Job burnout and turnover intention among Chinese primary healthcare staff: the mediating effect of satisfaction

Burnout Prevalence and Associated Factors Among Palliative and Hospice Care Professionals During the COVID-19 Endemic: An Exploratory Survey

BACKGROUND

Burnout is a significant issue for palliative and hospice professionals, exacerbated by the impact of Coronavirus Disease 2019 (COVID-19) on healthcare professionals. It is crucial to update our understanding of prevalence data, identify associated factors, and evaluate support resources during the COVID-19 pandemic.

METHODS

We aimed to explore the prevalence of burnout among palliative and hospice care workers, 2 years into the COVID-19 pandemic by using the Maslach's Burnout Inventory; anxiety, using General Anxiety Disorder-7 (GAD-7), workload, risk perception of COVID-19, confidence in protective measures (personal, workplace, and government), and usage and perceived helpfulness of support resources. Univariate logistic regression analysis was conducted to analyse burnout against these factors.

RESULTS

Of the 115 respondents encompassing doctors, nurses and social workers (76.5% female; average age 40.9), 48.7% experienced burnout. Burnout correlated with increased anxiety, higher COVID-19 risk perception, heavier workload, and reduced confidence in protective measures. Peer support, COVID information, and psychological programs were rated as the most effective for coping.

CONCLUSION

The study indicates considerable levels of burnout among palliative and hospice care workers, linked to workload, anxiety, and perceived risk. Traditional mental health interventions had limited efficacy; respondents favoured peer support and organisational changes. The findings stress the need for a holistic approach, including diverse resources, workload management, and regular mental health assessments.

Social support, psychological capital, multidimensional job burnout, and turnover intention of primary medical staff: a path analysis drawing on conservation of resources theory

BACKGROUND

Job burnout is a prevalent and emerging challenge in the primary medical system, causing mass turnover, especially of primary medical staff. Little attention has been paid to the different dimensions of job burnout (emotional exhaustion, personality disintegration, and reduced sense of achievement), which may hinder efforts to tackle high turnover intention among primary medical staff. From the perspective of conservation of resources theory, social support and psychological capital are basic resources with potential to diminish job burnout and thus lower turnover intention. However, there is insufficient research evidence on the relationships between social support, psychological capital, and the three dimensions of job burnout within the primary medical system.

OBJECTIVES

Focusing on primary medical staff, this study conducts a path analysis to examine the correlations between two types of resources (social support and psychological capital) and the three dimensions of job burnout, and to test the impact of the latter on turnover intention. Based on the results, effective management strategies to improve the work stability of primary medical staff are proposed.

METHODS

Multi-stage cluster random sampling was used to select participants in Anhui Province, China. Data were collected using a self-administered questionnaire containing measures of the main variables and demographic questions. In total, 1132 valid questionnaires were returned by primary medical staff. Structural equation modeling was used for path analysis of the data.

RESULTS

Social support was negatively associated with emotional exhaustion (β = - 0.088, P = 0.020), personality disintegration (β = - 0.235, P < 0.001), and reduced sense of achievement (β = - 0.075, P = 0.040). Moreover, psychological capital was negatively associated with emotional exhaustion (β = - 0.079, P = 0.030), personality disintegration (β = - 0.156, P < 0.001), and reduced sense of achievement (β = - 0.432, P < 0.001). All three dimensions of job burnout positively affected turnover intention (emotional exhaustion: β = 0.246, P < 0.001; personality disintegration: β = 0.076, P = 0.040; reduced sense of achievement: β = 0.119, P = 0.001).

CONCLUSIONS

The results highlight the importance of social support and psychological capital for diminishing the three dimensions of job burnout for primary medical staff and, in turn, lowering their turnover intention. Accordingly, to alleviate job burnout and improve staff retention, material and psychological supports from leaders, colleagues, family, relatives, and friends are essential, as are measures to improve the psychological energy of primary medical staff.

Uneven distribution of stressful working conditions among Japanese nurses: a secondary analysis of nurses with and without children

Supportive measures for employees raising children may have increased workloads on other nurses, causing psychological stress. This study aimed to clarify the differences in working conditions and psychological status among female Japanese nurses based on child-rearing attributes. We used data from 1,600 female nurses at 10 Japanese hospitals collected by the study of the Work Environment for Hospital Nurses in Japan conducted in 2016. The variables included work conditions (number of night shifts per month, daily overtime, number of paid holidays per year, and social support received), psychological status (sense of coherence, emotional exhaustion, and work engagement), and sociodemographic characteristics. An analysis of covariance was performed on the differences between the three groups (without children, with preschool-age children, and with children of other ages groups). The group without children had a relatively higher workload (p<0.01) and lower social support (p<0.01 and p<0.05). Additionally, they had higher emotional exhaustion and lower work engagement (p<0.01). This study confirmed the uneven distribution of work environment by work-life balance measures.

