimensions of burnout. Mental health problems were about 1.5 to 3 times more prevalent among BC nurses compared to their peers nationally. Improving nurses' mental health requires multi-factorial and multi-level efforts. Evidence-based and workplace-specific policies and interventions that better support nurses at risk are recommended.
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Affiliation(s)
- Farinaz Havaei
- Assistant Professor, School of Nursing, University of British Columbia, Vancouver, BC
| | - Andy Ma
- Master of Arts Student in Measurement, Evaluation and Research Methodology, University of British Columbia, Vancouver BC
| | - Michael Leiter
- Honorary Professor of Organizational Psychology, Deakin University, Geelong, Australia
| | - Adriane Gear
- Case and Contact Management, Pandemic Response, Island Health; Former Consultant, Former Executive Councillor of Occupational Health and Safety, British Columbia Nurses' Union, Burnaby, BC
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Xie J, Wang L, Wang S, Duan Y, Wang K, Zhong Z, Yan J, Ding S, Li L, Cheng ASK. What influences new graduate nurses' core competencies transformation to clinical in China? A cross-sectional study. NURSE EDUCATION TODAY 2021; 100:104855. [PMID: 33711584 DOI: 10.1016/j.nedt.2021.104855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The core competencies of new graduate nurses (NGNs) have significant health outcomes in the clinical environment. However, these nurses experience a theory-practice gap, which creates a barrier in the transition process when they first enter the clinical workplace. OBJECTIVE To understand the general overview of the transition of the core competencies of NGNs to clinical practice in China and the influencing factors. DESIGN AND SETTING A cross-sectional study design consisting of a multi-stratified grounded random sample from 31 hospitals in seven regions nationwide. PARTICIPANTS 2400 NGNs were recruited by email. METHODS The Competencies Inventory for Registered Nurse (CIRN) was applied to evaluate NGNs' core competencies. RESULTS NGNs performed best on leadership and worst on critical thinking or research aptitude. Core competencies were predicted by depressive symptoms, worked for two-three years, having a nurse-in-charge title, professional values, department, happiness, etc. Besides, the preceptor program also has significant to core competencies. CONCLUSION The average level of Chinese NGNs' core competencies was at a moderate level, which wasn't well optimized. It is recommended to adopt appropriate interventions to support NGNs. With an increase in work years and the accumulation of more work experience, the corresponding core competencies of NGNs will also improve. Preceptor institutions, limiting first-degree recruitment, and early ICU or operating room department rotations can be carried out by nursing educators to improve core competencies.
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Affiliation(s)
- Jianfei Xie
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Sha Wang
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yinglong Duan
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Kewei Wang
- Hunan Children's Hospital, Changsha, China
| | - Zhuqing Zhong
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jin Yan
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lijun Li
- Xiangya Nursing School, Central South University, Changsha, China.
| | - Andy S K Cheng
- The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hong Kong, China
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Abstract
Nurses’ turnover is a major global problem with significant service and cost implications. Although sizeable research inquiries have been made into the antecedents, the dynamics, and the consequences of nurses’ turnover, there is still a lack of fine-grained understanding of the psychological states that reflect the cumulative impact of different antecedents and immediately precede nurses’ intentions to quit either from their unit/organization and/or their profession. This paper introduces and develops a meaning-based view of nurses’ turnover. This perspective distinguishes between meaning in work (based on the nurses’ relationship with their work) and meaning at work (based on the nurses’ relationship with their work environment) and explain the implications of high/low meaning in and at work on nurses’ turnover. This meaning-based view of nurses’ turnover offers nurses, administrators and policy makers a deeper and a more nuanced understanding of turnover and promises more tailored remedies for the turnover problem.
