Predictors of Home Healthcare Nurse Retention

Exploring the experiences of female undergraduate nursing students in providing home healthcare to older adults

BACKGROUND

In light of the growing ageing population in Saudi Arabia and Saudi nurses' hesitation to work with the older population, it is important to understand the experiences of nursing students on their clinical placement in home healthcare.

METHODS

This study is a descriptive qualitative study based on five focus groups of 3-5 students each. Data were collected from female senior baccalaureate nursing students at a female governmental university in Saudi Arabia, and during their placement in home healthcare. Data were analysed using thematic analysis.

RESULTS

Five main themes emerged : struggling with their own family; struggling with cultural and social beliefs; struggling during clinical training; struggling with domestic caregivers; and reflections for the future were considered important impressions in clinical experience.

CONCLUSION

The culture of Saudi Arabian society is an important factor in shaping the training experience of female nursing students either positively or negatively, specifically in the context of home healthcare nursing for older patients. The results of this study show how important it is for students to be prepared for the clinical environment, the nature of the work, and the role of the home healthcare nurse in order to improve their clinical learning.

Bridging Educational Grant in Nursing (BEGIN) students' intentions for retention in long-term, home and community care: A survey protocol

INTRODUCTION

Retention of nurses in long-term care (LTC) and home and community care (HCC) settings is a growing concern. Previous evidence underscores factors which contribute to nurses' intentions for retention in these sectors. However, perspectives of nursing students preparing to enter the workforce, and their intentions for short-term and long-term retention, remain unknown. This study aims to explore relationships between short-term and long-term intentions for retention with psychological empowerment, work engagement, career commitment, burnout, prosocial motivation, self-care and personal resilience among students enrolled in nursing educational bridging programs supported by the Bridging Educational Grant in Nursing (BEGIN) program in Ontario, Canada.

METHODS AND ANALYSIS

This cross-sectional design study will use an open online survey to investigate perspectives of current nursing students enrolled in educational bridging programs on factors relating to psychological empowerment, work engagement, career commitment, resilience, burnout, prosocial motivation, self-care and intentions for retention. Additionally, the survey will collect demographic information, including age, gender, ethnicity, citizenship, income, family status, nursing role, and years of employment and/or education. Open-ended questions will elicit participants' perspectives on financial considerations for career planning and other factors impacting intentions for retention. Descriptive data will be presented for contextualisation of participants' demographic characteristics to enhance generalisability of the cohort. Descriptive statistics will be used to summarise participants' scores on various assessment measures, as well as their short-term and long-term intentions for retention in LTC and HCC after completion of BEGIN. A Pearson's product moment r correlation will determine relationships between intentions for retention and other measures, and linear regression will determine whether any potential correlations can be explained by regression.

ETHICS AND DISSEMINATION

This research protocol received ethical approval from a research-intensive university research ethics board (#123211). Findings will be disseminated to nursing knowledge users in LTC and HCC through publications, conferences, social media and newsletters.

Nurses' job preferences on the internet plus nursing service program: a discrete choice experiment

BACKGROUND

The Internet Plus Nursing Service (IPNS) is being instigated in all provincial-level regions throughout China, in which registered nurses (with more than five years of experience from qualified medical institutions) will provide services to those in their communities or homes after receiving online applications. The growing shortage of human resources in nursing is a critical issue for this project, so effective policies for recruiting and retaining nurses are critical.

OBJECTIVE

This study aims to pinpoint the significant job characteristics that play a crucial role in shaping the job decisions of sharing nurses in the IPNS program, and to estimate the strength of job attributes.

METHODS

A discrete choice experiment (DCE) was used to assess job attributes influencing sharing nurses' preferences. A qualitative design, including in-depth interview and focus interview methods, was conducted to determine the inclusion of attributes. The final included six attributes were: work modes, duration per visit, income per visit, personal safety, medical risk prevention, and refresher training. This study was conducted at 13 hospitals in Guangdong Province, China, from April to June 2022, and a total of 220 registered sharing nurses participated in the survey. The multinomial logit model explored attributes and relative valued utility. Preference heterogeneity is explored via latent class analysis (LCA) models.

