Nurse turnover: A longitudinal survival analysis of the Korea Nurses' Health Study

Influence of nurse work environment and psychological distress on resignation from hospitals: a prospective study

With the global nurse shortage, identifying nurse work environments that allow nurses to continue working is a common concern worldwide. This study examined whether a better nurse work environment (1) is associated with reducing nurses' psychological distress; (2) reduces nurse resignations; (3) weakens the influence of psychological distress on their resignation through interaction effect; and (4) whether psychological distress increases nurse turnover. Multilevel logistic regression analyses were performed using data obtained in 2014 from 2,123 staff nurses from a prospective longitudinal survey project of Japanese hospitals. The nurse work environment was measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI) consisting of five subscales and a composite, and psychological distress by K6. All the PES-NWI subscales and composite (ORs 0.679-0.834) were related to K6, significantly. Regarding nurse turnover, K6 had a consistent effect (ORs 1.834-1.937), and only subscale 2 of the PES-NWI had a direct effect (OR 0.754), but there was no effect due to the interaction term. That is, (1) and (4) were validated, (2) was partly validated, but (3) was not. As better work environment reduces K6 and a lower K6 decreases nurses' resignation, high-level hospital managers need to continue improving the nurse work environment.

Study on the psychological health status and influencing factors of operating room nursing staff

To comprehensively analyze the psychological health status of operating room nurses and identify influencing factors. The research compares psychological health differences based on nurses' years of experience, specifically examining depression and anxiety scores. A detailed assessment was conducted, focusing on nurses with varying experience levels. Findings revealed higher depression scores among mid to senior-level nurses, while junior-level nurses exhibited elevated anxiety scores. Additionally, overall dissatisfaction with physical health and various subhealth symptoms were reported. Multifactorial analysis identified working hours, disaster relief experience, and perceived occupational benefits as primary influencers. Through comparative analysis, it was found that the average score of self-rating depression scale and self-rating anxiety scale was 53.8 ± 12.2 points and 47.6 ± 10.5 points respectively. The depression score of middle and senior nurses was significantly higher than that of junior nurses (P < .05). The anxiety score of primary nurses was significantly higher than that of middle and senior nurses (P < .05). The results indicate that the duration of work, previous experience in disaster relief, and nurses' perception of occupational benefits were the main factors influencing the psychological health status of operating room nurses (P < .05). Healthcare institutions are recommended to implement targeted interventions based on nurses' experience levels, addressing specific psychological health needs. Future research should delve into specific subgroups, conduct long-term tracking, expand the scope of influencing factors, assess the effectiveness of intervention measures, and explore cross-cultural aspects.

Mediating effects of social support and presenteeism on turnover intention and post-traumatic stress disorder among Chinese nurses in the post-pandemic era: a cross-sectional study

Background

The shift in national policies for epidemic prevention and control in the post-pandemic era is undoubtedly a challenge for health care professionals. Nurses, as an important part of the health care professional population, have an even greater impact on their mental health and occupational safety. This may expose nurses to post-traumatic stress disorder (PTSD) and presenteeism, and ultimately lead to their turnover.

Objective

This study aimed to investigate the relationship between turnover intention and post-traumatic stress disorder among Chinese nurses during post-pandemic era, and the mediating role of social support and presenteeism.

Methods

In this study, a multicentre cross-sectional survey was conducted in April 2023 among nursing staff in several tertiary general hospitals in northern China, with online data collection using the Turnover intention Scale (PTSD), the Impact of Events Scale (IES), the Social Support Scale (SSS), and the Stanford presenteeism Scale (STAS) and the relationship between variables was analyzed using hierarchical multivariate regression, and Structural Equation Modeling (SEM) was used to analyze the relationship between post-traumatic stress disorder and the Turnover intention from the pathway between.

Results

Data were collected from 2,513 nurses who met the inclusion criteria, in which general information such as age, department, specific department, Professional title, history of alcohol consumption, form of employment, Years of working, and Average working hours per day were statistically significant with the difference in the turnover intention. The results of the study showed a 32% high turnover intention among nurses in the post-pandemic era, which was lower than the turnover intention during the pandemic. The results of hierarchical multiple regression analysis showed that post-traumatic stress disorder, social support, and presenteeism were significant predictors of turnover intention. The total effect of post-traumatic stress disorder on turnover intention to work was 0.472 [bias modified 95% confidence interval (0.415-0.483), p < 0.001]. Social support and attendance played a partially intermediate role in post-traumatic stress disorder and propensity to leave (an indirect effect of 26% of the total effect).

Conclusion

Turnover intention and post-traumatic stress disorder levels are high and social support plays an important role in the tendency to leave the job and post-traumatic stress disorder, healthcare institution can be achieved by strengthening social support for nurses in the post-epidemic era and preventing the occurrence of presenteeism.