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Affiliation(s)
- AR Elangovan
- Gustavson School of Business, University of Victoria, Victoria, BC, Canada
| | - Anirban Kar
- Beedie School of Business, Simon Fraser University, Burnaby, BC, Canada
- Anirban Kar, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Claudia Steinke
- Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
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40
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Bae SH, Cho M, Kim O, Pang Y, Cha C, Jung H, Kim S, Jeong H. Predictors of actual turnover among nurses working in Korean hospitals: A nationwide longitudinal survey study. J Nurs Manag 2021; 29:2102-2114. [PMID: 33894028 DOI: 10.1111/jonm.13347] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
AIM To examine the factors affecting actual turnover among nurses working in hospitals using the Brewer-Kovner synthesis model. BACKGROUND To increase retention of nurses, it is important to understand factors contributing to actual turnover among nurses. METHODS A longitudinal study design was utilized with 2,633 of 20,613 eligible female hospital nurses who participated in Korea Nurses' Health Study. We created two age groups: a younger group (20-35 years) and an older group (36-49 years). Multivariate logistic regression was used to identify the factors influencing turnover by age group. RESULTS Pregnancy and childbirth increased young nurses' turnover. When we excluded intent to leave, depression and burnout were significant factors affecting young nurses' turnover. Salary and hospital size were factors predicting nurse turnover among nurses older than 36 years. CONCLUSIONS It is essential to develop prevention strategies of female nurse turnover based on the age group in Korea. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers and health care institutes need to develop new managerial and policy strategies to reduce nurse turnover in each age group.
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Affiliation(s)
- Sung-Heui Bae
- College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea
| | - Mijung Cho
- College of Nursing, Ewha Research Institute of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Oksoo Kim
- College of Nursing, Ewha Research Institute of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Yanghee Pang
- College of Nursing, Ewha Research Institute of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Chiyoung Cha
- College of Nursing, Ewha Research Institute of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Heeja Jung
- College of Nursing, Konyang University, Daejeon, Korea
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul, Korea
| | - Hyunseon Jeong
- College of Nursing, Ewha Research Institute of Nursing Science, Ewha Womans University, Seoul, Korea
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Heo YM, Lee M, Jang SJ. Intentions of frontline nurses regarding COVID-19 patient care: A cross-sectional study in Korea. J Nurs Manag 2021; 29:1880-1888. [PMID: 33844348 PMCID: PMC8250349 DOI: 10.1111/jonm.13333] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/16/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
Aim This cross‐sectional study, conducted from August to September 2020, examined nurses’ stress, self‐efficacy and nursing intentions when caring for COVID‐19 patients and identified the predictors of nursing intentions during the pandemic. Background The COVID‐19 outbreak has increased nurses' role expectations and imposed a heavy social responsibility. In particular, frontline nurses are under significant stress when caring for patients during a novel epidemic because of the lack of accurate information. Methods A total of 232 nurses with experience in providing care for suspected or confirmed COVID‐19 patients from seven large hospitals in three cities in Korea completed the Perceived Stress Scale, Self‐Efficacy Scale and Predictive Nursing Intention Scale. Results Multiple regression confirmed that completing COVID‐19‐related education and self‐efficacy were significant predictors of nursing intentions during the current pandemic; the regression model explained 22.0% of the variance in nursing intentions. Conclusion Stress did not affect frontline nurses' nursing intentions towards COVID‐19 patient care, but completing COVID‐19‐related education and higher self‐efficacy predicted improved nursing intentions. Implications for Nursing Management Nurse leaders should recognize that to improve nursing intentions during a novel infection outbreak, infection‐related education should be provided and strategies to improve self‐efficacy should be implemented.