Impact of Relational Coordination on Job Satisfaction and Willingness to Stay: A Cross-Sectional Survey of Healthcare Professionals in South Tyrol, Italy

Job satisfaction and willingness to stay are critical for workforce stability in a challenging healthcare environment. This study examined how relational coordination, a key factor in teamwork and communication, influences outcomes among healthcare professionals in a bilingual, culturally mixed region of Italy. This cross-sectional survey included general practitioners, hospital physicians, nurses, and administrators from the South Tyrol Health Service, using the 'Relational Coordination Survey' and additional measures of job satisfaction and willingness to stay. The analytical methods used included descriptive statistics, correlations, and regression analyses. This study applied path analysis, including mediation and moderation techniques, to investigate the roles of relational coordination and job satisfaction in influencing the willingness to stay. It employs Conditional Process Analysis with the PROCESS macro in SPSS, focusing on models for moderated mediation analysis. The results indicated a critical influence of relational coordination on both job satisfaction and willingness to stay among the 525 healthcare professionals. Job satisfaction varied by health district and years of service, with midcareer professionals being the least satisfied. The findings highlight the central role of relational coordination in job satisfaction and willingness to stay and confirm that low job satisfaction increases turnover intentions. Relational coordination directly enhanced job satisfaction and willingness to stay, while also serving as a mediating factor that amplifies the impact of job satisfaction on retention intentions. This study reinforces the need for strong teamwork and communication to stabilize the healthcare workforce. Targeted interventions aimed at improving relational coordination could significantly enhance job satisfaction and retention among healthcare professionals, particularly in culturally diverse settings such as South Tyrol.

Intercultural communication competence and job burnout in MNC employees: the mediation role of job stress

This study examined the relationship between intercultural communication competence (ICC) and job burnout, as well as the mediating effects of job stress, using data collected from employees (n = 1,064) from a Chinese multinational corporation in Brunei. Through regression analysis and mediation effect tests, we found that ICC was negatively associated with job burnout (β = -0.19, p < 0.001) and job stress (β = -0.08, p < 0.001). Job stress was positively associated with job burnout (β = 0.65, p < 0.001). Job stress played a partial mediating role between ICC and job burnout. The total effect of ICC on job burnout was -0.19, the direct effect was -0.14, and the indirect effect of ICC via job stress was -0.05. The findings call for ICC training for employees in multinational corporations.

The Impact of high-performance work system perceived by medical staff on job satisfaction: the mediating role of self-efficacy

As the mainstay of healthcare, the job satisfaction of medical staff deserves attention. This study aimed to explore the correlation between the perception of the high-performance work system (P-HPWS) and job satisfaction of medical staff in public hospitals and to further investigate the mediating effect of self-efficacy. From November 2019 to January 2020, a cross-sectional survey on working doctors and nurses was conducted in five tertiary public hospitals in China. A total of 520 participants were surveyed. The P-HPWS, job satisfaction, and self-efficacy were assessed using the 25-item self-administered scale, six-item job satisfaction questionnaire, and the General Self-Efficacy Scale, respectively. Linear regression and mediation effects models were used to identify the associations between primary variables. The results showed a significant positive correlation between P-HPWS and job satisfaction (P < 0.01), while self-efficacy played a mediating role between P-HPWS and job satisfaction. This finding reveals the benefits of improving employees' P-HPWS and self-efficacy on their job satisfaction, and that hospitals can improve their management systems by implementing and refining HPWS.

Psychological Capital and Turnover Intention: The Mediating Role of Burnout among Healthcare Professionals

Psychological capital (PsyCap) has been identified as an individual's positive psychological state of development that can help to reduce negative organizational outcomes. However, there is still a gap in understanding how PsyCap influences different aspects of organizations. This study investigates the mediating role of burnout in the relationship between PsyCap and turnover intentions among healthcare professionals. A cross-sectional survey was conducted among 320 healthcare professionals. The estimation of the relationships between PsyCap, burnout, and turnover intentions was obtained through structural equation modelling (SEM). A mediation analysis was carried out using bootstrapping procedures. The results show that burnout has a significant and positive effect on turnover intention and PsyCap has a significant and negative effect on burnout. Moreover, burnout fully mediates the relationship between PsyCap and turnover intention. These findings suggest that PsyCap can effectively reduce negative outcomes like burnout, but its positive impact may be limited when considering other outcomes such as turnover intention.

Turnover behavior and intention among dentists and medical doctors: a cross-sectional study in China

BACKGROUND

Retention of doctors is a global challenge and doctors working in different departments may face different problems. The study aimed to explore the turnover behavior and intention and correlated factors among Chinese dentists and medical doctors in other clinical fields.

METHODS

A cross-sectional study was conducted online in 5 regions of China from March 12th to April 12th, 2020. The questionnaire included 3 parts, socio-demographic characteristics, turnover behavior and intention, and concerns about work-related factors. Chi-square test and/or Wilcoxon Mann-Whitney test were applied for comparison, and binary logistic regression was used for finding the factors.

RESULTS

A total of 2428 eligible questionnaire were received, comprising 1954 responses from dentists and 474 from medical doctors. Rates of turnover behavior among dentists and medical doctors were 2.87% and 6.96%, respectively. Similarly, rates of turnover intention were 51.79% among dentists and 71.20% among medical doctors. Educational level was negatively correlated with turnover behavior of both medical doctors and dentists, and concern about salary was a unique negatively correlated factor for dentists. Age was negatively correlated with turnover intention in both medical doctors and dentists. Conversely, concerns about workload and doctor-patient relationship were positively correlated with turnover intention in both groups. Concern about salary was the distinct correlated factor of medical doctors' turnover intention, while gender and annual household income were correlated with turnover intention among dentists.