RESULTS

A total of 220 participants answered the questionnaire. Income was the most influential characteristic of a sharing nursing position, followed by personal safety management, duration per visit, medical risk prevention, and refresher training, and nurses' preferences differed among different types of classes.

CONCLUSIONS

Sharing nurses place most value on income and personal safety with career-related decisions, which indicates an urgent need to develop complete security for personal safety. This study can be helpful to decision-makers in the Chinese government.

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

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

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

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

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

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

Objective

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

Results

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

Supplementary Information

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

The Role of Schedule Volatility in Home Health Nursing Turnover

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

Turnover among foreign nurses in Saudi Arabia

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.

Homecare nurses' length of conversation and intention to remain at the workplace: A multilevel analysis

AIMS

To examine the relationship between homecare nurses' length of conversation with nurse managers and colleagues and intention to remain at the workplace.

BACKGROUND

Nurse turnover is an important issue. Previous studies focused on the perceived function of communication. However, we do not know the contribution of homecare nurses' actual conversations to nurse turnover prevention.

METHODS

We conducted a cross-sectional study in 330 homecare nurse organisations in Japan. We recruited 2,315 homecare nurses and analysed the data of 608 nurses. We used a questionnaire to investigate participants' intention to remain.

RESULTS

Nearly 68% had the intention to remain. The mean length of conversation was 34 min/day with the manager and 68 min/day with colleagues. Multilevel logistic regression analysis showed that long conversations with the nurse manager (20 min and more) and colleagues (40 min and more) were significantly related to the intention to remain.

CONCLUSIONS

Ensuring the time of conversation with a manager and colleagues may contribute to preventing potentially avoidable nurse turnover.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should encourage homecare nurses to have daily conversations of 20 min or more with the nurse manager and 40 min or more with colleagues to continue working at their current workplace.

Turnover Intention Among Nurses in Nurse Managers, Directors, and Executives: Developing a Tool for Measuring Environmental Factors

Background and Purpose

Turnover among nurse managers, directors, and executives is associated with staff nurse retention and patient outcomes. The purpose of this article is to describe the development of an instrument to evaluate factors associated with intent to leave among these leaders within acute care facilities.

Methods

The Nurse Leader Environment Support Survey (NLESS) was developed and evaluated using exploratory factor analysis and reliability testing (Cronbach's α). Data was obtained as part of a large nationwide electronic survey (N = 1,903).

Results

Factors converged into three major themes (organizational culture, professional vulnerability, and workplace relationships) which were consistent across all three leadership groups. Factor subscales exhibited Cronbach's α > .7.

Conclusions

The NLESS is a useful tool in comparing reasons for turnover among nursing leadership groups. Future refinement may prove useful in identifying and clarifying foundational causes of turnover.

Identification of Measures Affecting Job Satisfaction and Levels of Perceived Stress and Burnout among Home Health Nurses of a Developing Asian Country

BACKGROUND

Factors affecting job satisfaction of home health nurses are studied.

METHODS

PSS-10, CBI and HHNJS are used to measure the perceived stress, burnout of home health nurses and Job Satisfaction.

RESULTS

The significant predictors for Job satisfaction were Relationship with organization, Autonomy and control, Salary and Benefits as 82% of variation in job satisfaction was explained by these, (F change (3, 144) = 236.72, p < .001).

CONCLUSION

Agencies should work upon improving the dimensions such as the "relationship with the organization", "Autonomy and control" and "Salary and Benefits" to increases the Job satisfaction of home health nurses.

Factors influencing the recruitment and retention of registered nurses in adult community nursing services: an integrative literature review

BACKGROUND

Adult community nursing services are evolving around the world in response to government policies and changing patient demographics. Amidst these changes, recruitment and retention of community nursing staff are proving a challenge. An integrative literature review has identified multiple factors that influence nurse retention in adult community nursing with sparse information on recruitment factors. Although factors impacting retention of community nurses have been identified, their generalisability around the world is a challenge as they are context and co-dependent. Indicating the need for this area of study to be explored at a local level, as the same factors present with different findings globally.