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Affiliation(s)
- Yu-Mi Heo
- College of Nursing, Eulji University, Daejeon, Korea
| | - Miyoung Lee
- College of Nursing, Eulji University, Daejeon, Korea
| | - Sun Joo Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Alreshidi NM, Alrashidi LM, Alanazi AN, Alshammri EH. Turnover among foreign nurses in Saudi Arabia. J Public Health Res 2021; 10. [PMID: 33849251 PMCID: PMC8054764 DOI: 10.4081/jphr.2021.1971] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon. Design and methods: The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals. Results: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores. Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted. Significance for public health The nursing workforce is considered the backbone of the healthcare delivery system. In Saudi Arabia, foreign nurses employ a large percentage of human resources required in healthcare institutions. Thus, foreign nurses’ increasing turnover rates remain a significant problem affecting healthcare institutions across the country. Staff turnover rate is the prime source of workforce shortage that impacts the operational domain, thereby negatively affecting productivity and revenues. The high turnover rates negatively impact organizational in quality of care and resources to recruit and train new staff, prompts many scholars to investigate possible causes, and to develop a comprehensive staff retention strategies. Determining associated factors on staff turn-over, provides insights that will guide facility policy makers and stakeholders to keep pace with the demand of public health system.
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Affiliation(s)
- Nashi Masnad Alreshidi
- Continuing Nursing Education Director, Nursing Administration in Hail Region, Hail City.
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Hewko S, Oyesegun A, Clow S, VanLeeuwen C. High turnover in clinical dietetics: a qualitative analysis. BMC Health Serv Res 2021; 21:25. [PMID: 33407423 PMCID: PMC7789381 DOI: 10.1186/s12913-020-06008-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. METHODS Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. RESULTS Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. CONCLUSIONS Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.
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Affiliation(s)
- Sarah Hewko
- University of Prince Edward Island, 550 University Avenue, Charlottetown, PE C1A 4P3, Canada.
| | - Amirah Oyesegun
- University of Prince Edward Island, 550 University Avenue, Charlottetown, PE C1A 4P3, Canada
| | - Samantha Clow
- University of Prince Edward Island, 550 University Avenue, Charlottetown, PE C1A 4P3, Canada
| | - Charlene VanLeeuwen
- University of Prince Edward Island, 550 University Avenue, Charlottetown, PE C1A 4P3, Canada
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Rubin B, Goldfarb R, Satele D, Graham L. Burnout and distress among nurses in a cardiovascular centre of a quaternary hospital network: a cross-sectional survey. CMAJ Open 2021; 9:E19-E28. [PMID: 33436452 PMCID: PMC7843080 DOI: 10.9778/cmajo.20200058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Burnout and distress have a negative impact on nurses and the treatment they provide. Our aim was to measure the prevalence of burnout and distress among nurses in a cardiovascular centre at 2 quaternary referral hospitals in Canada, and compare these outcomes to those for nurses at academic health science centres (AHSCs) in the United States. METHODS We conducted a survey of nurses practising in a cardiovascular centre at 2 quaternary referral hospitals in Toronto, Ontario, between Nov. 27, 2018, and Jan. 31, 2019. The survey tool included the Well-Being Index (WBI), which measures fatigue, depression, burnout, anxiety or stress, mental and physical quality of life, work-life integration, meaning in work and distress; a score of 2 or higher on the WBI indicated high distress. We also evaluated nurses' perception of the adequacy of staffing levels and of fair treatment in the workplace, and satisfaction with the electronic health record. We carried out standard univariate statistical comparisons using the χ2, Fisher exact or Kruskal-Wallis test as appropriate to perform univariate comparisons in the sample of respondents. We assessed the relation between a WBI score of 2 or higher and demographic characteristics. We compared univariate associations among WBI data for nurses at AHSCs in the US who completed the WBI to responses from our participants. RESULTS The response rate to the survey was 49.1% (242/493). Of the 242 respondents, 188 (77.7%) reported burnout in the previous month; 189 (78.1%) had a WBI score of 2 or higher, and 132 (54.5%) had a score of 4 or higher (indicative of severe distress). Ordinal multivariable analysis showed that lower WBI scores were associated with satisfaction with staffing levels (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.16-0.69) and the perception of fair treatment in the workplace (OR 0.41, 95% CI 0.23-0.74). Higher proportions of our respondents than nurses at AHSCs in the US reported burnout (77.7% v. 60.5%, p < 0.001) and had a WBI score of 2 or higher (78.1% v. 57.0%) or 4 or higher (54.5% v. 32.0%) (both p < 0.001). INTERPRETATION Although levels of burnout and distress were high among nurses, their perceptions of adequate staffing and fair treatment were associated with lower distress. Addressing inadequate staffing and unfair treatment may decrease burnout and other dimensions of distress among nurses, and improve their work experience and patient outcomes.
