Turnover of New Graduate Nurses in Their First Job Using Survival Analysis

Newly qualified nurses' and midwives' experience with continuing professional development during transition: A cross-sectional study

AIM

To explore newly qualified nurses and midwives' experience of continuing professional development (CPD) and factors associated with CPD participation during newly qualified nurses and midwives' transition, such as job satisfaction and intention to leave.

BACKGROUND

Newly qualified nurses and midwives find it difficult to make the transition to their first registered post. During the transition, professional support through CPD is essential to build competence and confidence and increase job satisfaction and retention.

DESIGN

A cross-sectional study.

METHODS

This study was conducted from September 2021 to October 2022. The online survey, consisting of 83 items, included: the Questionnaire of Professional Development of Nurses (Q-PDN), the McCloskey/Mueller Satisfaction Scale, three questions about Intention to Leave and two open-ended questions. The analysis was conducted by combining the results from the three European countries. Descriptive and logistic regression analyses were performed. The participants were Newly qualified nurses and midwives from Ireland, Italy and Croatia RESULTS: A total of 476 Newly qualified nurses and midwives completed the survey. Of these, 32 % (n=152) were satisfied with opportunities to participate in CPD activities and 54.8 % (n=261) had participated in a formal CPD programme. Most newly qualified nurses and midwives (89.1 %, n=424) agreed that they would like to participate in a formal CPD programme. Almost half of the participants (46.4 %, n=219) had thought of leaving the profession in the previous 12 months. We found that 'having participated in a programme to support newly qualified nurses (OR=0.29; p<.001), 'participating in mandatory CPD activities' (OR=0.76; p=0.016) and 'working in the clinical area of community' (OR=0.31; p<.001) or in maternity (OR=0.46; p=0.040) were positively associated with better job satisfaction.

CONCLUSIONS

Participation in support programs during the transition period contributes to increasing job satisfaction for newly qualified nurses and midwives. During their transition, newly qualified nurses and midwives need more support from their institution managers, in terms of ensuring a better learning environment, as well as formal and informal supports.

New Graduate Nurses' Competencies, Organizational Socialization, and Turnover Intention

OBJECTIVE

This study aimed to identify core competencies in new-graduate nurses (NGNs) by determining which competencies affected their organizational socialization (OS) and turnover intention (TI) in their 1st year of employment.

BACKGROUND

NGNs face stressful transitions with expanded nursing responsibilities that motivate them to leave their jobs. Therefore, NGN turnover in the 1st year of practice is higher than the overall nurse turnover rate. Previous research suggested that NGNs' competency levels affect their OS and TI. However, little research has been done to determine which competencies affect these variables.

METHODS

Multiple linear regression analysis was performed on cross-sectional survey data to determine the effects of NGN work competencies on OS and TI.

RESULTS

Health promotion, supervision, interpersonal communication, and direct care competencies significantly predicted NGNs' OS, and computer technology competency significantly predicted NGNs' TI.

CONCLUSIONS

NGNs should be given early opportunities for expanded hands-on clinical experiences along with clear awareness of the organization's goals and values. Moreover, they should be offered roles that take advantage of their computer technology skills and that challenge them to contribute to their organization and nursing care in new ways.

A survival analysis approach to determine factors associated with non-retention of newly hired health workers in Iran

BACKGROUND AND AIM

One of the main tasks of the healthcare human resource management is to maintain and retain professional staff. The high level turnover of professional staff may reduce the quality of healthcare service delivery. Therefore, this study investigated the factors associated with the turnover of the newly recruited healthcare professionals using survival analysis method in Iran.

MATERIALS AND METHODS

This historical cohort analysis comprised 6811 employees who began working at Mashhad University of Medical Sciences between 2005 and 2020. Employees recruited at any of the university's units between the years 2005 to 2019 were included. We used appropriate descriptive indices and Log-rank test and the Cox proportional-hazards model to assess the staff turnover. A significance level of 0.05 was used for all tests.

RESULTS

The findings of the survival analysis showed that the probability of turnover in one year, two years, and five years of employment were 0.12, 0.16, and 0.27. Based on the findings of the Log-rank test, the probability of turnover in entire of the study period was not statistically different between male and female (p = 0.573), and likewise between employees with healthcare occupations and non-healthcare occupations (p = 0.351). Employees whose current workplace and birthplace were not similar had a significantly higher probability of turnover (p < 0.001). Accordingly, the Cox regression result showed, the risk of turnover for the singles was 1.22 times higher than the married. For the Ph.D degree was 3.23 times higher compared to those with a diploma or an associate degree, and for a bachelor's or master's degree was 2.06 times more likely to change their workplace than those with a diploma or an associate degree.

CONCLUSION

Policies promoting the recruitment of native-born professionals, given priority to the married candidates than single ones, and/or recurring candidates to pledge to stay in the locality of recruitment site can increase the staff retention and reduce the costs of staff turnover including re-hiring, initial and on-the-job training, accommodation, and other extra living consumptions away from home and family.

Comprehensive assessment of factors contributing to the actual turnover of newly licensed registered nurses working in acute care hospitals: a systematic review

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.

The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals

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.

Association of Work Schedules With Nurse Turnover: A Cross-Sectional National Study

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.

