The relationships between nurses' work environments and emotional exhaustion, job satisfaction, and intent to leave among nurses in Saudi Arabia

Work characteristics, job satisfaction and intention to leave: a cross-sectional survey of advanced nurse practitioners

BACKGROUND

Advanced Nurse Practitioners (ANPs) are highly skilled health care professionals with the potential to play a major role in improving the quality and accessibility of health care services. However, there is emerging evidence of disquiet among nurse practitioners who often work in suboptimal work environments. Therefore, it is important to understand the elements that contribute to ANPs' job satisfaction and retention in healthcare services.

AIM

To examine the effects of commitment to the workplace, work engagement, and influence at work on job satisfaction and intention to leave of ANPs.

METHODS

A total of 153 ANP's on the advanced practice section of the Nursing and Midwifery Board of Ireland register completed a web survey between July and August 2020. Independent variables (commitment to the workplace, work engagement, and influence at work) were measured using the Copenhagen Psychosocial Questionnaire (COPSOQ). Multivariable logistic regression models were used to investigate the association between dependent and independent variables.

RESULTS

Participants who reported higher levels of influence at work and higher levels of commitment to the workplace were also satisfied in their job (OR 1.05, 95% CI 1.01-1.09, p = 0.025), (OR 1.10, 95% CI 1.06-1.14, p < 0.001) respectively. Additionally, ANPs with higher levels of commitment to work were significantly less likely to leave their role (OR 0.94, 95% CI .92-.96, p < 0.001).

CONCLUSION

Healthcare organisations can improve job satisfaction and decrease intention to leave by creating environments in which ANPs are supported by their colleagues and supervisors, and facilitate their practice to the full extent of their capabilities.

Impact of the Work Environment on Nurse Outcomes: A Mediation Analysis

BACKGROUND

The nursing workforce remains in a vulnerable state post pandemic as working conditions are difficult and exacerbated by a global nursing shortage. Identifying factors leading to turnover intentions are thus critical for health care system recovery.

PURPOSE

The purpose of this study was to examine the impact of nurses' work environment and the pandemic on missed nursing care, scope of practice, emotional exhaustion, and intent to leave.

METHODS

This study was a cross-sectional, self-reporting online survey, sent to hospital-based nurses in a Canadian province (n = 419). Mediation analysis was used to examine both direct and indirect effects of work environment and COVID-19 impact on nurse outcomes (emotional exhaustion and intent to leave) through missed care and scope of practice.

RESULTS

The results showed that 73% of nurses were considering leaving the profession. Several direct and indirect pathways predicted emotional exhaustion and intent to leave. A better work environment was related to both decreased emotional exhaustion and intent to leave. Nurses' scope of practice partially mediated the relationship between work environment and intent to leave. On the other hand, missed care did not mediate emotional exhaustion or intent to leave.

CONCLUSIONS

While considering the global nursing shortage, it is imperative to implement strategies to promote nurses' well-being and their retention within the health care system.

Medical staff's emotional exhaustion and its relationship with patient safety dimensions

PURPOSE

Medical staff's emotional exhaustion increases cynical attitudes and behaviors about work and patients and leads medical staff to become detached from work. This may decrease patients' trust and satisfaction and even endanger patients' lives. There is a need to examine the critical factors affecting the medical staff's emotional exhaustion by investigating its relationship with the patient-safety dimensions based on the safety attitudes questionnaire (SAQ).

DESIGN/METHODOLOGY/APPROACH

A case study is conducted from the viewpoints of physicians and nurses to examine the relationship between emotional exhaustion and six dimensions of the SAQ from 2016 to 2020 from a regional teaching hospital in Taiwan. Linear regression with forward selection is employed. Six dimensions of the SAQ are the independent variables, whereas emotional exhaustion is the dependent variable for each year.

FINDINGS

Stress recognition is the most important variable to influence emotional exhaustion negatively, while job satisfaction is the second important variable to affect emotional exhaustion positively from 2016 to 2020. On the contrary, working conditions do not influence emotional exhaustion in this hospital from medical staff's viewpoints.