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Affiliation(s)
- Barry Rubin
- Division of Vascular Surgery (Rubin), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network; Goldfarb Intelligence Marketing (Goldfarb), Toronto, Ont.; Division of Biomedical Statistics and Informatics (Satele), Mayo Foundation for Medical Education and Research, Rochester, Minn.; Office of Professional Practice & Policy (Graham), Toronto General Hospital, Toronto, Ont.
| | - Rebecca Goldfarb
- Division of Vascular Surgery (Rubin), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network; Goldfarb Intelligence Marketing (Goldfarb), Toronto, Ont.; Division of Biomedical Statistics and Informatics (Satele), Mayo Foundation for Medical Education and Research, Rochester, Minn.; Office of Professional Practice & Policy (Graham), Toronto General Hospital, Toronto, Ont
| | - Daniel Satele
- Division of Vascular Surgery (Rubin), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network; Goldfarb Intelligence Marketing (Goldfarb), Toronto, Ont.; Division of Biomedical Statistics and Informatics (Satele), Mayo Foundation for Medical Education and Research, Rochester, Minn.; Office of Professional Practice & Policy (Graham), Toronto General Hospital, Toronto, Ont
| | - Leanna Graham
- Division of Vascular Surgery (Rubin), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network; Goldfarb Intelligence Marketing (Goldfarb), Toronto, Ont.; Division of Biomedical Statistics and Informatics (Satele), Mayo Foundation for Medical Education and Research, Rochester, Minn.; Office of Professional Practice & Policy (Graham), Toronto General Hospital, Toronto, Ont
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Rubin B, Goldfarb R, Satele D, Graham L. Burnout and distress among allied health care professionals in a cardiovascular centre of a quaternary hospital network: a cross-sectional survey. CMAJ Open 2021; 9:E29-E37. [PMID: 33436453 PMCID: PMC7843078 DOI: 10.9778/cmajo.20200059] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Burnout and distress negatively affect the well-being of health care professionals and the treatment they provide. Our aim was to measure the prevalence of burnout and distress among allied health care staff at a cardiovascular centre of a quaternary hospital network in Canada, and compare outcomes to those for nonphysician employees in the United States. METHODS We conducted a survey of allied health care staff, including physical, respiratory and occupational therapists, pharmacists, social workers, dietitians and speech-language pathologists, in a cardiovascular centre at 2 quaternary referral hospitals in Toronto, Ontario, between Nov. 27, 2018, and Jan. 31, 2019. The survey tool included the Well-Being Index (WBI), which measures fatigue, depression, burnout, anxiety or stress, quality of life, work-life integration, meaning in work and overall distress; a score of 2 or higher indicated high distress. We carried out standard univariate statistical comparisons using the χ2, Fisher exact or Kruskal-Wallis test as appropriate to perform univariate comparisons in the sample of respondents. We assessed the relation between a WBI score of 2 or higher and demographic characteristics. We compared univariate associations among WBI data for nonphysician employees in the US who completed the WBI to responses from our participants. RESULTS The response rate to the survey was 86% (45/52). Thirty-three respondents (73%) reported experiencing burnout in the previous month, and 31 (69%) reported emotional problems. Compared to respondents who perceived fair treatment in the workplace, those who perceived unfair treatment (20 [44%]) were more likely to report emotional problems (17 [85%] v. 13 [54%], p = 0.05), to worry that work was hardening them emotionally (15 [75%] v. 8 [33%], p = 0.008), and to feel down, depressed or hopeless (12 [60%] v. 4 [17%], p = 0.005). Twenty-five respondents (56%) and 13 respondents (29%) reported WBI scores consistent with high (≥ 2) or severe (≥ 5) distress, respectively. Respondents were more likely to have a high WBI score if they perceived unfair treatment or inadequate staffing levels. Our respondents had a higher prevalence of burnout (73.3% v. 53.6%, p = 0.008) and a higher average WBI score (2.6 [SD 2.8] v. 1.7 [SD 2.6], p = 0.05) than 9096 nonphysician employees in the US. INTERPRETATION The prevalence of burnout, emotional problems and distress was high among allied health care staff. Fair treatment in the workplace and adequate staffing may lower distress levels and improve the work experience of these health care professionals.