Nursing the Future: Building New Graduate Capacity (Part I)

The transition from student to practitioner for newly graduated nurses is impacted by their physical, social, professional, and practice environments. COVID-19, global insecurity, institutional restructuring, and "acute on chronic" staffing shortages have increased the immediate burden experienced by emerging nurses. As detailed through the historical development of Duchscher's Stages of Transition Theory and Transition Shock Model, theorization of the transition process offers graduates, their educators, and workplace managers key areas of support opportunities for these new practitioners. In part 1 of a 2-part article series, this article explores how novel new graduate supports have been developed and delivered in partnership with nonprofit groups, government bodies, and employers across much of Canada. For nurse stakeholders, theorists, and beyond, support for the transition period of new nurses remains anecdotally, evidentially, and fiscally advisable, with an increasing urgency due to rising human capital pressures.

Health-Related Factors Influencing Nurse Turnover by Clinical Career: A Secondary Data Analysis of Clinical Nurses in South Korea

The increase in clinical nurse turnover is an important issue in human resource management worldwide. Factors influencing it include health-related risk factors such as sleep quality and presenteeism, which need further exploration. We examined differences in job survival time of clinical nurses in relation to nurses' sleep quality and presenteeism. Participants were 857 Korean clinical nurses with more than three months' experience providing direct patient care. Data were analyzed using a time-independent Cox proportional hazard regression analysis of factors affecting actual turnover of clinical nurses. Average job survival times of competent, proficient, and expert nurses were 33, 64, and 143 months, respectively. Sleep quality and presentism significantly affected turnover risk. For clinical nurses with less than three years of experience, sleep quality significantly influenced the risk of turnover. For clinical nurses with more than six years of experience, presenteeism significantly affected the risk of turnover. The findings of this study offer a clinical career-based approach to reduce the turnover rate of clinical nurses. A differentiated approach based on work experience is necessary to establish a turnover management strategy for clinical nurses.

Leadership Empowerment Behavior and Psychiatric Nurses' Intent to Leave

There is a shortage of registered nurses (RNs) who work in the specialty of Psychiatric-Mental Health (PMH). Attrition among Psychiatric-Mental Health Nurses (PMHNs) may be related to a lack of leadership empowerment which includes autonomy and access to professional development opportunities. The purposes of this study, guided by Kanter's theory of structural empowerment, were to determine (a) if there was a relationship between leadership empowerment behavior and PMH RNs' intent to leave within the first 2 years of practice in inpatient psychiatric settings and (b) if there was a relationship between leadership empowerment behavior and intent to leave among this population who are in their first 2 years of practice, based on RN demographics. The key variables were measured with the Leader Empowering Behavior Questionnaire and the Turnover Intention Scale. The study participants included 111 psychiatric RNs in their first 2 years of practice who were recruited via social media. Results showed an inverse relationship between leadership empowerment behavior and intent to leave. The RN demographic characteristics did not affect this relationship. The study findings could be used for social change by creating awareness for PMHN leaders to develop empowerment behavior as a strategy to mitigate new PMH RN turnover so that they can stay in practice and positively impact therapeutic and quality patient care delivery. Future studies using mixed methods and a larger sample size would be helpful to obtain an in-depth understanding of the role of leadership empowerment behavior and retention from the RN's perspective.

Factors influencing the professional identity of nursing interns: a cross-sectional study

BACKGROUND

Improving the professional identity of nursing intern is significant for enhancing the number of new registered nurses and easing the shortage of nursing personnel. The clinical internship is a key period for the formulation of professional identity. However, we know little about the factors influencing the nursing interns' professional identity during clinical internship. Therefore, this study explore the influencing factors of nursing interns' professional identity during clinical internship. This study will provide evidence and suggestions for generating effective strategies contributing to professional identity improvement of nursing interns.

METHODS

This was a cross-sectional study. The convenience sampling was used to recruit 398 nursing interns from a teaching hospital in Hunan, China. The demographic characteristics information was collected by a self-developed questionnaire. The nursing interns' professional identity and potential influencing factors (e.g., work atmosphere, teacher capacity) were measured by questionnaires with good psychometric properties. The appropriate indicators were used for descriptive statistics, and t test, analysis of variance, Pearson's correlation analysis and multiple linear regression were used to analyse the influencing factors.

RESULTS

In this study, the influencing factors of nursing interns' professional identity are education level, first choice of major, residential status, work atmosphere, and teacher capacity. The results showed that: (1) the nursing interns with a higher education level reported a lower level of professional identity; (2) the nursing interns whose first choice of major was not nursing discipline reported a lower level of professional identity; (3) the nursing interns live in rural areas (compared to urban areas) reported a higher level of professional identity; (4) the nursing interns in better work atmosphere reported a higher level of professional identity; (5) the nursing interns under the guidance of the teachers equipped with better teaching capacity reported a higher level of professional identity.

CONCLUSION

The education level, first choice of major and residential status are influence factors of nursing interns' professional identity. The nursing educators need to pay attention to nursing interns whose first choice is not nursing, and in a bachelor program, who may have a lower level of professional identity. It is crucial to enhance the nursing interns' professional identity by improve the work atmosphere and clinical teachers' capacity, to promote nursing interns to choose nursing as a profession and reduce the shortage of nursing workforce.

Job change among early career nurses and related factors: A postgraduation 4-year follow-up study

AIMS

This study aimed to identify the job change status and related factors among nurses during the first 4 years of their professional life.

BACKGROUND

The early turnover and job change of nurses results in negative patient and nurse outcomes and financial losses.

METHODS

A prospective longitudinal observational design and convenience sampling were used. From five nursing schools in South Korea, 526 individuals participated in the first survey conducted before graduation; 317 and 338 individuals participated in the second and third surveys, respectively (4 months after employment, and 4 years after graduation).