ORIGINALITY/VALUE

This study uses longitudinal data to find that both stress recognition and job satisfaction consistently influence emotional exhaustion negatively and positively, respectively, in this five-year period. The third dimension to impact emotional exhaustion varies from time to time. Thus, the findings from a cross-sectional study might be limited. The authors' findings show that reducing stress recognition and enhancing job satisfaction can lead to the improvement of emotional exhaustion from medical staff's viewpoints, which should be monitored by hospital management.

Professional autonomy among nurses in Saudi Arabian critical care units

BACKGROUND

Professional autonomy is essential in expanding the scope of nursing practice and has been recognized as a top nursing priority.

OBJECTIVE

This study aims to assess Saudi nurses' autonomy level in critical care settings and examine the influence of sociodemographic and clinical characteristics on their autonomy level.

METHODS

A correlational design and a convenience sampling approach were used to recruit 212 staff nurses from five Saudi governmental hospitals in Jouf region of Saudi Arabia. The data were collected through a self-administered questionnaire composed of two sections, including sociodemographic characteristics and the Belgen autonomy scale. The Belgen autonomy scale used in this study measures nurses' autonomy levels and consists of 42 items rated on an ordinal scale. The scale's minimum score of 1 indicates nurses with no authority, while the maximum score of 5 indicates nurses with full authority.

RESULTS

Descriptive statistics revealed that nurses in the sample had a moderate overall work autonomy (M = 3.08), with higher autonomy in patient care decisions (M = 3.25) compared to unit operations decisions (M = 2.91). Nurses had the highest level of autonomy in tasks related to preventing patient falls (M = 3.84), preventing skin breakdown (M = 3.69), and promoting health activities (M = 3.62), while they had the lowest level of autonomy in ordering diagnostic tests (M = 2.27), determining the day of discharge (M = 2.61), and planning the unit's annual budget (M = 2.22). The multiple linear regression model (R2 = 0.32, F (16, 195) = 5.87, p < .001) showed that education level and years of experience in critical care settings were significantly related to nurses' work autonomy.

CONCLUSION

Saudi nurses in acute care settings have moderate professional autonomy, with higher autonomy in making patient care decisions than unit operations decisions. Investing in nurses' education and training could increase their professional autonomy, leading to improved patient care. Policymakers and nursing administrators can use the study's results to develop strategies that promote nurses' professional development and autonomy.

The relationship between practice environment, job satisfaction and intention to leave in critical care nurses

BACKGROUND

Recent studies in the Kingdom of Saudi Arabia (KSA) have shown that the increasing nursing turnover in the health care industry has become a great source of concern. The overdependence on the supply of expatriate nurses (74%) and coronavirus disease 2019 (COVID-19) travel restrictions have exacerbated this staffing issue.

AIMS

To examine the relationship between perception of nursing practice environment (NPE), job satisfaction and intention to leave (ITL) among critical care nurses working in the state of Ha'il in KSA.

DESIGN

Cross-sectional correlational (observational) design.

METHODS

Data were collected via electronic online survey distributed to registered critical care nurses working in King Khalid Hospital (KKH), Ha'il, KSA, between July and August 2020. Participant demographics and key variables data related to NPE, job satisfaction and ITL respectively were collected from the participants using existing and validated questionnaires. Descriptive statistics and correlational analysis and multivariable analyses were conducted.

RESULTS

A response rate of 98% was achieved (152/160) for the study. Findings showed that the NPE was largely favourable (M = 2.89, SD = 0.44); however, nurse participation in hospital affairs (M = 2.83, SD = 0.47) and staffing and resource adequacy (M = 2.88, SD = 0.47) scored lowest. NPE was found to be significantly correlated with job satisfaction (rs = .287, P < .01). A significant negative relationship was found between NPE and ITL (rs = -0.277**, P < .01). However, job satisfaction was associated with ITL (rs = -.007, P = .930).

CONCLUSIONS

Maintaining a healthy work environment and job satisfaction levels in critical care units is key to improving, recruitment and retention of nursing staff.