AIM

To establish factors influencing recruitment and retention of registered nurses in adult community nursing services.

DESIGN

Integrative literature review.

DATA SOURCES

Four electronic databases were searched in August 2019 from January 2008 to December 2018: CINAHL Complete, Web of Science, MEDLINE and PROQUEST. Both qualitative and quantitative studies focusing on factors influencing community nursing recruitment and retention were included.

REVIEW METHODS

An integrative literature review methodology by Whittemore and Knafl (The integrative review: updated methodology. Journal of Advanced Nursing 52, 546-553) was followed, supported by Cochrane guidelines on data synthesis and analysis using a narrative synthesis method. The Center for Evidence-Based Management (CEBMa) critical appraisal tools were used for study quality assessment.

RESULTS

Ten papers met the study inclusion criteria. Data synthesis and analysis revealed individual and organisational factors influencing the retention of community nurses with the following three dominant themes: (1) work pressure, (2) working conditions and (3) lack of appreciation by managers.

CONCLUSION

The review identified context-dependent factors that influence adult community nurses' retention with limited generalisability. There is a lack of data on factors influencing recruitment into adult community nursing; further research is needed to explore factors affiliated to community nursing recruitment.

Evidence-Based Practice Guideline: Nurse Retention for Nurse Managers

Nursing retention and turnover impacts health care on many facets; pressures are increasing to provide quality care in a cost-effective manner to a satisfied patient with an engaged staff as defined by the Quadruple Aim. Retention of experienced staff nurses is paramount as the nursing profession enters another shortage era, which leads to impact on patient safety and quality of care. The purpose of this nurse retention evidence-based practice guideline is to provide strategies for first line nurse managers in various health care settings to use in enhancing job satisfaction and decreasing turnover of staff nurses. Interventions are focused on three areas that are beyond compensation issues and are within the purview of nurse managers: (a) autonomy; (b) recognition; and (c) communication. Retaining expert nurses will have a positive effect on quality patient care. [Journal of Gerontological Nursing, 45(11), 11-19.].

Effects of recognition of flexible work systems, organizational commitment, and quality of life on turnover intentions of healthcare nurses

BACKGROUND

It is necessary to adjust and mediate environmental, personal, and structural aspects to reduce the turnover rate among healthcare nurses, and awareness of flexible work systems, organizational commitment and quality of life are factors contained in this category.

OBJECTIVE

The purpose of this study was to identify the influence of awareness regarding flexible work systems, organizational commitment, and quality of life on turnover intentions among healthcare nurses.

METHODS

Two hundred and twenty-six healthcare nurses participated in the study. Data were collected from September 1 to October 1, 2018, and analyzed using SPSS/WIN 23.0 version.

RESULTS

The results in the first analysis revealed that being dissatisfied with work (β= 0.287) and having poor subjective health (β= 0.197) were significant influencing factors with a combined explanatory power of 14.9% (p< 0.001). In the second analysis, dissatisfied with work satisfaction (β= 0.143), organizational commitment (β=-0.389), and quality of life (β= 0.256) were significant influencing factors with a combined explanatory power of 29.5% (p< 0.001).

CONCLUSION

It is necessary to reflect awareness of flexible work systems, organizational commitment and quality of life in interventions to reduce the turnover intention of healthcare nurses.

Improving Retention of Home Health Nurses: Fostering Outcome Sustainability Through an Innovative Orientation and Mentorship Program

Home healthcare plays an increasingly vital role in contemporary postacute healthcare. Staffing instability and lack of perceived organizational support is a stimulus for nursing attrition from the organization with far-reaching impact on staff morale, patient care, agency budgets, and relationships with other healthcare settings. The purpose of this article is to describe a redesign of an agency's nursing orientation and the development of a mentorship program for newly hired home healthcare nurses within a large Midwestern integrated health system. During this time frame, 154 nurses completed the newly designed orientation program and, of those, 91 participated in the mentorship program. In this article, we evaluate 1-year new-hire nursing retention rates over a 4-year period, examine new-hire job satisfaction and perceptions of preceptors and mentors during their first year, and discuss issues of outcome sustainability. Agency-wide turnover rates for all home healthcare nurses decreased from 15.4% in 2016 to 10.1% in 2018, demonstrating the associated impact of these initiatives on staffing stabilization.