RESULTS

In total, 42.0% of the participants remained at the hospital of their first job, 26.6% switched hospitals, and 12.1% moved to a nonhospital job. Multinomial logistic regression analyses showed that switching hospitals was associated with nurses' grade point average, type of hospital, first job satisfaction, and current pay. Moving to a nonhospital job was related to gender, type of hospital, current pay, and work-life balance.

CONCLUSION

To reduce the early turnover and job change, hospitals should provide educational programmes for nurses, support male nurses, and increase job satisfaction and work-life balance.

IMPLICATIONS FOR NURSING MANAGEMENT

Since this study addresses the working conditions and satisfaction of individuals who were re-employed after experiencing job turnover, it clarifies how nurse managers may reduce turnover. Namely, nurse managers should establish a work environment promoting good work-life balance.

The association between shift work disorder and turnover intention among nurses

Background

Shift work disorder (SWD) is highly prevalent among shift-working nurses and has multiple negative health-related effects. There is a dearth of insight into career-related decisions made by nurses suffering from SWD, for instance in terms of their intention to quit work (turnover intention). In this study, we aimed to investigate the association between SWD and turnover intention among nurses, and the individual and work-related correlates of turnover intention.

Method

Data were derived from the ongoing longitudinal cohort study “SUrvey of Shift work, Sleep and Health (SUSSH)” among Norwegian nurses. An annual survey was initiated in 2008/2009 (N = 2965). The present study used data collected in year 2015 (wave 7) and 2016 (wave 8). Nurses were included if: 1) they were working as nurses in both 2015 and 2016, and 2) had completed a three-item scale adapted from the Michigan Organizational Assessment Questionnaire assessing turnover intention (in wave 8), and 3) did not only work day-shifts. SWD was measured in wave 7 with three questions based on the minimal criteria from the third edition of the International Classification of Sleep Disorders. Job demands, decision latitude, and social support at the workplace were measured with subscales of the Swedish Demand-Control-Support Questionnaire.

Results

Eight Hundred eighty-nine nurses were included. The results from the hierarchical linear regression showed that SWD predicted turnover intention one year later, i.e. from 2015 to 2016 (F_1,835 = 6.00, p < 0.05; β = 0.084, p = 0.015). The findings remained significant when controlling for age, sex, organizational tenure, number of nights worked, shift work schedule and workplace social support, job demands and decision latitude.

Conclusion

This study showed that SWD is associated with turnover intention, even when controlling for individual and work-related variables.

Nurses' turnover intention, hope and career identity: the mediating role of job satisfaction

Background

A high turnover rate has become a critical issue in the field of nursing and how to tackle the problem of nursing turnover has received increased attention worldwide. Hope, career identity, job satisfaction may be useful for reducing turnover. The aim of this study is to explore the relationships among career identity, hope, job satisfaction, and the turnover intention of nurses, and to test the mediating role of job satisfaction on the associations of hope and career identity with turnover intention.

Methods

A descriptive cross-sectional design was used. A total of 500 nurses were recruited from five comprehensive tertiary hospitals using convenience sampling. The questionnaire included items about sociodemographic information as well as the Adult Dispositional Hope Scale, Nursing Career Identity Scale, Job Satisfaction Index Scale, and Nurse Turnover Intention Scale. Pearson’s correlation, multiple linear regression, and structural equation modeling were used to analyze the data. We describe the study in accordance with the STROBE statement.

Results

Hope (r = − 0.227, p < 0.001) and career identity (r = − 0.342, p < 0.001) were negatively correlated with turnover intention. Job satisfaction played a completely mediating role on the associations of hope and career identity with turnover intention (β₁ = − 0.09, β₂ = − 0.33).

Conclusions

Job satisfaction mediated the associations of career identity and hope with turnover intention. Thus, effective measures can be taken to enhance nurses’ hope and career identity in order to improve their job satisfaction and thereby reduce their turnover intention. Providing nurses with more support, helping them find a spiritual foundation, and holding mindful activities that stimulate positive emotions are helpful. In addition, colleges should pay more attention to instilling nursing students with career identity and nursing values.

Global prevalence of resilience in healthcare professionals: A systematic review, meta-analysis, and meta-regression

AIMS

This review aims to examine the prevalence estimate of low resilience among healthcare professionals and identify the factors affecting the prevalence.

BACKGROUND

Healthcare professionals experience high levels of stress. Understanding the healthcare professionals' resilience may provide an insight into how they perform in a highly stressed environment. Evaluation A comprehensive search of 11 databases was conducted. Studies that provided prevalence rates for low resilience among healthcare professionals working in a healthcare setting were included. Meta-analyses, sensitivity, subgroup analyses and meta-regression were conducted.

KEY ISSUES

Among 27,720 studies, 41 studies (N = 17,073) across 16 countries were included. The prevalence of low resilience was 26% (95% CI: 20-32). Subgroup analyses indicated that types of resilience measures affect resilience prevalence significantly. A higher prevalence of low resilience was observed among allied health professions during the COVID-19 pandemic in the Middle East.

CONCLUSIONS

This review indicated the prevalence of low resilience and type of resilience measurement instruments that affected the prevalence.

IMPLICATIONS FOR NURSING MANAGEMENT

This review provides a roadmap to design tailored, discipline-specific, and sustainable resilience training for nurses. Nursing managers should monitor the working hours and workload of nursing staffing in order to provide a protective working environment.

