Turnover intention among hospital-based registered nurses in the Eastern Caribbean

Analyzing and Validating a Structure for Measuring the Nurse Practice Environment

Nurse shortages pose a challenge in many countries and retaining existing nursing staff is crucial to addressing these shortages. To inform possible interventions aimed at retaining nurses, managers need a comprehensive understanding of the nature of the nurse practice environment. The scales from two of the main instruments used to assess nurses' practice environments are tested. A survey of an online panel obtained responses from 459 Australian nurses. Analyses determined a combination of items with good construct validity and improved predictive utility for outcomes of interest for individual nurses. By essentially combining the best items from each instrument, a more comprehensive representation of the nurse work environment is obtained with improved predictive utility. The resulting combined set of scales is recommended for analyses of the nurse working environment and uses a combined set of scales from each of the two source instruments, namely: nurse participation in hospital affairs, recognition, nursing process, peer work standards, nursing competence, orientation, managers, resources, nurse-physician collaboration, and positive scheduling climate. Future research can then build on that strong set of items with a validated structure and predictive utility to inform management and interventions.

Palliative care integration: a critical review of nurse migration effect in Jamaica

BACKGROUND

Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies.

METHODS

A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth's methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing.

RESULTS

Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. 'Push-factors' such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration.

CONCLUSION

Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.

Struggle Turning Back to Professional Nursing Practice in Iran: A Qualitative Study

Background

Current nursing shortage is becoming more complicated because of turnover intention among nurses. Most of the inactive nurses in Iran after a long time for various rations Returned To Professional Nursing Practice (RTPNP). Because the RTPNP program does not exist in Iran to prepare inactive nurses returning to practice, this study aimed to explore the strategies that contribute to preparing nurses for RTPNP.

Materials and Methods

The present study was a part of the findings of a larger grounded theory study that lasted about 9 months from April 2019 to December 2019. The data were collected through semi-structured interviews with participants after signing an informed consent form. The average interview duration was 40 minutes. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Participants included eight nurses, two education supervisors, two matrons, and two head nurses. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method.

Results

Struggle turning back to PNP was the main category that emerged from four categories of "seeking learning resources," "return to practice support," "getting used to a practice," and "building a new family life" from the data analysis process.

Conclusions

Returners struggle to get prepared for providing PNP to clients if there is no definite process of RTPNP. Organizational support and RTPNP programs are efficient strategies and could help these returners get prepared for PNP.

Trends in Turnover Research on Korean Nurses: Based on 8 Journals Published by Member Societies under the Korean Academy of Nursing Science, 2006-2015

Purpose:

This study was done to identify the current status of turnover research on Korean nurses and to suggest directions for future research.

Methods:

A total of 63 articles over the past 10 years were selected using key words such as turnover intention or turnover-related variables from several databases. Frequency and percent were used to describe the characteristics of the turnover studies.

Results:

Quantitative research accounted for 90.5% of the total studies, and 60.3% of the studies were published by the Journal of Korean Academy of Nursing Administration. Most studies focused on the turnover intention of general nurses (71.9%) working in general hospitals (54.4%). Lawler’s turnover intention tool was used in 28.1% of the studies with a relatively high score for Cronbach’s alpha (0.7≤ a in 98.2% studies). 50.9% of the studies used descriptive survey design, and stepwise or hierarchical regression was used for the final statistical methods in 49.1% of the studies. Among the studies, 42.1% included job satisfaction as an influencing factor for turnover intention. In late twenties, single status, college graduates, staff nurse, low salary, and nursing experience with 1-5 years appeared to be significantly related to turnover intention across the studies.

Conclusion:

To date, turnover intention has been substituted for turnover in most studies. Because it is believed that nursing turnover will continue and ultimately challenge patient care and nursing outcomes, longitudinal research with actual turnover data is needed to produce new evidence on the turnover culture and its effects on health care outcomes in Korea.

Practice Environment Scale of the Nursing Work Index: A Reliability Generalization Meta-Analysis

A healthy work environment is a critical factor in nurse satisfaction, retention, and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most commonly used instrument to measure the nursing practice environment. This study uses meta-analysis to examine the reliability generalization of the PES-NWI. A meta-analysis of 51 studies representing a total of 80,563 subjects was conducted. The mean score reliability for the PES-NWI based on 38 studies ( n = 68,278) was .922 ( p < .05). The Mean Weighted Effect Size was stronger for studies conducted in the United States versus non-U.S. (.946 vs. .907). For studies rated high and moderate quality, the mean score reliability was .911 and .946, respectively. Scores on the PES-NWI are reliable for measuring the nursing practice environment across samples in the United States and non-U.S. countries.

Association Between Burnout and Intention to Emigrate in Peruvian health-care Workers

Background

Emigration of health-care workers is a problem within global health systems which affects many countries, including Peru. Several factors have caused health-care workers to emigrate, including burnout syndrome (BS). This study aims to identify the association between BS and its dimensions with the intention of physicians and nurses to emigrate from Peru in 2014.