Concept analysis of nurse retention

Nurse retention is widely acknowledged as a crucial international workforce issue, yet the concept remains ambiguous. This study focuses on a concept analysis in an effort to clarify the attributes of nurse retention, including its antecedents and consequences. The Walker and Avant approach was applied to analyze the concept of nurse retention. Four key attributes of nurse retention were identified in the analysis, specifically motivation, intention, and individual decision; strategy and intervention; geographic context; and attachment to work. Antecedents of nurse retention included the healthcare system at the macro level, the health care facility, health personnel, and living conditions. Retention has consequences for individual nurses, the healthcare organization, and the overall health system. Our concept analysis provides clarification to better understand nurse retention along with its implications for the healthcare workforce. The analysis further emphasizes the importance of retention as a comprehensive priority issue for human resources when recruiting and maintaining the nursing workforce internationally.

Training opportunities and the increase in the number of nurses in home-visit nursing agencies in Japan: a panel data analysis

Background

A training opportunity in which ongoing education is encouraged is one of the determinants in recruiting and retaining nurses in home-visit nursing care agencies. We investigated the association between ensuring training opportunities through scheduled training programs and the change in the number of nurses in home-visit nursing agencies using nationwide panel data at the agency level.

Methods

We used nationwide registry panel data of home-visit nursing agencies from 2012 to 2015 in Japan. To investigate the association between planning training programs and the change in the number of nurses in the following year, we conducted fixed-effect panel data regression analysis.

Results

We identified 4760, 5160 and 5025 agencies in 2012, 2013, and 2014, respectively. Approximately 60–80% of the agencies planned training programs for all staff, both new and former, during the study period. The means and standard deviations of the percentage change in the number of full time equivalent (FTE) nurses in the following year were 4.2 (19.8), 5.7 (23.5), and 5.8 (25.1), respectively. Overall, we found no statistically significant association between scheduled training programs and the change in the number of FTE nurses in the following year. However, the associations varied by agency size. Results of analysis stratified by agency size suggested that the first and second quartile sized agencies (2.5–4.0 FTE nurses) with scheduled training programs for all employees were more likely to see a 9.0% (95% confidence interval [CI]: 4.5, 13.5) and 8.5% (95% CI: 2.4, 14.5) increase in the number of FTE nurses in the following year, respectively. Similarly, the first and second quartile sized agencies with scheduled training programs for new employees were more likely to see a 4.7% (95% CI: 2.1, 7.2) and 3.3% (95% CI: 0.4, 6.2) increase in the number of FTE nurses in the following year, respectively.

Conclusions

Ensuring training opportunities through scheduled training programs for all staff, both new and former, in relatively small-sized home-visit nursing agencies might contribute to an increase in the number of nurses at each agency.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4225-8) contains supplementary material, which is available to authorized users.

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

Background

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

Methods

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

Results

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

Conclusions

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

Electronic supplementary material

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

Work-related factors influencing home care nurse intent to remain employed

BACKGROUND

Health care is shifting out of hospitals into community settings. In Ontario, Canada, home care organizations continue to experience challenges recruiting and retaining nurses. However, factors influencing home care nurse retention that can be modified remain largely unexplored. Several groups of factors have been identified as influencing home care nurse intent to remain employed including job characteristics, work structures, relationships and communication, work environment, responses to work, and conditions of employment.

PURPOSE

The aim of this study was to test and refine a model that identifies which factors are related to home care nurse intentions to remain employed for the next 5 years with their current home care employer organization.