Retention Rates and the Associated Risk Factors of Turnover among Newly Hired Nurses at South Korean Hospitals: A Retrospective Cohort Study

This retrospective cohort study analyzed the turnover rate and the risk factors of turnover among newly hired nurses at tertiary and secondary hospitals in South Korea. Using National Health Insurance Service data, this study created a cohort of 21,050 newly hired nurses across 304 hospitals in 2018, with a follow-up period of 18 months. Retention and turnover risk factors were analyzed at 6-month intervals. Differences in retention period according to hospitals’ organizational characteristics and nurses’ individual characteristics were analyzed using the chi-squared test. The likelihood of staying at work was analyzed using Kaplan–Meier survival curves with the log-rank test, and the hazard ratios of turnover at each retention period were analyzed using multilevel Cox proportional hazards analysis. The turnover rate of newly hired nurses within 1 year of employment was 26.4%, with 20.1% resigning within 6 months, and 6.3% resigning between 7 and 12 months. For all retention periods, turnover risk was associated with a higher bed-to-nurse ratio and older age. Higher standardized monthly income was associated with lower turnover between 13 and 18 months. Hospitals should develop nurse-retention strategies that consider risk factors for turnover. To reduce turnover, adequate nursing personnel should be maintained and fair compensation should be offered.

Proceed With Caution: Integrating Newly Graduated Nurses Into an Emergency Department

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.

Factors associated with difficulty in adapting and intent to leave among new graduate nurses in South Korea

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.

Assessing the effect of nursing stress factors on turnover intention among newly recruited nurses in hospitals in China

Aim

This study sought to investigate some possible job stress factors that could influence newly recruited nurses’ behaviour to either continue or discontinue their job with their organization.

Design

A cross‐sectional study design was adopted for this study.

Method

Using 654 responses from novice nurses working in 20 county Chinese hospitals, we estimated the effects of six job stressors from the perceived stress scale on the turnover intention with a structural equation model in AMOS version 21 software.

Results

The results showed that four stressors, stress from taking care of patients (β = 0.111, p < .01), stress from roles and workload (β = 0.129, p < .001), stress from co‐workers and daily life (β = 0.323, p < .001) and stress from lack of professional knowledge and skills (β = 0.137, p < .001), from the perceived stress scale had a significant impact on turnover intention among nurses.

'It was quite a shock': A qualitative study of the impact of organisational and personal factors on newly qualified nurses' experiences

AIMS AND OBJECTIVES

To explore how newly qualified nurses' work experiences are constructed through the interplay between self, workplace and home-life influencing their retention.

BACKGROUND

Nurses are critical to achieving the goal of universal health coverage. However, shortages of nursing staff are endemic. Of particular concern, newly qualified nurses are more likely to leave the nursing workforce. The point of transition to working as a newly qualified nurse is a time of vulnerability. Most studies attempt to discover why nurses leave. This study uses the concept of job embeddedness to examine the experience of this transition and first two years of practice to understand what might help newly qualified nurses stay.

DESIGN

Qualitative approach using semi-structured telephone interviews.

METHODS

Self-selecting sample of nurses (n = 23) who participated 1-year (n = 12) and 2 years (n = 11) post-qualification. Participants were part of a larger longitudinal cohort (n = 867) study which has followed them since September 2013 when they entered nurse education in two Scottish universities. Thematic analysis was used to understand the interplay between organisation/workplace and the individual.

RESULTS

Three themes were developed: transition shock; workplace factors and work/life balance. Two further subthemes were developed: experience of support and belonging; and feeling unsupported and alienated. Eight participants had changed job or left, and two were looking to leave nursing.

CONCLUSION

This study highlights how the experience of transition shock can be positively or negatively impacted by the workplace environment, and how in turn this impacts the home environment. Ultimately, this impacts retention of newly qualified nurses.

RELEVANCE TO CLINICAL PRACTICE

Having adequate support resources, such as staffing, supportive team morale, professional development and family-friendly work environment, can create a work environment where they feel the purpose and meaningfulness of working as a nurse. This 'job embeddedness' can potentially enhance nurse retention. Reporting follows the COREQ checklist.

Relationship between nurse burnout, patient and organizational outcomes: Systematic review

BACKGROUND

Burnout, characterized by emotional exhaustion, depersonalization, and decreased personal accomplishments, poses a significant burden on individual nurses' health and mental wellbeing. As growing evidence highlights the adverse consequences of burnout for clinicians, patients, and organizations, it is imperative to examine nurse burnout in the healthcare system.

OBJECTIVE

The purpose of this review is to systematically and critically appraise the current literature to examine the associations between nurse burnout and patient and hospital organizational outcomes.

DESIGN AND DATA SOURCES

A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. PubMed, CINAHL, PsychInfo, Scopus, and Embase were the search engines used. The inclusion criteria were any primary studies examining burnout among nurses working in hospitals as an independent variable, in peer-reviewed journals, and written in English. The search was performed from October 2018 to January 2019 and updated in January and October 2020.

RESULTS

A total of 20 studies were included in the review. The organizational-related outcomes associated with nurse burnout were (1) patient safety, (2) quality of care, (3) nurses' organizational commitment, (4) nurse productivity, and (5) patient satisfaction. For these themes, nurse burnout was consistently inversely associated with outcome measures.

CONCLUSIONS

Nurse burnout is an occupational hazard affecting nurses, patients, organizations, and society at large. Nurse burnout is associated with worsening safety and quality of care, decreased patient satisfaction, and nurses' organizational commitment and productivity. Traditionally, burnout is viewed as an individual issue. However, reframing burnout as an organizational and collective phenomenon affords the broader perspective necessary to address nurse burnout. Tweetable abstract: Not only nurse burnout associated w/ worsening safety & quality of care, but also w/ nurses' organizational commitment and productivity. Reframing burnout, as an organizational & collective phenomenon is necessary.