CONCLUSIONS

Low turnover rate but high turnover intention rate was the current status of Chinese doctors' employment. Turnover behavior and intention were more optimistic among dentists than medical doctors. Factors related to turnover behavior and turnover intention were not identical among dentists and medical doctors. Therefore, personalized retention measures were necessary for dentists and medical doctors.

Association between Organizational Support and Turnover Intention in Nurses: A Systematic Review and Meta-Analysis

Although recent studies suggest a negative relationship between organizational support and turnover intention among nurses, there has been no systematic review on this issue. The aim of this systematic review and meta-analysis was to synthesize and evaluate the association between organizational support and turnover intention in nurses. The review protocol was registered with PROSPERO (CRD42023447109). A total of eight studies with 5754 nurses were included. All studies were cross-sectional and were conducted after 2010. Quality was moderate in five studies and good in three studies. We found a moderate negative correlation between organizational support and turnover intention since the pooled correlation coefficient was -0.32 (95% confidence interval: -0.42 to -0.21). All studies found a negative correlation between organizational support and turnover intention ranging from -0.10 to -0.51. A leave-one-out sensitivity analysis showed that our results were stable when each study was excluded. Egger's test and funnel plot suggested the absence of publication bias in the eight studies. Subgroup analysis showed that the negative correlation between organizational support and turnover intention was stronger in studies in China and Australia than those in Europe. Organizational support has a moderate negative correlation with turnover intention in nurses. However, data regarding the impact of organizational support on turnover intention are limited. Moreover, our study had several limitations, and thus, we cannot generalize our results. Therefore, further studies should be conducted to assess the independent effect of organizational support on turnover intention in a more valid way. In any case, nursing managers should draw attention to organizational support by developing effective clinical practice guidelines for nurses so as to reduce turnover intention.

Physicians' Turnover Intention During the "Post-COVID-19" Era: Risk and Protective Factors

PURPOSE

This research investigates risk and protective factors affecting physicians' turnover intention during the post-COVID-19 era.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional online survey study of 958 physicians working in Lombardy (Northern Italy) hospitals was conducted.

FINDINGS

In the post-COVID-19 era, burnout significantly increases physicians' turnover intention. The same is true for fear of being infected by COVID-19 (FIC), which indirectly affects turnover intention via burnout. The higher FIC and burnout, the higher intention to leave the job or working unity. Self-efficacy significantly decreases turnover intention by reducing FIC and burnout.

ORIGINALITY/VALUE

Implementing turnover preventive programs in healthcare professionals is essential, mainly reducing BO and promoting physicians' personal resources, such as self-efficacy.

Effects of work-family conflict on turnover intention among primary medical staff in Huaihai Economic Zone: a mediation model through burnout

Background

Countries worldwide face the challenge of how medical personnel manage conflicts between work and family. Especially after the challenge of the COVID-19 epidemic, it is necessary to explore the possible mechanisms of work-family conflict, burnout, and turnover intention among primary medical staff.

Objectives

This study aims to observe the turnover intention of Chinese primary medical staff and explore the relationship between work-family conflict, burnout, and turnover intention.

Methods

A cross-sectional study included a turnover intention questionnaire, the Maslach Burnout Inventory-General Survey (MBI-GS), and the Work-Family Conflict Scale (WFCS) to understand turnover intention, burnout, and work-family conflict among primary medical staff in four cities (Xuzhou, Linyi, Huaibei, and Shangqiu cities) within the Huaihai Economic Zone. Spearman correlation analysis and hierarchical multiple regression analysis were used to examine the related factors of turnover intention. Structural equation modeling (SEM) was used to study the mediating role of burnout between work-family conflict and turnover intention.

Results

In this study, there is a positive correlation between work-family conflict and turnover intention (P < 0.01). Demographic characteristics, work-family conflict, and burnout explained 2.3%, 20.3%, and 8.8% of the incremental variances, respectively. Burnout mediated the association between work-family conflict and turnover intention.

Conclusions

Burnout can be regarded as a mediator between two different variables: work-family conflict and turnover intention. Improving work-family conflict and alleviating burnout may play a key role in reducing the willingness of primary medical staff to resign. Corresponding measures can be taken to balance the conflict between work and family, alleviate burnout, reduce turnover rates, and build a primary medical staff team with higher medical service quality and stability.

Individual- and institution-level predictors of the turnover intention of medical staff among rural primary medical institutions in Xinjiang Production and Construction Corps, China: a cross-sectional multi-level analysis

Background

Primary medical staff (PMS) are the guardians of population health. However, their loss further worsens the shortage and uneven distribution of human health resources, which should be addressed immediately. This study aimed to investigate the current status of turnover intention of rural PMS in Xinjiang Production and Construction Corps (XPCC) in China and its influencing factors atthe individual and institutional levels to provide reliable baseline data for intervention strategies to protect valuable rural PMS.

Methods

Participants were recruited from rural public health institutions of the XPCC using a cross-sectional multistage sampling process. Data on participants' turnover intention and individual- and institution-level indicators were obtained through standardized electronic questionnaires and statistical reports of regional health administrative departments. The key factors influencing PMS turnover intention were identified us ingunivariateandmulti-level logistic regression analysis.