METHODOLOGY/APPROACH

A cross-sectional survey design was implemented to test and refine a hypothesized model of home care nurse intent to remain employed. Logistic regression was used to determine which factors influence home care nurse intent to remain employed.

FINDINGS

Home care nurse intent to remain employed for the next 5 years was associated with increasing age, higher nurse-evaluated quality of care, having greater variety of patients, experiencing greater meaningfulness of work, having greater income stability, having greater continuity of client care, experiencing more positive relationships with supervisors, experiencing higher work-life balance, and being more satisfied with salary and benefits.

PRACTICE IMPLICATIONS

Home care organizations can promote home care nurse intent to remain employed by (a) ensuring nurses have adequate training and resources to provide quality client care, (b) improving employment conditions to increase income stability and satisfaction with pay and benefits,

A Cyclic Model Describing the Process of Sustaining Meaningfulness in Practice: How Nurses Continue Working at One Home Care Agency

This study aimed to elucidate the experiences of home care nurses who had continued working a single agency, to gain insight into the prevention of premature turnover. We adopted a grounded theory approach to qualitative exploration of the experiences of 26 Japanese nurses working in a home care agency, using semistructured interviews and participant observation. Nurses' experience progressed through three phases: "encountering difficulty," "enjoying the fruitfulness," and "becoming dissatisfied." Nurses' cognitive rounding involving these phases was conceptualized as "cycle of sustaining meaningfulness." To move from encountering difficulty to enjoying the fruitfulness, nurses needed to discover the meaningfulness of practice, and to move from becoming dissatisfied to encountering difficulty, they needed to requestion their practice. During their time at the agency, nurses progressed through the phases of the cycle of sustaining meaningfulness repeatedly. Knowing the point at which nurses are in the cycle and assisting their further progress could aid in their retention.

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

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

Factors associated with the choice of public health service among nursing students in Thailand

Background

Despite the fact that public and private nursing schools have contributed significantly to the Thai health system, it is not clear whether and to what extent there was difference in job preferences between types of training institutions.

This study aimed to examine attitudes towards rural practice, intention to work in public service after graduation, and factors affecting workplace selection among nursing students in both public and private institutions.

Methods

A descriptive comparative cross-sectional survey was conducted among 3349 students from 36 nursing schools (26 public and 10 private) during February-March 2012, using a questionnaire to assess the association between training institution characteristics and students’ attitudes, job choices, and intention to work in the public sector upon graduation. Comparisons between school types were done using ANOVA, and Bonferroni-adjusted multiple comparisons tests. Principal component analysis (PCA) was used to construct a composite rural attitude index (14 questions). Cronbach’s alpha was used to examine the internal consistency of the scales, and ANOVA was then used to determine the differences. These relationships were further investigated through multiple regression.

Results

A higher proportion of public nursing students (86.4% from the Ministry of Public Health and 74.1% from the Ministry of Education) preferred working in the public sector, compared to 32.4% of students from the private sector (p = <0.001). Rural upbringing and entering a nursing education program by local recruitment were positively associated with rural attitude. Students who were trained in public nursing schools were less motivated by financial incentive regarding workplace choices relative to students trained by private institutions.

Conclusions

To increase nursing workforce in the public sector, the following policy options should be promoted: 1) recruiting more students with a rural upbringing, 2) nurturing good attitudes towards working in rural areas through appropriate training at schools, 3) providing government scholarships for private students in exchange for compulsory work in rural areas, and 4) providing a non-financial incentive package (e.g. increased social benefits) in addition to financial incentives for subsequent years of work.

Job demands-resources predicting burnout and work engagement among Belgian home health care nurses: A cross-sectional study

BACKGROUND

A better knowledge of the job aspects that may predict home health care nurses' burnout and work engagement is important in view of stress prevention and health promotion. The Job Demands-Resources model predicts that job demands and resources relate to burnout and work engagement but has not previously been tested in the specific context of home health care nursing.

PURPOSE

The present study offers a comprehensive test of the Job-Demands Resources model in home health care nursing. We investigate the main and interaction effects of distinctive job demands (workload, emotional demands and aggression) and resources (autonomy, social support and learning opportunities) on burnout and work engagement.