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Affiliation(s)
- Barry Rubin
- Division of Vascular Surgery (Rubin), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network; Goldfarb Intelligence Marketing (Goldfarb), Toronto, Ont.; Division of Biomedical Statistics and Informatics (Satele), Mayo Foundation for Medical Education and Research, Rochester, Minn.; Office of Professional Practice & Policy (Graham), Toronto General Hospital, Toronto, Ont.
| | - Rebecca Goldfarb
- Division of Vascular Surgery (Rubin), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network; Goldfarb Intelligence Marketing (Goldfarb), Toronto, Ont.; Division of Biomedical Statistics and Informatics (Satele), Mayo Foundation for Medical Education and Research, Rochester, Minn.; Office of Professional Practice & Policy (Graham), Toronto General Hospital, Toronto, Ont
| | - Daniel Satele
- Division of Vascular Surgery (Rubin), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network; Goldfarb Intelligence Marketing (Goldfarb), Toronto, Ont.; Division of Biomedical Statistics and Informatics (Satele), Mayo Foundation for Medical Education and Research, Rochester, Minn.; Office of Professional Practice & Policy (Graham), Toronto General Hospital, Toronto, Ont
| | - Leanna Graham
- Division of Vascular Surgery (Rubin), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network; Goldfarb Intelligence Marketing (Goldfarb), Toronto, Ont.; Division of Biomedical Statistics and Informatics (Satele), Mayo Foundation for Medical Education and Research, Rochester, Minn.; Office of Professional Practice & Policy (Graham), Toronto General Hospital, Toronto, Ont
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Alfuqaha OA, Al-Hairy SS, Al-Hemsi HA, Sabbah AA, Faraj KN, Assaf EM. Job rotation approach in nursing profession. Scand J Caring Sci 2020; 35:659-667. [PMID: 33326130 DOI: 10.1111/scs.12947] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/09/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The nursing profession still needs more attention from decision-makers to enhance satisfaction and commitment in the work environment. AIMS AND OBJECTIVES This study aims to explore the perceived level of job rotation, job satisfaction, job commitment, job turnover and job conflict among nurses who previously had job rotation experience in Jordan. The study also investigates the correlation between studied variables and job rotation approach based on the type of hospitals. Furthermore, it also evaluates the contribution of job rotation, job commitment and many demographic factors in predicting job satisfaction among nurses who had job rotation experience in Jordan. DESIGN The study adopted the cross-sectional survey design of the correlational type. METHODS The study was performed on a stratified convenience sample of 786 nurses from five hospitals in Jordan. The scales used to explore the perceived level of studied variables were obtained from previously published studies, translated to Arabic language and then checked for validity and reliability before being used. RESULTS Results show that job rotation, job satisfaction, job commitment, job turnover and job conflict are all found to be at high levels. Job rotation approach among nurses seems necessary since job satisfaction and job commitment are positively correlated with job rotation. Also, job commitment, job rotation and gender are identified as significant predictors of job satisfaction among nurses in Jordan. CONCLUSION Nurses who experienced job rotation are found have high levels of job satisfaction and job commitment. However, job turnover is also found to be at high level which should be emphasised. Nurse leaders are advised to apply the job rotation approach by moving nurses between different departments in a planned manner to increase the level of job satisfaction and job commitment.