Findings

Overall, 20.5% (447/2182) of participants reported turnover intention. Univariate analysis showed that the occurrence of turnover intention was significantly influenced by marriage, education, age, year of working, monthly income, human resource management practices (HRMP), job satisfaction, per capita served population (PCSP) and number of beds (p < 0.05). Multi-level logistic regression analysis showed that bachelor's degree or above and intermediate professional title were closely related to the occurrence of turnover intention (p < 0.05), age 41-50 years old and above, high human resource management practice, and high job satisfaction effectively reduced the odds (p < 0.05). The odds of turnover intention increased by 37% (p < 0.10) for PMS in institutions with PCSP more than 250 people. In contrast, the odds of turnover intention decreased to 68% (p < 0.05) for PMS in institutions with more than 50 beds.

Conclusion

Government-run primary medical institutions face the risk of PMS turnover intention. From a personal perspective, the high-risk population fortheturnover intention was mainly the PMS with bachelor's degrees or above and intermediate professional titles. The low-risk population was the PMS with aged over 40 years, a higher evaluation of human resource management practice, and job satisfaction. From the perspective of primary medical institutions, larger institutions can reduce the turnover intention of individuals, whereas the size of the service population has the opposite effect.

Key determinates of job satisfaction for acute care nurse practitioners in Taiwan

BACKGROUND

Taiwan is a super-aged society, and the shortage of hospital doctors; nurse practitioners (NPs) became vital healthcare providers to fulfill the healthcare demands of the population. The purpose of this study was to explore the key determinates of job satisfaction for NPs in acute care practices using significant practice variables, such as empowerment and burnout.

METHODS

Participants of this descriptive survey study were recruited from a national sample of NPs with membership in the Taiwan Association of Nurse Practitioners. The data were collected utilizing an online questionnaire based on demographic and practice variables, the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS), the Condition for Work Effectiveness Questionnaire II (CWEQ II), and the Copenhagen Burnout Inventory (CBI). A total of 1,211 NPs completed the online survey. A multiple regression model with the stepwise selection was used to explore job satisfaction.

RESULTS

The mean overall satisfaction score indicated that the level of satisfaction was between slightly dissatisfied and slightly satisfied. Regression results indicated that formal power, work-related burnout, access to information, and needed resources were critical components of job satisfaction, and accounted for 63% of the variance. Moreover, NPs who were married, had a higher annual salary, worked only during the day shift, and had lower patients-related burnout showed better job satisfaction.

CONCLUSIONS

This study provides evidence for healthcare organizations to formulate policies to strengthen NP job satisfaction. Empowerment and burnout are vital factors in NPs' job satisfaction. Healthcare organizations have an obligation to implement policies to empower NPs in practice and provide interventions to mitigate burnout. Implementing these changes will improve job satisfaction and with it the quality of patient care.

The association between workplace ostracism and knowledge-sharing behaviors among Chinese university teachers: The chain mediating model of job burnout and job satisfaction

Workplace ostracism is an essential predictor of knowledge-sharing behaviors, but few studies have explored the influence of this mechanism in higher education. According to the conservation of resources theory, this study elucidated the roles of job burnout and job satisfaction as sequential mediators of the link between workplace ostracism and knowledge-sharing behaviors in a sample of 388 university teachers. The results of the study were analyzed via structural equation modeling (SEM). Higher knowledge-sharing behaviors were associated with lower workplace ostracism, lower job burnout, and more job satisfaction. Furthermore, increased workplace ostracism was associated with more job burnout, but job satisfaction was not related to workplace ostracism. The relationship between workplace ostracism and knowledge-sharing behaviors was mediated by job burnout and was sequentially mediated by job burnout and job satisfaction. These findings help to clarify the mechanisms underlying the association between workplace ostracism and knowledge-sharing behaviors in university teachers. The theoretical and practical implications of the findings are discussed.

Teacher burnout and turnover intention in higher education: The mediating role of job satisfaction and the moderating role of proactive personality

Introduction

Teacher burnout and frequent turnover negatively affect stability and productivity in the context of higher education. Despite the fact that the relationship between burnout and turnover intention has been thoroughly studied, the role of other factors in this relationship should be evaluated in order to better clarify underlying mechanisms, particularly in the context of higher education.

Methods

In this study, we first aim to bridge a research gap by utilizing job satisfaction as a mediating variable for the relationship between burnout and turnover intention. Moreover, we uniquely evaluate the role of proactive personality as a moderating variable, first in terms of the relationship between burnout and job satisfaction, and then for the relationship between job satisfaction and turnover intention. Based on 296 valid questionnaires collected from university faculty members in China, proposed hypotheses were evaluated empirically.

Results

The results demonstrate that, as expected, burnout has a significant and positive impact on turnover intention, and job satisfaction has significantly negative impact on turnover intention, with job satisfaction partially mediating the relationship between burnout and turnover intention. Moreover, proactive personality moderated the relationship between job satisfaction and turnover intention, with this relationship being stronger for individuals with high proactive personality as compared to low proactive personality.

Discussion

These findings provide a better understanding of the relationship between burnout and turnover intention of university instructors. Theoretical and practical implications, limitations, and recommendations for further research are provided.