METHODS

Analyses were conducted using cross-sectional data from 675 Belgian home health care nurses, who participated in a voluntary and anonymous survey.

RESULTS

The results show that workload and emotional demands were positively associated with burnout, whereas aggression was unrelated to burnout. All job resources were associated with higher levels of work engagement and lower levels of burnout. In addition, social support buffered the positive relationship between workload and burnout.

CONCLUSIONS

Home health care organizations should invest in dealing with workload and emotional demands and stimulating the job resources under study to reduce the risk of burnout and increase their nurses' work engagement.

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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

Proud to be a nurse? Recently graduated nurses' experiences in municipal health care settings

BACKGROUND

Recently graduated nurses are the future of the nursing profession and the municipal health care that will need nursing competency for an increasing number of frail elderly persons. This study is part of a larger project on newly graduated nurses where previous research indicated that building professional pride at their workplace could be important for remaining in the profession and in municipal health care. However, the recently graduated nurse's first job assignment in municipal health care can also be a critical period with cuts in their pride as nurses who may have an impact on nursing care for their patients.

AIM

The aim of this study is to illuminate recently graduated nurses' experiences with professional pride in municipal health and care services.

METHODS

A phenomenological hermeneutic approach was chosen to illuminate meaning. A purposive sample of eight recently graduated nurses working in nursing homes or home health care was chosen for this study with narrative interviews and diaries.

FINDINGS

Three themes were identified: doing the good thing and doing what is right; being recognized and confirmed; and finally thriving in a community of practice. An important source of pride is the relation to patients. Recently graduated nurses build their professional pride in an active and social process in a community of practice. The first cut in their professional pride seems to take place when they were not recognized and confirmed as professional persons.

CONCLUSION

Recently graduated nurses in municipal health care describe their professional pride as a complex phenomenon with relational, dynamic and collective dimensions. The cuts in their pride may hurt their identity and nursing care.

The importance of monitoring nurses' workplace satisfaction of nurses for the well-being of all employees in nursing

Introduction: Work is an important constituent of an individual’s life since the experience of work influences well-being and health. The well-being of employees is an important issue in the work environment. The aim was to examine the relationship between satisfaction in the workplace and the well-being of employees in nursing. Methods: Quantitative research based on a cross-sectional study was used, with 640 employees in nursing from eight Slovenian hospitals participating in the study. A structured survey questionnaire was administered. The relationship between psychological well-being and workplace satisfaction was analysed with correlation and linear regression analysis. Results: The workplace satisfaction (x = 3.69, s = 1.13) and well-being ( x=161.27, s = 55.19) of employees in nursing are at a middle level. With the correlation analysis we established that well-being statistically significantly correlates with workplace satisfaction (r = 0.611, p < 0.001). Workplace satisfaction explains 42 % of the total variability of well-being of employees in nursing. Discussion and conclusion: It is necessary for every health care organization to take care of its employees' workplace satisfaction and well-being. Health care organizations can be successful and achieve their organisational objectives if their employees are satisfied with their work and have a high level of well-being.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN, SETTING AND PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Influence of work values and personality traits on intent to stay among nurses at various types of hospital in Taiwan

AIM

In this study, the influence of work values and personality traits on the intent to stay at work was examined among nurses in Taiwan.

BACKGROUND

No empirical studies in this area have been conducted in the nursing industry.

METHODS

A cross-sectional predictive study was performed during 2012 with 1246 nurses recruited from three different types of hospital located in northeastern Taiwan. A structured questionnaire based on the 5-factor model was used. Multiple regression analyses were used to investigate the various factors associated with the intent to stay at work among nurses.

RESULTS

The overall response rate was 85%. The nurses who had a high level of intent to stay at work were significantly more likely to be in senior roles; exhibited positive work values, conscientiousness, emotional stability; and worked at a non-religious hospital.

CONCLUSION

Age, the role of work values, personality traits and type of hospital were crucial in enhancing the level of intent to stay at work.