Methods

A cross-sectional study, based on a secondary analysis of the National Survey of Health Users (ENSUSALUD - 2014) was conducted. Sampling was probabilistic, considering the 24 departments of Peru. We include the questionnaire for physicians and nurses, accounting for 5062 workers. BS was measured by the Maslach Burnout Inventory-Human Services Survey. Adjusted odds ratio (OR) was calculated using multiple logistic regression.

Results

Of the study population, 44.1% were physicians, 37.7% males, and 23.1% were working in Lima. It was found that 2.8% [95% confidence interval (CI): 2.19–3.45] of health-care workers had BS. The overall prevalence of intention to emigrate among health-care workers was 7.4% (95% CI: 6.36–8.40). Association was found between BS and intention to emigrate in Peruvian health-care workers (OR = 2.15; 95% CI: 1.05–4.40). Emotional exhaustion was the BS dimension most associated with intention to emigrate (OR = 1.80; 95% CI: 1.16–2.78).

Conclusion

Physicians and nurses from Peru who suffered from BS were more likely to have intention to emigrate. Policies should be established to reduce BS as a strategy to control “brain drain” from health-care workers of Peru.

Validation of work pressure and associated factors influencing hospital nurse turnover: a cross-sectional investigation in Shaanxi Province, China

Background

Nurses' turnover is a major contributor to nursing shortages, strongly influenced by nurses’ intentions to leave. Several factors influencing the turnover intention have been well identified in Western countries and large cities in China. However, whether these factors also contribute to nurses' work stress in Midwest China are still unclear. The main purpose of this study was to examine the work pressure and associated factors influencing the nurses’ intent to leave.

Methods

A cross-sectional questionnaire-based survey with multistage sampling was conducted by recruiting 800 employed registered nurses with >1 year of work experience. Chi-square test and multi-factor logistic regression were applied to attain the relative comparisons. Sub-group analysis was conducted to explore the different turnover intention patterns in different age groups.

Results

The turnover intention was classified as strong/very-strong (19%), weak (62%), and very-weak (19%). Among the factors influencing the nurses’ desire to leave the profession, work pressure was the most prominent. The predominantly associated factors contributing the work stress were age, experience, and workload. However, the scale of income did not affect the intent to leave decision. Pediatrics was identified to be the highest tormented department with a significant (P < 0.05) turnover of nurses. Among different age sub-groups, 30–39 age group nurses in Secondary hospitals demonstrate a stronger intent to leave.

Conclusion

Nurses’ turnover intentions were associated with stress, age, job duty, and career commitment in Shaanxi Province. The intent to leave is dynamically multifactorial, and effective managements and supportive strategies are needed to reduce the nurses work stress accordingly.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Nurse administrators' intentions and considerations in recruiting inactive nurses

AIMS

To understand nurse administrators' intentions and considerations in recruiting inactive nurses and to examine predictors of intent to recruit.

BACKGROUND

Few studies have provided insight into employer intentions and considerations in recruiting inactive nurses.

METHODS

A census survey collected data from 392 nurse administrators via a mailing method.

RESULTS

Overall, 89.0% of nurse administrators were willing to recruit inactive nurses. Stepwise regression analysis revealed that the only predictor of nurse administrators' intention to recruit was nurse turnover rate at the hospital. Nurse administrators perceived the most important recruiting considerations were inactive nurses' cooperation with alternating shifts, health status and nursing licence. The most frequent reasons for not recruiting were an inactive nurse's lack of understanding of the medical environment and poor nursing competence.

CONCLUSIONS

Most hospital nurse administrators were willing to recruit inactive nurses. Inactive nurses who wish to return to work should be qualified, willing to work both day and night shifts, and in good health.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators can reduce the nursing shortage by recruiting inactive nurses. Re-entry preparation programmes should be implemented that will provide inactive nurses with knowledge of the current medical environment and the skills required to improve their nursing competence.

Exploring the relationship between work environment, job satisfaction, and intent to stay of Jordanian nurses in underserved areas

AIMS

The aims of this study are to (1) examine the relationships between work environment, job satisfaction and intention to stay at work; and (2) explore the predicting factors of intention to stay at work among nurses in underserved areas.

BACKGROUND

Developing and fostering creative work environment are paramount especially in underserved areas, where the work conditions present many challenges.

METHODS

A descriptive correlational design was utilized to collect data from 330 hospital nurses who worked in two underserved governorates in Jordan. A set of instruments were used to measure the variables of the study.

RESULTS

The results showed a strong positive association between job satisfaction and work environment. The results of logistic regression indicated receiving housing, job satisfaction, and work environment were the predicting variables of the level of intention to stay at work.

CONCLUSION

It is critical to improve work conditions and create a culture of supportive work environment in underserved area.

Testing the Nursing Worklife Model in Canada and Australia: a multi-group comparison study

STUDY AIM

To test a model derived from the Nursing Worklife Model linking elements of supportive practice environments to nurses' turnover intentions and behaviours in Canada and Australia.

BACKGROUND

With the worldwide shortage of nurses, retaining nurses within fiscally challenged health care systems is critical to sustaining the future of the nursing workforce and ultimately safe patient care. The Nursing Worklife Model describes a pattern of relationships amongst environmental factors that support nursing practice and link to nurse turnover. This model has been tested in north American settings but not in other countries.