Turnover Rates and Factors Influencing Turnover of Korean Acute Care Hospital Nurses: A Retrospective Study Based on Survival Analysis

PURPOSE

This study aimed to explore turnover rates for Korean acute care hospital nurses and identify factors influencing their turnover.

METHODS

The study was retrospective in nature. Nurse cohort data were obtained from hospital status data from Korea's Health Insurance Review Assessment Service. The observation period was from January 1, 2012 to December 31, 2016, and data for 96,158 nurses were analyzed. Independent variables included nurses' age and sex and hospital setting, type, ownership, and nurse staffing level. Kaplan-Meier analysis was performed to estimate survival curves, and factors influencing turnover were analyzed using Cox's proportional hazard regression.

RESULTS

The cumulative turnover probability for all nurses was .17, .29, .38, .45, and .50 for the first, second, third, fourth, and fifth years, respectively. The results showed that the longer the career duration, the lower the turnover rates. According to the factors influencing nurse turnover, both nurses' (i.e., sex and career duration) and hospitals' (i.e., hospital setting, type, ownership, and nurse staffing level) characteristics were statistically significant.

CONCLUSION

It should be noted that the turnover rate of nurses with less than three year of career duration and of those with less than one year has been shown to be quite high. Therefore, target populations for acute care hospital nurse turnover should be expanded from new graduate nurses to experienced nurses with less than 3 years of career. Further studies are required to examine the causes of high turnover rates in hospitals that are small and/or have low nurse staffing levels.

Resilience in new nurses: a qualitative study

Objectives

To explore the resilience experience of new nurses and how new nurses develop and apply resilience strategies to cope with the difficulties during the transition period.

Methods

A descriptive qualitative research method was on data acquired using data semi-structured interviews with 12 new nurses aged 20–26 years whose working time was more than 12 months but less than 24 months.

Results

Analysis of the data could determine participants adopting resilience strategies to withstand difficulties and challenges in transition period. This period consisted of three main phases: “self-protection,” “undertaking challenges,” and “planning future.” The first-line nurse managers’ feedback and flexible shift scheduling paid a vital part in promoting the resilience development of new nurses.

Conclusions

Recognizing the importance of understanding and developing the resilience of new nurses in the transition period could greatly reduce the turnover rate and alleviate the shortage of nurses in global nursing workforce.

Occupational stress and the risk of turnover: a large prospective cohort study of employees in Japan

Background

Although several studies have examined the association between occupational stress and turnover, these studies relied on cross-sectional designs, subjects’ self-report, healthcare workforce, or small sample sizes. This study aimed to confirm whether occupational stress increases the risk of turnover in a large-scale prospective cohort study using actual turnover data from company records.

Methods

The participants were 3892 male and 5765 female employees aged 20–49 years in a financial service company. We followed them from October 2012 until April 1, 2016 and used company records to identify employees who resigned. We identified employees with high and low stress using the Brief Job Stress Questionnaire. Hazard ratios for turnover in high-stress employees were estimated using Cox proportional hazards models, and population attributable risks were calculated separately for men and women.

Results

During 11,475,862 person-days, 122 men and 760 women resigned. After adjustment for age, length of service, job type, and position, the hazard ratios (95% confidence intervals) for turnover in high-stress employees were 2.86 (1.74–4.68) for men and 1.52 (1.29–1.78) for women. The corresponding population attributable risks for high stress were 8.2% for men and 8.3% for women. The component scores, i.e., job stressors, psychological/physical stress response, workplace social support, and job strain (the combination of high job demands and low job control) were also significantly associated with turnover (p < 0.05).

Conclusions

Occupational stress increases the risk of actual turnover. Measures to prevent occupational stress may be useful to prevent employee turnover.

Burning out physical and emotional fatigue: Evaluating the effects of a programme aimed at reducing burnout among mental health nurses

Burnout is a common problem among mental health nurses. High levels of burnout result in job dissatisfaction, rapid turnover of staff, physical and psychological discomfort, and a reduction in the quality of patient care. While there is an abundance of research relating to burnout per se, research regarding the impact of burnout prevention programmes is lacking. This study aimed to measure the effects of a burnout prevention programme on mental health nurses working in Saudi Arabia (SA). A quasi-experimental design was used to test the effectiveness of a two-day burnout prevention workshop. The sample consisted of an intervention group (n = 154) and a control group (n = 142). Data collected using the Maslach Burnout Inventory (MBI) measured the effects of the workshop at 1-, 3-, and 6-month intervals after completion of the programme. Data were analysed using the latest version of SPSS. Means, standard deviations, frequencies, and percentages were used to describe the sample and levels of burnout. A t-test, ANOVA, multiple linear regression, and chi-squared were used to measure the effect of the workshop before and at the three time points after exposure. Findings indicate the programme was effective with a significant reduction being reported 1 month after the intervention. However, although not returning to baseline scores, burnout scores had increased at 6 months. In conclusion, while the overall efficacy of the burnout reduction programme is evident, mental health nurses would benefit from having opportunity to use some of the strategies on a regular basis.

Why newly graduated nurses in South Korea leave their first job in a short time? A survival analysis

BACKGROUND

South Korea is one of the countries with a very low percentage of active nurses among the Organization for Economic Cooperation and Development (OECD) countries. Although the number of nurses has increased steadily, the number of active nurses has not increased more than expected due to continued turnover.