IMPLICATIONS FOR NURSING MANAGEMENT

The study findings provide evidence for managers to develop an optimal strategy for nurses with specific personality traits and highly positive work values, which can guide the recruitment and retention of nurses.

Work, work environments and other factors influencing nurse faculty intention to remain employed: a cross-sectional study

BACKGROUND

Given the role nurse faculty have in educating nurses, little is known about what influences their intention to remain employed (ITR) in academic settings.

OBJECTIVES

Findings from a nurse faculty survey administered to test a conceptual model of factors hypothesized as influencing nurse faculty ITR are reported.

DESIGN

A cross-sectional survey design was employed.

SETTING

We included colleges and universities in Ontario, Canada.

PARTICIPANTS

The population of Ontario nurse faculty who reported being employed as nurse faculty with the College of Nurses of Ontario (Canada) was included. Of the 1328 nurse faculty who were surveyed, 650 participated.

METHODS

Participants completed a questionnaire with measures of work, work environment, job satisfaction, burnout and ITR. Regression analyses were conducted to test the model.

RESULTS

Ten of 26 independent variables explained 25.4% of variance in nurse faculty ITR for five years. These variables included: proximity to retirement, quality of relationships with colleagues, being employed full time, having dependents, satisfaction with work-life balance, quality of education, satisfaction with job status, access to financial support for education from organization, access to required human resources and being unionized.

CONCLUSIONS

Although not all influencing factors are modifiable, academic leadership should develop strategies that encourage nurse faculty ITR. Strategies that support collegial relationships among faculty, increase the number of full time positions, promote work-life balance, engage faculty in assessing and strengthening education quality, support faculty choice between full-time and part-time work, and ensure adequate human resources required to teach effectively will lead to heightened nurse faculty ITR.

Job satisfaction and work related variables in Chinese cardiac critical care nurses

AIM

To explore critical care nurses' views of their job satisfaction and the relationship with job burnout, practice environment, coping style, social support, intention to stay in current employment and other work-related variables.

BACKGROUND

Nurse shortage is a global issue, especially in critical care. Job satisfaction is the most frequently cited factor linked to nurses' turnover.

METHOD

A convenience sample of cardiac critical care nurses (n = 215; 97.7% response rate) from 12 large general hospitals in Shanghai was surveyed from December 2010 to March 2011.

RESULT

Over half of the sample reported satisfaction with their jobs. Nurses with 10-20 years of professional experience and those who had taken all their holiday entitlement reported higher levels of job satisfaction. The independent variables of practice environment, intention to stay, emotional exhaustion, personal accomplishment and positive coping style explained about 55% of the variance in job satisfaction.

CONCLUSION

Chinese cardiac critical care nurses' job satisfaction was related to work related variables, which are amenable to managerial action.

IMPLICATIONS FOR NURSING MANAGEMENT

Our findings highlight the imperative of improving intrinsic and extrinsic rewards, together with the flexibility of work schedules to promote job satisfaction and staff retention. A clinical ladder system is needed to provide promotion opportunities for Chinese nurses.

Factors influencing home care nurse intention to remain employed

AIM

To identify factors affecting Canadian home care nurse intention to remain employed (ITR).

BACKGROUND

In developed nations, healthcare continues to shift into community settings. Although considerable research exists on examining nurse ITR in hospitals, similar research related to nurses employed in home care is limited. In the face of a global nursing shortage, it is important to understand the factors influencing nurse ITR across healthcare sectors.

METHODS

A qualitative exploratory descriptive design was used. Focus groups were conducted with home care nurses. Data were analysed using qualitative content analysis.

RESULTS

Six categories of influencing factors were identified by home care nurses as affecting ITR: job characteristics; work structures; relationships/communication; work environment; nurse responses to work; and employment conditions.

CONCLUSION

Findings suggest the following factors influence home care nurse ITR: having autonomy; flexible scheduling; reasonable and varied workloads; supportive work relationships; and receiving adequate pay and benefits. Home care nurses did not identify job satisfaction as a single concept influencing ITR.