METHODS

A secondary analysis of data collected in two cross-sectional studies in Canadian and Australian hospitals (N=4816) was conducted to test our theoretical model. Multigroup structural equation modelling techniques were used to determine the validity of our model in both countries and to identify differences between countries.

RESULTS

The hypothesized model relationships were supported in both countries with few differences between groups. Components of supportive professional practice work environments, particularly resources, were significantly linked to nurses' turnover intentions and active search for new jobs. Leadership played a critical role in shaping the pattern of relationships to other components of supportive practice environments and ultimately turnover behaviours.

CONCLUSION

The Nursing Worklife Model was shown to be valid in both countries, suggesting that management efforts to ensure that features of supportive practice environments are in place to promote the retention of valuable nursing resources.

Israeli nurse practice environment characteristics, retention, and job satisfaction

Background

There is an international nursing shortage. Improving the practice environment has been shown to be a successful strategy against this phenomenon, as the practice environment is associated with retention and job satisfaction. The Israeli nurse practice environment has not been measured. The purpose of this study was to measure practice environment characteristics, retention and job satisfaction and to evaluate the association between these variables.

Methods

A demographic questionnaire, the Practice Environment Scale, and a Job Satisfaction Questionnaire were administered to Israeli acute and intensive care nurses working in 7 hospitals across the country. Retention was measured by intent to leave the organization and work experience. A convenience sample of registered nurses was obtained using a bi-phasic, stratified, cluster design. Data were collected based on the preferences of each unit, either distribution during various shifts or at staff meetings; or via staff mailboxes. Descriptive statistics were used to describe the sample and results of the questionnaires. Pearson Product Moment Correlations were used to determine significant associations among the variables. A multiple regression model was designed where the criterion variable was the practice environment. Analyses of variance determined differences between groups on nurse practice environment characteristics.

Results

610 nurses reported moderate levels of practice environment characteristics, where the lowest scoring characteristic was ‘appropriate staffing and resources’. Approximately 9% of the sample reported their intention to leave and the level of job satisfaction was high. A statistically significant, negative, weak correlation was found between intention to leave and practice environment characteristics, with a moderate correlation between job satisfaction and practice environment characteristics. ‘Appropriate staffing and resources’ was the only characteristic found to be statistically different based on hospital size and geographic region.

Conclusions

This study supports the international nature of the vicious cycle that includes a poor quality practice environment, decreased job satisfaction and low nurse retention. Despite the extreme nursing shortage in Israel, perceptions of the practice environment were similar to other countries. Policy makers and hospital managers should address the practice environment, in order to improve job satisfaction and increase retention.

Quality of work life as a predictor of nurses' intention to leave units, organisations and the profession

AIM

To examine the relationships between quality of work life (QWL) and nurses' intention to leave their unit (ITLunit), organisation (ITLorg) and profession (ITLpro).

BACKGROUND

The high turnover rate among nurses presents a major challenge to health care systems across the globe. QWL plays a significant role in nurses' turnover.

METHODS

A descriptive cross-sectional survey design was conducted via purposive sampling of 1283 hospital nurses and administering the Chinese version of the Quality of Nursing Work Life scale (C-QNWL), a three-ITL-type scale questionnaire, and a demographic questionnaire for individual- and work-related variables. Descriptive data, correlations, and ordinal regression models were analyzed.

RESULTS

QWL predicted ITLpro and ITLorg better than ITLunit. Three QWL dimensions (work arrangement and workload, nursing staffing and patient care, and work-home life balance) were significantly predictive of all three ITL measures. However, the dimension of teamwork and communication was only predictive for ITLunit, not for ITLorg and ITLpro.

CONCLUSIONS

Different patterns of QWL dimensions are predictive of ITLunit, ITLorg, and ITLpro.

IMPLICATIONS FOR NURSING MANAGEMENT

The study provides important information to nurse administrators about the aspects of QWL that most commonly lead nurses to leave their units, organisations, and even the profession itself.

The work environment of haemodialysis nurses and its impact on patients' outcomes

The aims of this study were to assess haemodialysis nurses' work environment and investigate the correlation between work environment and patients' outcomes. A cross-sectional study was conducted at the 11 public hospital-based haemodialysis units of the 5th Regional Health Authority of Greece. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to assess work environment. Nurses were asked to report the frequency of a series adverse events and errors. Study population consisted of 133 nurses (response rate 89.3%). The overall PES-NWI scored just < 2.5 (Mean = 2.48, standard deviation = 0.34) indicating a non-favourable haemodialysis workplace. Nurse-physician Relations, nurse manager ability and nursing foundations for quality of care were the most favourable aspects of work environment. Multivariate logistic regression analysis identified that hypotension (odds ratio (OR) = 0.3, 95% confidence interval (CI) = 0.1-0.9, P = 0.03), venous needle disconnection (OR = 0.14, 95% CI = 0.03-0.65, P = 0.012) and patient fall (OR = 0.02, 95% CI = 0.001-0.51, P = 0.018) were associated with a non-favourable work environment. Findings have important implications for improvement of haemodialysis work environment and enhancement of patients' safety.