The relationship between organisational support for career development, organisational commitment, and turnover intentions among healthcare workers in township hospitals of Henan, China

Background

Township hospitals in China face the challenge of shortage and turnover of healthcare workers. This study aims to evaluate the relationship between organisational support for career development (OSCD), organisational commitment, and turnover intentions among healthcare workers in township hospitals.

Methods

The data in this study were obtained from the Health Service Capacity Survey of Primary Health Institutions (2020), one of the special surveys of rural health poverty alleviation in Henan, China. The sample comprised 298 healthcare workers. Three standardised instruments were used: the turnover intention scale, OSCD scale, and organisational commitment scale. Descriptive statistics, One-way Analysis of Variance, Pearson correlation analysis, and the simple mediation model were used for data analysis.

Results

The results showed that the mean score of the healthcare workers’ turnover intentions was 2.21 ± 0.77, which was low. The healthcare workers’ turnover intentions had significant differences in gender, age, marital status, education, professional title, and organisational tenure. OSCD had no significant direct relationship with turnover intentions, while having a significant positive direct relationship with organisational commitment. Organisational commitment had a significant negative direct relationship with turnover intentions, and played a fully mediating role in the relationship between OSCD and turnover intentions.

Conclusions

OSCD had an indirect negative effect on healthcare workers’ turnover intentions in township hospitals through the full mediation of organisational commitment. The findings of this study suggest the importance of policymakers and organisation managers to improve OSCD practice and pay attention to ‘humanistic management’. In addition, the formulation and implementation of talent retention policies should consider socio-demographic differences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01753-4.

Village doctors' dilemma in China: A systematic evaluation of job burnout and turnover intention

Background

Village doctors (VDs) in China undertook arduous primary healthcare missions. However, they received little attention in comparison to doctors in urban public secondary and tertiary hospitals. There is an urgent need to explore the overall situation of turnover intention and job burnout among VDs to evaluate and adjust current health manpower policy.

Methods

In this study, seven databases like PubMed, EMBASE, Web of Science (WOS), WanFang, China Science and Technology Journal Database (VIP), Chinese BioMedical Literature Database (CBM), and China National Knowledge Infrastructure (CNKI) were systematically searched, relevant experts were consulted, and empirical research on job burnout and turnover intention among VDs in international publications was evaluated. Therefore, we evaluated the prevalence of job burnout among VDs in general, across all dimensions and different severity levels, as well as the scores of each category. For turnover intention, we assessed the prevalence of different groups and their overall situation and also identified significant contributors.

Results

In this study, we integrated 20 research evidences on job burnout and turnover intention among 23,284 VDs from almost all provinces in China, and the prevalence of turnover intention among VDs in China was as high as 44.1% [95% confidence interval (CI): 34.1-54.2], which was two to four times that of primary health workers in high-income countries, but not much different from some developing countries. Simultaneously, VDs with the highest risk of turnover intention were men [odds ratio (OR): 1.22 (1.05-1.43)], those with a monthly income below USD 163.4 [OR: 0.88 (0.78-0.98)], those with a high educational level [OR: 0.88 (0.78-0.98)], and those <40 years old [OR: 1.27 (1.16-1.40)]. Similarly, the detection rate of job burnout toward them was 59.8% (95% CI: 38.7-79.1) with the MBI-GS score being 44.44 (95% CI: 37.02-51.86) in a total of 90, while the detection rate of job burnout in moderate and above almost reached 20%. The most significant contributor that affects job burnout was low personal accomplishment (LPA), and the detection rate for moderate and higher severity was 65.2% (95% CI: 58.7-71.7).

Conclusion

Attention should be paid to the high turnover intention and severe job burnout of primary health workers in rural areas of developing countries, and targeted measures should be taken to improve the situation. Health policymakers should increase financial subsidies for VDs, set a reasonable workload, improve various health policies such as pension insurance for VDs, and encourage "targeted training" for medical students to enrich and expand their team.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021289139.

The impact of burnout on turnover intention among Chinese general practitioners: The mediating effect of job satisfaction and the moderating effect of professional identity

BACKGROUND

Turnover among general practitioners (GPs) has become a significant public health concern worldwide.

AIMS

This study aimed to investigate the interrelationships between job satisfaction, professional identity, burnout, and turnover intention among GPs in China and to assess the mediating effect of job satisfaction on the association between burnout and turnover intention and the moderating effect of professional identity on the association between burnout and job satisfaction.

METHOD

A cross-sectional study was conducted to collect data from 3,236 GPs in eastern, central, and western China between October 2017 and February 2018 using a self-administered questionnaire. Pearson's correlation analysis and hierarchical regression were used to identify the relationships between job satisfaction, professional identity, burnout, and turnover intention among Chinese GPs.

RESULTS

Among these respondents, 65.02% reported a medium or high level of emotional exhaustion (EE), 35.38% reported a moderate or high level of depersonalization (DP), and 62.05% reported reduced personal achievement (PA). Overall, 71.08% of GPs expressed a relatively high intention to seek another position (turnover intention). We found all 3 dimensions of burnout contributed to job dissatisfaction while turnover intention arising from burnout was associated with EE and DP. Job satisfaction had a direct negative impact on turnover intention and partially mediated the impact of EE and DP on turnover intention. Professional identity played a partial moderated role between EE and job satisfaction.