METHODS

This study used data of a longitudinal panel of Graduates Occupational Mobility Survey (GOMS) and performed survival analysis to determine the turnover rate of nurses and the average time of turnover.

RESULTS

The turnover rate was the highest at 25% within first year and 50% of nurses left their first job during the study period. The hospital size and salary levels were major factors that affected the turnover rate, with small-scale hospitals and extremely low salary levels having the highest turnover. Dissatisfaction with the organization and dissatisfaction with the profession also directly impacted job turnover. Turnover rate of male nurses was higher than that of female nurses.

CONCLUSION

Turnover of newly graduated nurses is highly inefficient personnel management. A strategy for reducing the turnover is needed.

Pre-employment health lifestyle profiles and actual turnover among newly graduated nurses: A descriptive and prospective longitudinal study

BACKGROUND

Newly graduated nurses' pre-employment health lifestyles play particularly important roles in their smooth adaptation to and retention in clinical nursing; however, the longitudinal relationship between pre-employment health lifestyles and work outcomes, such as turnover, remains underexamined. To identify the health lifestyle profiles of specific populations of interest, recent studies have employed multifaceted approaches using health behaviors and/or statuses.

OBJECTIVES

To identify the pre-employment health lifestyle profiles of newly graduated nurses, and to examine the longitudinal relationships between health lifestyle profiles and actual turnover.

DESIGN

Descriptive and prospective longitudinal study design.

SETTINGS

One tertiary hospital in Seoul, South Korea.

PARTICIPANTS

A total of 464 newly graduated nurses who started work between September 2014 and December 2015.

METHODS

The outcome was actual turnover-whether participants had resigned from the organization and the days they worked up to December 31, 2017. We measured eight health lifestyle variables on the first day of orientation before ward placement (i.e., at baseline): quantity and quality of sleep, eating three meals a day, having a regular diet, alcohol consumption, moderate exercise, depression, and self-rated health. We employed latent class analysis to identify the health lifestyle profiles of new nurses, and used Cox proportional hazards regression to examine the longitudinal relationships between health lifestyle profiles and actual turnover.

RESULTS

We classified newly graduated nurses' pre-employment health lifestyle profiles into two groups: unhealthy lifestyle (15.6%) and discordant (84.4%). Compared with the new nurses in the discordant group, those in the unhealthy lifestyle group had significantly higher probabilities of resigning (HR = 2.38, 95% CIs of HR = 1.62-3.50); this relationship remained significant after adjusting for perceived job stress at six weeks of work (HR = 2.26, 95% CIs of HR = 1.50-3.39).

CONCLUSIONS

This study identified significant differences in the patterns of newly graduated nurses' pre-employment health lifestyles; our analysis showed that classification in the unhealthy lifestyle group was a turnover risk factor. Given that new nurses' health lifestyles affect work outcomes, hospitals should implement organizational and educational initiatives to encourage healthy lifestyles. In considering pre-employment health lifestyle profiles, hospitals should also monitor novice nurses' adaptation and wellness. Nursing education should include strategies to enhance nursing students' own health. Further extensive longitudinal studies should seek to identify the health lifestyle profiles of heterogeneous nurse populations.

Relationships among demands at work, aggression, and verbal abuse among registered nurses in South Korea

BACKGROUND

In order to improve organizational culture and job outcomes, it is important to characterize and better understand the relationship between aggression and verbal abuse among nurses.

PURPOSE

To examine the relationships among demands at work, aggression, and verbal abuse among nurses.

METHODS

A cross-sectional study was conducted using survey data from three tertiary hospitals located in South Korea. Sixteen nursing units were selected and 378 nurses' data were used as the final sample. The relationships were examined by multiple linear or logistic regression analyses.

FINDINGS

More than 70% of the nurses had experienced at least 1 type of verbal abuse. Higher physical aggression and hostility were significantly related to greater verbal abuse experience.

CONCLUSION

To prevent the vicious cycle of victims becoming perpetrators, it is necessary to develop and implement concrete strategies to manage verbal abuse and aggression among nurse colleagues.

Factors Influencing Organizational Commitment and Turnover in Nurse Residents

BACKGROUND

Newly licensed RNs (NLRNs) are at risk for leaving employment in the first year. Nurse residency programs have demonstrated success for NLRN retention, yet other variables remain to be explored.

METHOD

A retrospective correlational approach was used to determine the effect of autonomy, competence, group cohesion, structural empowerment, and job satisfaction on organizational commitment, turnover intent, and actual job turnover using secondary data of 1,498 nurse residents.

RESULTS

At 1 year post-residency, turnover intent was low. The turnover rate at year 2 was 8.3% (n = 125). Group cohesion, job satisfaction, and structural empowerment had a significant effect on organizational commitment. Organizational commitment had a significant effect on turnover intent.

CONCLUSION

As part of the global NLRN population, findings based on the U.S. residency programs provide nursing professional development with information to foster the needs of NLRNs and nursing administrators with information to support the development and effectiveness of nurse residency programs in the organization. J Contin Educ Nurs. 2018;49(10):482-488.

The Relationship between Resiliency and Burnout in Iranian Nurses: A Systematic Review and Meta-Analysis

BACKGROUND:

The impact of resiliency on professional burnout in nurses has been evaluated in several studies.

AIM:

This meta-analysis was conducted to examine the effect of resiliency on different aspects of nurses’ professional burnout.