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Affiliation(s)
- Othman A Alfuqaha
- Department of Nursing, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Sakher S Al-Hairy
- Department of Nursing, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Haifa A Al-Hemsi
- Department of Nursing, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Afaf A Sabbah
- Department of Nursing, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Khadeejeh N Faraj
- Department of Nursing, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Eyad M Assaf
- Department of Nursing, Jordan University Hospital, The University of Jordan, Amman, Jordan
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Vanderspank-Wright B, Lalonde M, Squires J, Graham ID, Efstathiou N, Devey Burry R, Marcogliese E, Skidmore B, Vandyk A. Identifying, describing, and assessing interventions that support new graduate nurse transition into critical care nursing practice: a systematic review protocol. Syst Rev 2020; 9:241. [PMID: 33066825 PMCID: PMC7568385 DOI: 10.1186/s13643-020-01483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given a persistent nursing shortage in Canada and a decline in new nurses entering the profession, new graduate nurses (NGNs) are being hired into positions historically reserved for more experienced staff. Critical care settings, which are areas of specialty nursing practice, are now routinely hiring NGNs in many hospitals. While evidence on NGN transition into critical care is emerging, best practices around training and support for these nurses are limited internationally, and non-existent within the Canadian context. Therefore, the aim of this systematic review is to identify, describe, and assess the effectiveness of interventions that support NGN transition into critical care clinical practice settings. METHODS This is a systematic review of interventions using the Joanna Briggs Institute Methodology. Data sources will include MEDLINE, CINAHL, PsychINFO, Education Source, and Nursing and Allied Health electronic databases. Two independent reviewers will screen titles and abstracts using predetermined inclusion criteria. A consensus meeting will be held with a third reviewer to resolve conflicts when necessary. Full texts will also be screened by two independent reviewers and with conflicts resolved by consensus. Data will be extracted using a standardized extraction form. We will assess the quality of all included studies using Joanna Briggs Institute quality assessment tools. Data describing interventions will be reported narratively and a meta-analysis will be conducted to determine effectiveness, if appropriate. DISCUSSION This systematic review will identify interventions that support NGN transition into critical care nursing practice. The findings of this study will provide a foundation for developing strategies to support NGN transition into these areas of specialty nursing practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020147962.
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Affiliation(s)
| | - Michelle Lalonde
- University of Ottawa, School of Nursing, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Janet Squires
- University of Ottawa, School of Nursing, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Ian D Graham
- University of Ottawa, School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, K1G 5Z3, Ontario, Canada
| | - Nikolaos Efstathiou
- University of Ottawa, School of Nursing, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.,University of Birmingham, School of Nursing, Medical School, Vincent Drive, Birmingham, B15 2TT, United Kingdom
| | - Robin Devey Burry
- University of Ottawa, School of Nursing, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.,Bruyère Continuing Care, 60 Cambridge Street North, Ottawa, Ontario, K1R 7A5, Canada
| | - Emily Marcogliese
- University of Ottawa, School of Nursing, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
| | | | - Amanda Vandyk
- University of Ottawa, School of Nursing, 451 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
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Zhao Y, Russell DJ, Guthridge S, Ramjan M, Jones MP, Humphreys JS, Wakerman J. Cost impact of high staff turnover on primary care in remote Australia. AUST HEALTH REV 2020; 43:689-695. [PMID: 30158049 DOI: 10.1071/ah17262] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/20/2018] [Indexed: 11/23/2022]
Abstract