CONCLUSIONS

The prevalence of burnout and turnover intention among GPs is high in China. The effect of EE and DP on turnover intention is mediated by job satisfaction, and the effect of EE on job satisfaction is moderated by professional identity.

Systematic and meta-based evaluation on job satisfaction of village doctors: An urgent need for solution issue

Background

Village doctors are the health “gatekeepers” of rural residents in most developing countries. They undertake a series of strenuous but pivotal missions, including prevention, diagnosis, and treatment of complicated diseases, sanitation services and management, and preventive healthcare and education tasks. Hence, it is of great importance to evaluate the village doctors’ job satisfaction status, which is one of the most important indicators that can reflect the current working state, to provide guidelines for the healthcare policies.

Methods

Literature search was conducted in 7 authoritative databases, including PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure (CNKI). Experts in the field of social medicine were consulted to achieve supplement and obtain relevant literature. China was selected as a representative of the village doctor system for the in-depth analysis. Building on the previous literature, we modified and proposed a novel strategy that can transform and integrate the outcome indicators to conduct a meta-based and quantitative assessment on job satisfaction.

Results

A total of 37 publications and 23,595 village doctors were included in this research. The meta-analysis showed that the overall job satisfaction score of village doctors was 3.1858 (total score: 5.00), 95% CI: 2.9675–3.404, which represented the level of “neither satisfied nor dissatisfied.” However, in the subsequent adjustment of publication bias, this score reduced to 2.7579, 95% CI: 2.5254–2.9904, which indicated a direct “dissatisfied” level. To discover the underlying causes, a holistic analysis of each dimension and influencing factors of job satisfaction was conducted, and the results demonstrated that “Financial Rewards” (2.49) was the most important factor causing dissatisfaction among village doctors, followed by “Job Security (2.52)” and “Work Stress (3.05).” Several important themes were also identified and assessed to explore the factors related to this topic.

Conclusion

This study indicated that there is an urgent need to improve the working status of health workers in rural and remote areas, especially in the middle- and low-income countries. Health policy makers should not only improve the current remuneration and subsidies of village doctors but also guide the professional development and give them more job security to enhance the work stability of this group. More specifically, in the context of the COVID-19 pandemic, further surveys on job satisfaction of village doctors should be carried out to take targeted measures.

Systematic review registration

[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021289139].

Global Insights Into Rural Health Workers' Job Satisfaction: A Scientometric Perspective

Introduction

Rural health workers (RHWs) play an irreplaceable role in ensuring and improving the health level of rural residents as the most basic and extensive medical service providers in rural areas. However, rural health institutions are facing significant worker shortages worldwide, not only in low- and middle-income countries but also in developed countries. As an important variable to explain RHWs' work status and predict turnover behavior, job satisfaction has received more and more attention currently.

Methods

Publications from 1 January 1995 to 31 December 2021 were identified from the Science Citation Index Expanded (SCI-Expanded), the Social Sciences Citation Index (SSCI), and the Emerging Sources Citation Index (ESCI) of the Web of Science Core Collection (WoSCC); CiteSpace, VOSviewer, and R software were applied to conduct this study.

Results

A total of 251 publications were obtained from the WoSCC database. The number of publications had a statistically significant increase in the study period. Ranking in the top three of the most productive countries or regions in this field was the United States, the United Kingdom, and China. "Health Care Sciences & Services," "Nursing," and "Public, Environmental & Occupational Health" seemed to be the major subjects. According to the reference co-citation analysis, "motivation," "rural and remote areas," and "work environment" were three noteworthy topics during the development of the research field. Moreover, through the keyword analysis, the underlying relationship among "job satisfaction," "job burnout," and "turnover intention" was explored.

Conclusion

Publications about job satisfaction associated with RHWs had remarkably indicated that this research field had great development potential and broad prospects. As an emerging topic related to RHWs' job status, job satisfaction and its related affected factors were systematically summarized by cluster and keywords analysis. We also highlighted that job satisfaction had a negative predictive effect on RHWs' job burnout and turnover intention, and job burnout played a positive role in predicting turnover intention. In addition, the job satisfaction and working environment of RHWs under the COVID-19 pandemic should receive more attention in the future.

Burnout, stress and intentions to leave work in New Zealand psychiatrists; a mixed methods cross sectional study

BACKGROUND

Demand for mental health services in New Zealand and internationally is growing. Little is known about how psychiatrists are faring in this environment. This study aimed to investigate wellbeing of psychiatrists working in the public health system in New Zealand, identify the main risk factors for work-related stress, gauge perceptions of how workload has changed over time, assess job satisfaction and whether individuals intend or desire to leave their work.

METHODS

Psychiatrists working in New Zealand who were also members of the Association of Salaried Medical Specialists were invited to participate in an online survey. Main outcome measures were degree of burnout and stress experienced at work. Supplementary measures included perceived workplace demands and levels of support. Predictor variables included perceptions of changes to workloads over time, degree of job satisfaction and intentions to leave work. Logistic regression assessed characteristics associated with burnout and job satisfaction as well as intentions to leave work. Free text comments were analysed thematically alongside quantitative trends.