MATERIAL AND METHODS:

Publications were identified through targeted literature review in national and international databases between 1980-2017, in Persian and English. Two independent coders assessed and extracted articles. Data analysis was done by a random effects model. Study heterogeneity was measured by the I2 test. The data were analysed by STATA software v. 14.

RESULTS:

Initially, 227 articles were extracted. After titles and abstract screening, 108 articles were selected for full-text review. Only five of them had the necessary inclusion criteria for analysis. The meta-analysis performed on these observational studies showed that the correlation between resiliency and burnout was -0.57 with a 95% confidence interval of -0.354 to -0.726.

CONCLUSION:

Regarding the inverse relationship between resiliency and burnout, it is recommended to plan for the interventions that can improve the resilience of nurses against burnout. Conducting interventional and resilient training courses for nurses in nursing education can be considered.

THRIVEable work environments: A study of interplaying factors that enable novice nurses to thrive

AIM

The purpose of this study was to gain an understanding of the impact of the interplay between workplace and developmental factors that enable and disable thriving within the first year of nursing practice.

BACKGROUND

While much is known about the high attrition rates among new graduate nurses, little research has explored the impact of interplay between workplace stressors and developmental assets.

METHOD

Through a basic qualitative study, eight novice nurses underwent three in-depth interviews.

RESULTS

The interplay between workplace factors and development factors such as congruence and self-compassion had a significant impact on the participants' ability to effectively manage workplace stimuli.

CONCLUSION

Those lacking developmentally were more likely to perceive workplace stimuli as threatening, which had a significant impact on the ability to self-actualize as a novice nurse. Therefore, the role of interplay is significant in determining why some merely survive versus those who thrive, despite similar work environments.

IMPLICATIONS FOR NURSING MANAGEMENT

A greater understanding of the impact of the role of interplay will inform transition programs by enabling nurse leaders to cater to the unique needs of new graduates as they step over the threshold of professional practice.

A protocol to measure the impact of intentional changes to nurse staffing and skill-mix in medical and surgical wards

AIM

The aim of this research is to measure the impact that planned changes to nurse staffing and skill-mix have on patient, nurse, and organizational outcomes.

BACKGROUND

It has been highlighted that there are several design limitations in studies that explore the relationship between nurse staffing and patient, nurse and organizational outcomes; not least that the vast majority of research in this area emanates from studies that are predominantly observational in design. There are limited studies that measure nurse, patient, organizational, and economic outcomes using a longitudinal design following a planned change in nurse staffing.

DESIGN

The research will employ a longitudinal, multimethod approach to evaluate the impact that planned changes in nurse staffing and skill-mix have on wards in three pilot hospitals.

METHODS

Administrative data collection will take place on a shift-by-shift basis prospectively over a three-year period including the measurement of nursing sensitive outcomes: cross-sectional patient experience data and nurse outcomes (nursing work, job satisfaction, burnout, missed care) will be collected at intervals prior to, during and after the implementation of planned changes in nurse staffing and skill-mix. Data will be analysed using interrupted time-series models, adjusted for key hospital, ward and patient-level factors. An economic costing of the changes will further investigate the resources required for the intervention that can then be aggregated to a national level for future roll-out plans.

DISCUSSION

The study aims to provide evidence on the impact of planned changes to nurse staffing and skill-mix based on a systematic approach using a longitudinal design and to determine the extent to which the approach can be implemented at a national level.

Professional resilience among nurses working in an overcrowded emergency department in Taiwan

PURPOSE

Professional resilience has become increasingly important for nurses in adverse work environments to reduce the negative results and increase the positive outcomes of stress. This study aimed to explore and understand the experiences of resilience among nurses in an overcrowded emergency department (ED) and increase knowledge about what nurses identified as protective factors, which may be useful for future planning.

METHODS

A construction-grounded theory (CGT) approach was adopted. Purposive sampling and snowball technique were employed to recruit 13 participants, which proved sufficient to achieve theoretical saturation. In-depth interviews were conducted and audiotaped.

RESULTS

Doubting work value and maintaining optimism were the 2 main themes in the core category of seeing and taking work difficulty and responsibility. Nurses described how their passion for their profession gradually diminished, but they assessed the situation and took responsibility for their jobs.

CONCLUSION

This study found that nurses retain their compassion, which sustains them in their work. The issue of ED overcrowding led to pessimism among nurses. However, work rewards encouraged nurses to adopt a more proactive attitude toward work-related adversity.

[Patterns and Influential Factors of Inter-Regional Migration of New and Experienced Nurses in 2011~2015]

PURPOSE

The purpose of this study was to analyze the migration patterns of new nurses and experienced nurses and to identify the factors influencing inter-regional migration for solving regional imbalances of clinical nurses in South Korea.

METHODS

This study involved a secondary analysis of data from the Health Insurance Review and Assessment Service (HIRA). Data were analyzed using descriptive statistics and multiple logistic regression analysis.

RESULTS

New nurses tended to migrate from Kyunggi to Seoul. However, experienced nurses tended to migrate from Seoul and Chungchung to Kyunggi. Significant predictors of inter-regional migration among new nurses were location and nurse staffing grade of hospitals. Significant predictors of inter-regional migration among experienced nurses were location, hospital type, nurse staffing grade, ownership of hospitals and age of nurses.

CONCLUSION

Inter-regional migration occupied a small portion of total hospital movement among clinical nurses. The regional imbalances of nurses were not caused by the migration from non-metropolitan areas to Seoul. Nurse shortage problems in the small and medium hospitals of the non-metropolitan area can be solved only through improvement of work environment.