RELEVANCE TO CLINICAL PRACTICE

Critical care and hospital leaders should implement programs that enhance the quality of the practice environment. This will improve nurse participation in unit and hospital affairs, job satisfaction and intention to stay.

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 burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic

BACKGROUND

Intensive care unit (ICU) nurses are at an increased risk of burnout and may have an intention-to-leave their jobs. The COVID-19 pandemic may increase this risk.

OBJECTIVE

The objective of this study was to describe the prevalence of burnout risk and intention-to-leave the job and nursing profession among ICU nurses and to analyse the relationships between these variables and the work environment after two years of the COVID-19 pandemic.

DESIGN

A national cross-sectional survey of all nurses working in Belgian ICUs was conducted between December 2021 and January 2022 during the 4th and 5th waves of the COVID-19 pandemic in Belgium. The Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to measure the work environment, intention-to-leave the hospital and/or the profession was assessed. The risk of burnout was assessed using the Maslach Burnout Inventory scale including emotional exhaustion, depersonalisation, and reduced personal accomplishment.

SETTING

Nurses in 78 out of 123 Belgian hospital sites with an ICU participated in the survey.

PARTICIPANTS

2321 out of 4851 nurses (47.8%) completed the entire online survey.

RESULTS

The median overall risk of burnout per hospital site (high risk in all three subdimensions) was 17.6% [P25: 10.0 - P75: 28.8] and the median proportion of nurses with a high risk in at least one subdimension of burnout in Belgian ICUs was 71.6% [56.7-82.7]. A median of 42.9% [32.1-57.1] of ICU nurses stated that they intended-to-leave the job and 23.8% [15.4-36.8] stated an intent-to-leave the profession. The median overall score of agreement with the presence of positive aspects in the work environment was 49.0% [44.8-55.8]. Overall, nurses working in the top 25% of best-performing hospital sites with regard to work environment had a statistically significant lower risk of burnout and intention-to-leave the job and profession compared to those in the lowest performing 25% of hospital sites. Patient-to-nurse ratio in the worst performing quartile was associated with a higher risk for emotional exhaustion (OR = 1.53, 95% CI:1.04-2.26) and depersonalisation (OR = 1.48, 95% CI:1.03-2.13) and intention-to-leave the job (OR = 1.46, 95% CI:1.03-2.05).

CONCLUSIONS

In this study, a high prevalence of burnout risk and intention-to-leave the job and nursing profession was observed after two years of the COVID-19 pandemic. Nevertheless, there was substantial variation across hospital sites which was associated with the quality of the work environment.

TWEETABLE ABSTRACT

"Burnout & intention to leave was high for Belgian ICU nurses after 2 years of COVID, but wellbeing was better with high quality work environments and more favourable patient to nurse ratios".

Factors Influencing Nurse Intent to Leave Acute Care Hospitals: A Systematic Literature Review

Professional nurses are leaving their current positions in acute care hospitals and, in some cases, the profession in greater numbers than ever. Nurse leaders must understand factors surrounding nurses' intent to leave to develop strategies to mitigate this phenomenon and retain nurses. This review of the literature seeks to synthesize studies on nurses' intent to leave. Themes include job satisfaction, resources and staffing impacting workloads, leadership, and burnout.

Turnover-attachment motive of Saudi Arabia nursing workforce: A Cross-Sectional study

AIM

This study aimed to explore the association of turnover-attachment motive with socio-demographic data among Saudi and foreign nurses in a hospital in the Eastern Province of Saudi Arabia.

METHODS

A cross-sectional correlation study was conducted among n = 180 registered Saudi and foreign nurses working at a private tertiary hospital in the Eastern Province, Saudi Arabia. The turnover-attachment motive survey was used to evaluate the eight motivational forces. Data were analysed using JASP version 16 statistical software and Orange 3 version 3.26.0. The data were subjected to correlation analysis and multiple linear regression.

RESULTS

Only 8% of participants were identified with a high intention to leave driven by alternative, behavioural, normative and constitutive forces. Younger healthcare workers tend to have higher intentions to quit the job; the 29-33 age group has a statistically significant negative effect, increasing intention to leave. It was found that those with 5-6 years of clinical experience at Dr. Sulaiman Al Habib Hospital, Al Khobar and no experience abroad had statistically significantly lower intention to leave.