The role of sleep quality and perceived stress on depressive symptoms among tertiary hospital nurses: a cross-sectional study

BACKGROUND

Nurses in tertiary hospitals are at high risk for depression. Understanding sleep quality and perceived stress may contribute to nurses' mental health and health-related nursing productivity. The aim of this study was to investigate the role of sleep quality and perceived stress on depressive symptoms among nurses in tertiary hospitals.

METHODS

A total of 2,780 nurses (overall response rate = 91.1%) were recruited through a cross-sectional survey in 23 tertiary hospitals in China. Questionnaires included the Self-Rating Depression Scale, the Pittsburgh Sleep Quality Index, and the Chinese Perceived Stress Scale. Variables that were significant in Chi-square tests were further entered into binary logistic stepwise regression.

RESULTS

The prevalence of depressive symptoms was 60.3% (n = 1,676), of which 97.4% (n = 1,633) were female, and 77.8% were younger than 35 years (n = 1,304). Nurses who had moderate, poor, severe sleep quality and poor perceived pressure were more likely to be depressed. Master's degree, 6-10 years of work, and physical activity were protective factors, while the opposite was the case for shift work and high dissatisfaction.

CONCLUSIONS

More than half of nurses working in tertiary care hospitals reported depressive symptoms, and lower sleep quality and higher perceived stress were more associated with this. Perceived stress is an interesting concept, which may provide a new entry point for the well-known idea that there is a relationship between poor sleep quality and depression. It is possible to reduce depressive symptoms among public hospital nurses by providing information on sleep health and stress relief.

Health problems, turnover intention, and actual turnover among shift work female nurses: Analyzing data from a prospective longitudinal study

Aims

This study investigated health problems, turnover intention, and actual turnover among shift work nurses. While turnover intention is often used as a proxy variable for turnover, the relationship between these variables requires clarification. This study tested for relevant associations using prospective longitudinal data with a time lag of 12 months. We also tested for associations between health problems (sleep disturbance, fatigue, and depression) and turnover intentions/turnover, with a focus on the mediating role of turnover intention.

Methods

This study conducted a secondary analysis of data from the Shift Work Nurses’ Health and Turnover project, which is a prospective longitudinal cohort study. We analyzed health problems, turnover intention, and actual turnover. The data were analyzed via descriptive statistics, the Pearson’s chi-squared test, independent t-test, univariable logistic regression, multiple logistic regression, and causal mediation.

Results

Participants included 491 shift work female nurses. Of these, 112 (22.8%) had turnover intention, while 38 (7.7%) left their jobs within the 12-month period of investigation. Of the 112 with turnover intention, 22 left their jobs (OR 5.68. 95% CI 2.84–11.36). The logistic regression analysis showed that sleep disturbance and fatigue were associated with turnover intentions and actual turnover, while depression was only associated with turnover intention. The causal mediation analysis showed that turnover intention mediated the relationship between health problems (sleep disturbance and fatigue) and actual turnover (sleep disturbance OR 1.31, 95%CI = 1.02–1.60; fatigue OR 2.11, 95%CI = 1.50–2.68); sleep disturbance had a natural direct effect on actual turnover (OR 2.66, 95%CI,2.07–3.21).

Conclusion

Turnover intention strongly predicted actual turnover. Sleep disturbances may result in turnover, even in cases without existing turnover intention. These findings highlight the need for early interventions aimed at preventing and alleviating sleep disturbances for shift work female nurses.

Influence of sleep fragmentation and fatigue on turnover of female nurses working rotating shifts

AIMS AND OBJECTIVES

To investigate whether the sleep quality and fatigue of female nurses working rotating shifts could be used to predict future turnover status.

BACKGROUND

Female nurses working rotating shifts often suffer from sleep problems and fatigue, and the turnover rates of nurses are generally higher than those of other hospital personnel.

DESIGN

A prospective study.

METHODS

We recruited a total of 198 female nurses working rotating shifts from December 2017 to March 2019. The nurses completed the Checklist Individual Strength (CIS) scale and wore an actigraph for seven consecutive days in order to collect their sleep parameters. Their turnover status was tracked until 31 May 2021 at which time 55 participants (27.8%) had resigned. The Cox proportional hazard model was used to analyse the factors influencing turnover. In addition, the study adhered to the STROBE checklist.

RESULTS

The results revealed significant differences between the nurses in the still-working group and the resigned group in terms of the sleep quality parameters sleep efficiency (SE) and wake after sleep onset (WASO) as well as CIS scores. WASO was significantly correlated with intensity of fatigue, and fatigue was common among all of the nurses working rotating shifts. As time progressed, the sleep quality parameter WASO and CIS scores could be used to predict turnover status after 2.4 years.

CONCLUSION

The results of this study indicated more sleep fragmentation and poor sleep efficiency in the resigned group. Sleep fragmentation was highly correlated with fatigue, and sleep fragmentation and fatigue could be used to predict turnover status.

RELEVANCE TO CLINICAL PRACTICE

We suggest that relevant hospital management pay more attention to the sleep conditions and fatigue of female nurses working rotating shifts when arranging personnel and schedules and offer them more understanding.