RESULTS

368/526 responded (70% response rate). 34.6% met the criteria for burnout and 35.3% scored with high work stress. There were no significant patterns of association with demographic variables but significant correlation with all but one predictor variable; having experienced a change to the demands of the on-call workload. 45% agreed they would leave their current job if able and 87% disagreed that they are working in a well-resourced mental health service. Respondents emphasised the impact of growing workloads and expressed concerns about their ability to provide optimal care in these circumstances.

CONCLUSIONS

High burnout appears to affect one in three psychiatrists in New Zealand. Many attribute their feelings of burnout to demand for their services. These findings may assist with better workforce planning for psychiatry and emphasises potential consequences of demand for and poor resourcing of mental health services for the retention and wellbeing of doctors in psychiatry worldwide.

Turnover intention and related factors among resident physicians in China under the standardised residency training programme: a cross-sectional survey

OBJECTIVES

This study aimed at examining the extent of turnover intention among the Chinese resident physicians who entered the newly established national standardised residency training programme (SRTP), and exploring factors associated with their turnover intention.

DESIGN

Cross-sectional survey.

SETTING

Ten institutions from five geographical areas in China.

METHODS

1414 residents were surveyed using paper-based questionnaires and scales regarding their demographics, work situation, attitudes towards SRTP, job satisfaction, psychological resilience, burnout and turnover intention in 2017. The turnover intention was described and compared between categorical groups. Linear regressions were used to select the factors associated with turnover intention. The structural equation model was used to capture the potential mediating effects.

RESULTS

The mean turnover intention score was 12.45 (SD=4.47). Nearly half (47.87%) of the residents had a high and very high level of turnover intention. Psychological resilience (β=0.066), burnout (β=0.141) and job satisfaction (β=0.022) were positively associated with turnover intention, while specialty (β=-0.135), year of training (β=-0.687), career in medicine (β=-2.191), necessity of training (β=-0.695) and satisfaction with income (β=-1.215) had negative associations with turnover intention. Working hours and nightshift interval indirectly were associated with turnover intention through the mediating effects of burnout. Career in medicine, necessity of training, satisfaction with income, and psychological resilience showed direct effects and indirect effects on turnover intention through burnout and job satisfaction as mediators.

CONCLUSIONS

The turnover intention among Chinese residents was prevalent and unignorable. Burnout was the major contributing factor, while year of training and positive attitudes towards training were protective factors. Burnout and job satisfaction also served as mediators. Interventions targeting these factors should be incorporated in the training programmes to keep a prosperous physician workforce.

A Survey of Factors Influencing Specialization in Plastic Surgery Among Chinese Surgeons

In recent years, more Chinese surgeons have left other fields to enter plastic surgery. The factors influencing this respe-cialization have not been elicited. The authors aim to elucidate Chinese surgeons’ experience and career satisfaction in this specialty change. Between July and September 2020, the authors conducted an online survey of nonplastic surgeons who received plastic surgery training at an academic center. The survey evaluated their motivation for pursuing their field, practice patterns, and career satisfaction. Responses were compared those who respecialized in plastic surgery with those who did not. A total of 251 nonplastic surgeons completed the survey. The most frequent reasons for pursuing plastic surgery were lifestyle (61.1%), desire to help others (44.4%), and higher compensation (37.3%). Among those who changed fields, employment in academic centers declined from 85% to 51.7%, 70% devoted at least half of their practice to aesthetic surgery, and the median nights on call decreased from 1.54 to 0.38 per week after specializing in plastic surgery. Overall career satisfaction in plastic surgery was significantly higher compared with their former specialties (78.3% versus 28.3%, P 0.05). The authors’ study showed that outflow of surgeons from other specialties to plastic surgery is mainly due to burnout, which erodes physicians’ satisfaction level and the quality of care they are able to provide. The authors highlight the need for reducing burnout in other surgical fields as well as rigorous plastic and aesthetic surgery training for those changing fields to ensure high-quality patient care.

Nurses' experience of work stress related to COVID-19 regular prevention and control in China: A qualitative study

Aim

To explore the experiences of nurses' work stress related to COVID‐19 regular epidemic prevention and control in China.

Background

The global COVID‐19 epidemic is still severe, and China's ongoing regular epidemic prevention and control still cannot be relaxed, which places demands on nurses.

Methods

Thirty nurses and eight nurse managers were interviewed using semistructured in‐depth interviews, and the data were analysed by the Colaizzi seven‐step analysis method.

Results

Four themes were extracted as follows: environmental factors, organizational factors, personal factors and positive factors in coping with stress.

Conclusions

Nursing managers should pay attention to construction of the first‐line departments of regular epidemic prevention and control. The shortage of nurses' human resources and the increase of nurse–patient conflicts are problems that need to be solved urgently. In addition, this research also emphasizes the importance of promoting nurses' stress‐related growth and thinking about the possibility of reform.

Implications for Nursing Management

The construction of the hospital environment and increasing the resilience of nursing teams require attention. We should attach importance to the training of nurses' communication skills and provide sufficient organizational support and economic guarantees for nurses. Finally, perhaps we should also consider whether it is necessary to reform the relevant hospital systems and how to reform them.

Shift work amongst older UK workers and job exit

BACKGROUND

Night/shift work may be increasing but there are few data about the prevalence amongst older workers. With governments encouraging people to work to older ages, it is important to know how feasible night/shift work is for them and whether there are any adverse health consequences.