Objectives The aim of this study was to estimate the costs of providing primary care and quantify the cost impact of high staff turnover in Northern Territory (NT) remote communities. Methods This cost impact assessment used administrative data from NT Department of Health datasets, including the government accounting system and personnel information and payroll systems between 2004 and 2015, and the primary care information system from 2007 to 2015. Data related to 54 government-managed clinics providing primary care for approximately 27200 Aboriginal and non-Aboriginal people. Main outcome measures were average costs per consultation and per capita, cost differentials by clinic, year and levels of staff turnover. Linear regression and dominance analysis were used to assess the effect of staff turnover on primary care costs, after adjusting for remoteness and weighting analysis by service population. Both current and constant prices were used. Results On average, in constant prices, there was a nearly 10% annual increase in remote clinic expenditure between 2004 and 2015 and an almost 15% annual increase in consultation numbers since 2007. In real terms, the average costs per consultation decreased markedly from A$273 in 2007 to A$197 in 2015, a figure still well above the Medicare bulk-billing rate. The cost differentials between clinics were proportional to staff turnover and remoteness (both P<0.001). A 10% higher annual turnover rate pertains to an A$6.12 increase in costs per consultation. Conclusions High staff turnover exacerbates the already high costs of providing primary care in remote areas, costing approximately A$50 extra per consultation. This equates to an extra A$400000 per clinic per year on average, or A$21million annually for the NT government. Over time, sustained investments in developing a more stable primary care workforce should not only improve primary care in remote areas, but also reduce the costs of excessive turnover and overall service delivery costs. What is known about the topic? Population size and geographical remoteness are important cost drivers in remote clinics, whereas elsewhere in Australia the high use of short-term staff to fill positions has been identified as a major contributor to higher nurse turnover costs and to overall health service costs. Nursing staff expenditure accounts for a large proportion (46%) of total expenditure in NT remote health services, whereas expenditure on Aboriginal Health Practitioners (AHPs) comprises only 6%. Annual nurse turnover rates in remote NT clinics average approximately 150%, whereas levels of 40% in other contexts are considered high. What does this paper add? Annual expenditure for NT remote clinics has increased, on average, by 10% per annum between 2004 and 2015, but small declines in real expenditure have been observed from a maximum in 2012. Expenditure on nursing staff comprises 40% of overall expenditure in remote clinics, whereas expenditure on AHPs comprises less than 5%. The cost impact of every 10% increase in remote nurse and AHP annual turnover has been quantified as an extra A$6.12 per primary care consultation, which equates, on average, to an extra A$400000 per remote clinic, and an extra A$21million overall for the NT Department of Health each year. The average real expenditure per primary care consultation has decreased from A$273 in 2007 to A$197 in 2015, representing a statistically significant linear trend reduction of A$7.71 per consultation annually. What are the implications for practitioners (and other decision-makers)? Adjusting policy settings away from the high use of short-term staff to investment in appropriate training 'pipelines' for the remote primary care workforce may, in the medium and longer term, result in reduced turnover of resident staff and associated cost savings. Targeted recruitment and retention strategies that ensure individual primary care workers are an optimal fit with the remote communities in which they work, together with improved professional and personal support for staff residing in remote communities, may also help reduce turnover, improve workforce stability and lead to stronger therapeutic relationships and better health outcomes.
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Affiliation(s)
- Yuejen Zhao
- Northern Territory Department of Health, PO Box 40596, Darwin, NT 0800, Australia.
| | - Deborah J Russell
- Flinders Northern Territory, School of Medicine, Flinders University, PO Box U362, Casuarina, NT 0815, Australia. Email
| | - Steven Guthridge
- Menzies School of Health Research, PO Box 41096 Casuarina NT 0811, Australia. Email
| | - Mark Ramjan
- Northern Territory Department of Health, PO Box 40596, Darwin, NT 0800, Australia.