CONCLUSION

This study presented the factors influencing nursing staff to stay or leave work in a hospital in the Eastern Province of Saudi Arabia that can be a basis for reviewing existing policies and procedures to improve nurses' working conditions.

The effects of nursing work environment on patient safety in Saudi Arabian hospitals

Purpose

This study aims to investigate the impact of the nursing work environment on patients’ safety in Saudi Arabian hospitals.

Methods

This study used a cross-sectional design for collecting the data related to the nursing work environment and patients’ safety from nursing staff in Saudi Arabian hospitals. The survey questionnaire included in this study has two pre-validated questionnaires including practice environment scale-nursing work index questionnaire and hospital’s survey on patients’ safety developed by Surveys on Patients Safety Culture. The survey link was forwarded to HR administrators of 96 hospitals in Saudi Arabia, which included 72 public hospitals, 23 private hospitals, and one public-private hospital. Three hundred sixty-nine responses were received. After removing the incomplete responses, 357 responses were considered for the data analysis, in which t-tests and Pearson’s correlation techniques were adopted.

Results

Strongest correlations were identified between resource adequacy and work area (r = 0.763, p &lt; 0.01), “participation in management and leadership” and work area (r = 0.712, p &lt; 0.01), “participation in management and leadership” and supervisor/managers’ approaches (r = 0.731, p &lt; 0.01), and “nursing care and inter-disciplinary relationships and frequency of events” (r = 0.701, p &lt; 0.01).

Conclusion

The nursing work environment factors, especially participation, management and leadership, nursing care, inter-disciplinary relationships, and resource adequacy have to be improved in order to improve the patients’ safety.

Multi-level analysis of individual and work environment factors associated with nurses' perceived emotional exhaustion

BACKGROUND

Several factors at the individual- and work environment-level were suggested to correlate with emotional exhaustion development in nurses.

AIM

To explore nurses' perceived emotional exhaustion and associated factors by employing hierarchical modelling techniques.

METHODS

1539 nurses completed the cross-sectional survey. Generalized Linear Mixed Model was performed to identify predictors of emotional exhaustion.

RESULTS

At the individual level, female gender, high workload and emotional job demands increased the risk of emotional exhaustion; instead, higher education, satisfaction with the role of follower, perceiving nursing profession as meaningful, feeling independent at work, and group closeness were protective factors. At the work environment level, hospital ward type did not affect emotional exhaustion.

CONCLUSIONS

Emotional exhaustion is largely influenced by ward culture and organizational policies, and to a lower extent by socio-demographic variables. Moreover, it emerges as an intrinsic risk of the nursing profession rather than being associated with the clinical area profile.

Workplace violence and turnover intention among the Bangladeshi female nurses after a year of pandemic: An exploratory cross-sectional study

During the COVID-19 pandemic, workplace violence was widespread against healthcare personnel. Workplace violence (WPV) against nurses exhilarates their turnover intention (TI). The objective of this study was to investigate the association between workplace violence and turnover intention and also identify other factors associated with TI among Bangladeshi female nurses. An exploratory cross-sectional study was carried out among 881 female nurses between April 26 and July 10, 2021. The TI of the female nurses was the outcome variable of this study. The primary exposure variable was WPV faced by the nurses. Workplace Violence Scale (WPVS) was used to measure the WPV, and Turnover Intention Scale-6 (TIS-6) was used to measure the TI of the nurses. Multiple linear regression model was fitted to find the adjusted association of TI with WPV and other study variables. A stratified analysis by type of job (government vs. private) was also performed. The majority of the nurses (74.46%) faced low to high levels of WPV. The overall mean score of TIS was found 16.33 (± 4.72). Multiple linear regression analysis revealed that compared to government jobholders, the mean score of TIS (15.81 vs. 17.20) was found significantly higher among the private jobholders (p < 0.001). Nurses exposed to the intermediate and high level of WPV had a significantly higher TI score (β = 4.35, 95% CI: 3.36, 5.34) than the non-exposures. The TI of private jobholders was found significantly higher (β = 2.04, 95% CI: 1.09, 3.00) than the government jobholders. Compared to diploma degree holders, significantly higher TI was observed among the B.Sc. degree holders (β = 0.86, 95% CI: 0.22, 1.55) and M.Sc. degree holders (β = 1.46, 95% CI: 0.58, 2.34). Besides, the nurses who did not get timely salaries scored higher TI (β = 1.17, 95% CI: 0.12, 2.22). Moreover, the nurses who did not receive any training against WPV scored significantly higher TI (β = 1.89, 95% CI: 1.03, 2.74). The stratified analysis by type of job also revealed significant factors of TI in government and private settings. This study found a high prevalence of WPV and a high rate of TI among Bangladeshi female nurses. Moreover, this study explored an association between WPV and TI. The study findings could help policymakers facilitate a comfortable working environment by preventing WPV and addressing the factors to reduce nurses' frequent TI.