AIMS

Amongst current older workers (aged 50-64 years), to explore the prevalence of night/shift working and evaluate its health impacts and sustainability over 4 years of follow-up.

METHODS

Data from the Health and Employment After Fifty cohort were used to describe the demographic, job and health characteristics of men and women undertaking night/shift work. Longitudinal data were used to examine the number and nature of exits annually thereafter.

RESULTS

Amongst the 5409 working at baseline, 32% reported night/shift work in sectors which differed by sex. Night/shift workers were more likely to be: current smokers; doing physically demanding work; struggling to cope at work; dissatisfied with their hours; depressed; sleeping poorly; rating their health poorly. Women whose job involves night work were more likely to exit the workforce over 4 years.

CONCLUSIONS

Almost one in three contemporary UK older workers report night/shift work. We found some evidence of adverse impacts on health, sleep and well-being and higher rates of job exit amongst women. More research is needed but night/shift work may be challenging to sustain for older workers and could have health consequences.

Determinants of healthcare worker turnover in intensive care units: A micro-macro multilevel analysis

BACKGROUND

High turnover among healthcare workers is an increasingly common phenomenon in hospitals worldwide, especially in intensive care units (ICUs). In addition to the serious financial consequences, this is a major concern for patient care (disrupted continuity of care, decreased quality and safety of care, increased rates of medication errors, …).

OBJECTIVE

The goal of this article was to understand how the ICU-level nurse turnover rate may be explained from multiple covariates at individual and ICU-level, using data from 526 French registered and auxiliary nurses (RANs).

METHODS

A cross-sectional study was conducted in ICUs of Paris-area hospitals in 2013. First, we developed a small extension of a multi-level modeling method proposed in 2007 by Croon and van Veldhoven and validated its properties using a comprehensive simulation study. Second, we applied this approach to explain RAN turnover in French ICUs.

RESULTS

Based on the simulation study, the approach we proposed allows to estimate the regression coefficients with a relative bias below 7% for group-level factors and below 12% for individual-level factors. In our data, the mean observed RAN turnover rate was 0.19 per year (SD = 0.09). Based on our results, social support from colleagues and supervisors as well as long durations of experience in the profession were negatively associated with turnover. Conversely, number of children and impossibility to skip a break due to workload were significantly associated with higher rates of turnover. At ICU-level, number of beds, presence of intermediate care beds (continuous care unit) in the ICU and staff-to-patient ratio emerged as significant predictors.

CONCLUSIONS

The findings of this research may help decision makers within hospitals by highlighting major determinants of turnover among RANs. In addition, the new approach proposed here could prove useful to researchers faced with similar micro-macro data.

Mobile Phone Addiction Mediates the Relationship Between Alexithymia and Learning Burnout in Chinese Medical Students: A Structural Equation Model Analysis

Background

Learning burnout is a passive mental state among students. It is a common phenomenon that can cause many bad outcomes in Chinese medical students, such as mental disorders and suicide, and its causes are complex.

Purpose

To analyze the relationship between alexithymia and learning burnout, as well as the mediating effect of mobile phone addiction, and provide clues for future interventions to deal with learning burnout among Chinese medical students.

Methods

In this cross-sectional study, convenience cluster sampling was used to produce a sample of 1200 medical universities in Chongqing, China. The Toronto Alexithymia Scale (TAS-20), Mobile Phone Addiction Tendency Scale (MPATS), and Learning Burnout Questionnaire (LBQ) were used to examine participants. Hierarchical regression was used to analyze the effect of alexithymia and mobile phone addiction on learning burnout. A structural equation model (SEM) with maximum likelihood was used to evaluate the mediating effect of mobile phone addiction on the relationship between alexithymia and learning burnout. The bootstrap method was used to confirm the significance of this mediating effect.

Results

The final sample size was 1062, with a valid response rate of 88.5%. The prevalence of learning burnout among Chinese medical students was 39.6%. Results of hierarchical regression revealed that alexithymia (ΔR²=0.198, P<0.01) and mobile phone addiction (ΔR²=0.021, P<0.01) were independent factors of learning burnout; the SEM revealed that the mediating effect of mobile phone addiction between alexithymia and learning burnout accounted for 25.16% of the total effect of alexithymia on learning burnout; the bootstrap method revealed that the bounds of the CI did not contain 0, confirming the significance of this mediating effect.

Conclusion

Of the medical students, 39.6% had learning burnout. Alexithymia can positively predict learning burnout, and this relationship is partially mediated by mobile phone addiction.

Sleep quality, depression and frailty among Chinese community-dwelling older adults

We aimed to explore the relationship between sleep quality and frailty, and depression as a mediator and its interaction with sleep quality on frailty. This was a cross-sectional study among 936 Chinese community-dwelling adults aged≥60 years. Sleep quality, frailty and depression were measured by the Pittsburgh Sleep Quality Index (PSQI), the Frailty Phenotype and the 5-item Geriatric Depression Scale (GDS-5), respectively. We found that depression mediated the association between poor sleep quality and physical frailty, attenuating the association between poor sleep and physical frailty by 51.9%. Older adults with both poor sleep quality and depression had higher risk of frailty than those with poor sleep quality or depression alone. These results implicate multidisciplinary care for frail older adults with poor sleep quality.