A government policy on full-time nursing employment in Ontario, Canada: An evaluation

PURPOSE

To evaluate the impact of a government full-time employment policy targeting new graduate nurses in the province of Ontario, Canada, by comparing participants with non-participants.

METHODS

The Policy Impact on Nurse Employment (PINEP) survey was administered in 2014 to nurses who graduated between 2007 and 2012. Backward multiple logistic regression analysis was conducted to determine the effect of participation in the policy on key outcomes: full-time employment, retention and perceptions of clinical proficiency.

RESULTS

A total of 2369 nurses responded to the survey. Policy participants were 1.5 times more likely to be employed full-time and 2.3 times more likely to be retained in their initial position at the time of survey compared to non-participants. Participants also perceived their clinical proficiency to be higher.

CONCLUSIONS

The evidence is converging around the importance of providing full-time employment to nurses to sustain the workforce, increase clinical proficiency and improve patient outcomes. In Ontario, the government created a policy to stimulate full-time employment for nurses. Results demonstrate that nursing employment has become more stable. Yet more needs to be done particularly in relation to the precarious employment trend.

Effect of Curriculum Revision on Graduates' Transition to Practice

The effect of educational interventions on the transition experiences of new graduates of prelicensure programs is unclear. This study investigated the effect of curriculum revision on transition to practice of nursing graduates. The nursing curriculum can have a positive influence on professional and job satisfaction at 3 months postgraduation, but the practice environment becomes the dominant force after that. Graduates who demonstrated poorer transition to practice at 3 months were more likely to leave their first positions by 12 months.

New Graduate Nurses' Professional Commitment: Antecedents and Outcomes

PURPOSE

This study examines the factors that increase new graduate nurses' professional commitment and how this professional commitment in turn affects professional turnover intentions, anxiety, and physical health symptoms.

DESIGN

The study was carried out in association with the nursing undergraduate's affiliation of Quebec, Canada. A three-wave longitudinal design was employed among nursing students. Nurses were surveyed before they entered the labor market, and then twice after they started working.

METHODS

Participants were contacted by post at their home address. The hypotheses were tested using structural equation modeling.

FINDINGS AND CONCLUSION

Professional commitment explains why good work characteristics and the provision of organizational resources related to patient care reduce nurses' anxiety and physical symptoms, and increase their professional turnover intentions. Pre-entry professional perceptions moderate the effects of work characteristics on professional commitment such that when participants hold positive pre-entry perceptions about the profession, the propensity to develop professional commitment is higher.

CLINICAL RELEVANCE

There is a worldwide shortage of nurses. From a nurse training perspective, it is important to create realistic perceptions of the nursing role. In hospitals, providing a good work environment and resources conducive to their professional ethos is critical for ensuring nurses do not leave the profession early on in their careers.

Effects of Blended Cardiopulmonary Resuscitation and Defibrillation E-learning on Nursing Students' Self-efficacy, Problem Solving, and Psychomotor Skills

This study was conducted to identify the educational effects of a blended e-learning program for graduating nursing students on self-efficacy, problem solving, and psychomotor skills for core basic nursing skills. A one-group pretest/posttest quasi-experimental design was used with 79 nursing students in Korea. The subjects took a conventional 2-week lecture-based practical course, together with spending an average of 60 minutes at least twice a week during 2 weeks on the self-guided e-learning content for basic cardiopulmonary resuscitation and defibrillation using Mosby's Nursing Skills database. Self- and examiner-reported data were collected between September and November 2014 and analyzed using descriptive statistics, paired t test, and Pearson correlation. The results showed that subjects who received blended e-learning education had improved problem-solving abilities (t = 2.654) and self-efficacy for nursing practice related to cardiopulmonary resuscitation and defibrillation (t = 3.426). There was also an 80% to 90% rate of excellent postintervention performance for the majority of psychomotor skills, but the location of chest compressions, compression rate per minute, artificial respiration, and verification of patient outcome still showed low levels of performance. In conclusion, blended E-learning, which allows self-directed repetitive learning, may be more effective in enhancing nursing competencies than conventional practice education.

Nursing students' belongingness and workplace satisfaction: Quantitative findings of a mixed methods study

BACKGROUND

The relationship between nursing students' belongingness and workplace satisfaction has received limited attention in the literature to date.

AIM

The aim of this study was to explore the relationship between, and factors that may influence final semester nursing students' need to belong, sense of belonging and workplace satisfaction while on clinical placements.

METHODS

A cross-national longitudinal multiphase explanatory sequential mixed methods study underpinned by a pragmatic theoretical framework was used for this study. A convenience sample of third-year nursing students from two Australian and one Canadian university (n=468) were recruited. Participants were asked to complete a 62 item survey which was a composite of three previously validated surveys: the 10 item 'Need to Belong Scale', the 34 item 'Belongingness Scale: Clinical Placement Experience (BES:CPE)' and the 18 item 'Nursing Workplace Satisfaction Questionnaire'. Data were analysed using descriptive and inferential statistics.

RESULTS

Key results indicated that participants wanted to have someone to turn to, and to be accepted; they found nursing work interesting and considered it worthwhile to make an effort in this meaningful job. Participants were usually comfortable to ask for and accept help but many felt discriminated against during clinical placements. Only belongingness was strongly correlated with workplace satisfaction.

CONCLUSIONS

Irrespective of site, nursing students' satisfied sense of belonging influenced their workplace satisfaction while on clinical placements. Workplace satisfaction is a key determinant of career decisions and the results from this study have the potential to inform clinical placement practices and policies and to influence beginning nurses' decisions to continue in the profession.