Job demands, job control, and social support as predictors of job satisfaction and burnout in Croatian palliative care nurses

The Job Demands-Control-Support (JDCS) model has seldom been tested in palliative care settings, and occupational well-being of palliative care professionals has never before been investigated in Croatia. Our aim was therefore to fill that gap by testing the JDCS model among Croatian nurses providing palliative care. More specifically, we wanted to see how job demands, job control, and social support at work affect occupational well-being outcomes (i.e. job satisfaction and burnout dimensions of exhaustion and disengagement from work) in terms of the model’s iso-strain and buffer hypotheses. This cross-sectional study included 68 nurses working in various palliative care institutions across Croatia, who answered our online questionnaire. Overall, the nurses did not report high levels of burnout or low job satisfaction. The only significant effect was that of job control on job satisfaction (β=0.38; P<0.01) and disengagement (β=-0.45; P<0.01), while job demands and social support at work had a significant interaction effect on the burnout dimension of exhaustion (β=0.39; P<0.01) in the sense that high social support at work buffered the increase in exhaustion associated with high job demands. These findings suggest that interventions aimed at increasing perceived job control and social support at the workplace could improve occupational well-being of nurses working in palliative care.

How Safety Climate Influences the Willingness to Stay of Nursing Staff during the COVID-19 Outbreak

The outbreak of COVID-19 in China at the beginning of 2020 has made the problems that the aged care agency face with large mobility and high turnover of aged nursing staff become more serious. Aiming at this problem, this paper incorporates psychological capital and social panic into the model from the perspective of the organizational safety climate and constructs a theoretical model of the mechanism of the effect on nursing staff’s willingness to stay in the context of the outbreak. Through a questionnaire survey in an aged care agency in Anhui Province, a total of 321 valid questionnaires were collected for empirical analysis. The results show that: (1) the safety climate of the organization has a significant positive impact on the transactional psychological capital and interpersonal psychological capital of nursing staff in the aged care industry and their willingness to stay; (2) transactional psychological capital and social panic have a significant positive impact on the willingness to stay of nursing staff, while interpersonal psychological capital has no significant impact on the willingness to stay; (3) the mediating role of transactional psychological capital and interpersonal psychological capital between the safety climate and the willingness to stay is established, and the moderating role of social panic between psychological capital and willingness to stay is also established. Finally, based on the research conclusions, corresponding countermeasures and suggestions are put forward to deal with the problems that occur in special periods.

Burnout in Palliative Care Nurses, Prevalence and Risk Factors: A Systematic Review with Meta-Analysis

Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development. Thus, it is important to analyze the prevalence and risk factors of burnout in palliative care nurses and estimate its prevalence. A systematic review and meta-analysis was done with quantitative primary studies. n = 15 studies were included with n = 6 studies including information for the meta-analysis. The meta-analytic prevalence estimation of emotional exhaustion was 24% (95% CI 16–34%), for depersonalization was 30% (95% CI 18–44%) and for low personal accomplishment was 28% with a sample of n = 693 palliative care nurses. The main variables related with burnout are occupational variables followed by psychological variables. Some interventions to improve working conditions of palliative care nurses should be implemented to reduce burnout.