IMPLICATIONS FOR NURSING MANAGEMENT

Home care nursing management should support nurse autonomy, allow flexible scheduling, promote reasonable workloads and create opportunities for team building that strengthen supportive relationships among home care nurses and other health team members.

Home care nurses' experience of job stress and considerations for the work environment

Home care nurses report increased stress in their jobs due to work environment characteristics that impact professional practice. Stressors and characteristics of the professional practice environment that moderate nurses' experience of job stress were examined in this embedded multiple case study. Real life experiences within a complex environment were drawn from interviews and observations with 29 participants across two home care agencies from one eastern U.S. state. Findings suggest that role overload, role conflict, and lack of control can be moderated in agencies where there are meaningful opportunities for shared decision making and the nurse-patient relationship is supported.

Job Embeddedness Scoring: Measurement Equivalence Between Rural and Urban Nurses

This study examined the measurement equivalency (ME) of the job embeddedness (JE) instrument for rural and urban registered nurses (RNs) using a secondary analysis of a cross-sectional mailed survey. JE represents the sum of reasons an employee remains at the present job. RNs from both rural and urban areas returned a 40-item JE instrument designed to assess their level of embeddedness. Analysis was performed using a multi-group confirmatory factor analysis for JE ratings of rural and urban RNs. The findings indicated that the original 40-item JE instrument needed to be respecified to achieve adequate fit for the sample of rural and urban RNs. This 32-item respecified instrument demonstrated that rural and urban RNs use the same metric when giving ratings for JE items. The findings of ME across rural and urban RNs facilitate comparisons between the two groups. The implications of these findings are that differences in ratings between rural and urban RNs may be attributed to real differences and not merely measurement artifact. Examination of these differences may lead to real strategies to retain nurses, thus mitigating the impact of the global nursing shortage.

Job satisfaction in mainland China: comparing critical care nurses and general ward nurses

AIM

To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China.

BACKGROUND

Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown.

DESIGN

A cross-sectional design was selected for this descriptive correlation study.

METHODS

Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010.

RESULTS

Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job.

CONCLUSION

Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse.

Job satisfaction of nurses and identifying factors of job satisfaction in Slovenian Hospitals

Aim

To determine the level of job satisfaction of nursing professionals in Slovenian hospitals and factors influencing job satisfaction in nursing.

Methods

The study included 4 hospitals selected from the hospital list comprising 26 hospitals in Slovenia. The employees of these hospitals represent 29.8% and 509 employees included in the study represent 6% of all employees in nursing in Slovenian hospitals. One structured survey questionnaire was administered to the leaders and the other to employees, both consisting 154 items evaluated on a 5 point Likert-type scale. We examined the correlation between independent variables (age, number of years of employment, behavior of leaders, personal characteristics of leaders, and managerial competencies of leaders) and the dependent variable (job satisfaction – satisfaction with the work, coworkers, management, pay, etc) by applying correlation analysis and multivariate regression analysis. In addition, factor analysis was used to establish characteristic components of the variables measured.

Results

We found a medium level of job satisfaction in both leaders (3.49 ± 0.5) and employees (3.19 ± 0.6), however, there was a significant difference between their estimates (t = 3.237; P = <0.001). Job satisfaction was explained by age (P < 0.05; β = 0.091), years of employment (P < 0.05; β = 0.193), personal characteristics of leaders (P < 0.001; β = 0.158), and managerial competencies of leaders (P < 0.000; β = 0.634) in 46% of cases. The factor analysis yielded four factors explaining 64% of the total job satisfaction variance.

Conclusion

Satisfied employees play a crucial role in an organization’s success, so health care organizations must be aware of the importance of employees’ job satisfaction. It is recommended to monitor employees’ job satisfaction levels on an annual basis.

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

AIM

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

METHODS

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

FINDINGS

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

CONCLUSION

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

STUDY LIMITATIONS

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

The Correlates of Nursing Staff Turnover in Home and Hospice Agencies

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