| | - Michael P Jones
- Faculty of Human Sciences, Macquarie University, North Ryde, NSW 2109, Australia. Email
| | - John S Humphreys
- Monash Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia. Email
| | - John Wakerman
- Flinders Northern Territory, School of Medicine, Flinders University, PO Box U362, Casuarina, NT 0815, Australia. Email
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Exploring the Relational Intervention of Storytelling: A Qualitative Study of the Patient Stories Project in a Single ICU. Crit Care Explor 2020; 2:e0224. [PMID: 33063029 PMCID: PMC7523772 DOI: 10.1097/cce.0000000000000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives: Our study objective was to explore nurses’ experiences of how the Patient Stories Project, an intervention consisting of garnering and sharing ICU survivor stories with the ICU team, influenced their perceptions of the value of their work and their nurse-patient relationships. Design: This was a qualitative descriptive case study that used thematic analysis. Setting: This study was conducted in a single, 34-bed adult ICU in a Canadian tertiary care teaching hospital, serving a mixed medical and surgical patient population and employing over 200 nurses. Subjects: Semistructured focus groups with 12 ICU nurses were conducted between June 2019 and July 2019. Intervention: The Patient Stories Project is a systematic process for collecting and sharing former patients’ stories. On a regular basis, former ICU patients return to the ICU to say, “thank you,” share their experiences, and tell their stories to staff. Measurements and Main Results: Storytelling through the Patient Stories Project gives meaning to nurses’ work and provides avenues for nurses to think about their work more positively. Key themes were as follows: 1) perspective taking, 2) emphasizing the value in caring, 3) providing positive closure, 4) engendering team belonging, and 5) building a sense of hope. Conclusions: This study addresses the Critical Care Societies Collaboratives “call to action” to create a healthy work environment. Nurse focus group participants articulated how an initiative such as the Patient Stories Project may augment the relational aspects of work that are important to nurses, as well as their patients and families. Our study results have implications for the importance of using storytelling as a relational strategy to protect against depersonalization and cynicism, elements of burnout.
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"The hardest job you will ever love": Nurse recruitment, retention, and turnover in the Nurse-Family Partnership program in British Columbia, Canada. PLoS One 2020; 15:e0237028. [PMID: 32898142 PMCID: PMC7478534 DOI: 10.1371/journal.pone.0237028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background Nurse turnover is a significant issue and complex challenge for all healthcare sectors and is exacerbated by a global nursing shortage. Nurse-Family Partnership is a community health program for first-time pregnant and parenting girls and young women living in situations of social and economic disadvantage. In Canada, this program is delivered exclusively by public health nurses and only within a research context. The aim of this article is to explore and describe factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada between 2013 and 2018. Methods Interpretive description was used to guide sampling, data collection and analytic decisions in this qualitative component drawn from the British Columbia Healthy Connections Project mixed methods process evaluation. Semi-structured, individual interviews were conducted with 28 public health nurses who practiced in and then exited Nurse-Family Partnership. Results Nurses were motivated to join this program because they wanted to deliver an evidence-based program for vulnerable young mothers that fit with their personal and professional philosophies and offered nurse autonomy. Access to program resources attracted nursing staff, while delivering a program that prioritizes maintaining relationships and emphasizes client successes was a positive work experience. Opportunities for ongoing professional development/ education, strong team connections, and working at full-scope of nursing practice were significant reasons for nurses to remain in Nurse-Family Partnership. Personal circumstances (retirement, family/health needs, relocation, career advancement) were the most frequently cited reasons leading to turnover. Other factors included: involuntary reasons, organizational and program factors, and geographical factors. Conclusions Public health organizations that deliver Nurse-Family Partnership may find aspects of job embeddedness theory useful for developing strategies for supporting recruitment and retention and reducing nurse turnover. Hiring nurses who are the right fit for this type of program may be a useful approach to increasing nurse retention. Fostering a culture of connectivity through team development along with supportive and communicative supervision are important factors associated with retention and may decrease turnover. Many involuntary/external factors were specific to being in a study environment. Program, organizational, and geographical factors affecting nurse turnover are modifiable.
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