Nurses' intention to stay in the work environment in acute healthcare: a systematic review

Background

With staffing shortages affecting increasing numbers of health services globally, and predictions that shortages will worsen in the future, there is broad consensus that leaders at all levels must do more to support and develop current employees. However, the wide range of attributes of a healthy work environment identified in the literature and the financial implications of creating healthy work environments make it challenging to determine which elements of the nursing work environment are the most important in terms of workforce sustainability. This is a significant gap in our knowledge, and there is no consensus in the literature regarding definition and explanation of work environment factors in a way that facilitates prioritisation.

Objectives

The aim of this review was to synthesise and evaluate the evidence of the factors which may have an effect on intention to stay and role of the work environment in enhancing nurses' intention to stay in the work environment in acute healthcare.

Design and methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. A comprehensive search was performed for relevant articles published between 1990 and December 2017 using the following electronic databases: Allied and Complementary Medicine Database (AMED), Excerpta Medica dataBASE (EMBASE), ProQuest Nursing & Allied Health Source, ProQuest theses and dissertations, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, MEDLINE (Ovid) and PsycINFO. The reviewers independently screened the abstracts and full texts, extracted data, and assessed the methodological quality of the included papers using appropriate tools.

Results

A total of 4968 studies were screened by title, abstract, and full-text review, and 29 studies were included in this review. The identified determinants of nurses' intention to stay were grouped into four main categories: individual indicators (personal and professional), organisation/profile, work environment, and patient-related. Several working environment variables identified in this review were significantly associated with the nurses' intention to stay.

Conclusion

Despite the limitations of this review, the evidence indicates that attention to meso-level variables such as organisational characteristics and work environment is vital if the working environment is to improve and nurses' intention to stay is to increase. The multifaceted nature of the concept of intention to stay makes it difficult to present definitive conclusions based on the findings of this review. However, the identified theoretical models were instrumental in differentiating intention to stay from other concepts such as intention to leave, turnover and retention, theoretically, and operationally.

Factors Influencing Nurses’ Intention to Leave and Intention to Stay: An Integrative Review

Nursing retention is a critical issue for organization. High nurses’ turnover impact negatively on an organization requirement to meet patient needs and quality care. This integrative review aims to critically review and synthesize published studies to obtain better understanding of the determinants of nurse’s intention to leave or stay in the organization. Thirty-seven studies which met the inclusion criteria from different locations using a variety of instruments and research designs were identified using PRISMA guideline. Many factors including job satisfaction, organizational commitment, quality of work life, work environment, leadership style, bullying at work, family reason, and job security were identified to be associated negatively with nurse’s intention to leave and positively with intention to stay in organization. More qualitative studies are needed to understand in depth, the reasons and factors that underlie and influence turnover, intention to leave or remain in organization.

Intention to Leave the Nursing Profession and Its Relation with Work Climate and Demographic Characteristics

BACKGROUND

Because of the importance of staff shortage in health systems, considering the intention to leave the job and its related factors among nurses is very important. The aim of this study was to identify the association between the intention to leave the nursing profession and work climate and demographic characteristics.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 206 nurses, by random sampling method from six hospitals (response rate = 92%). A set of self-administered questionnaires were applied for the evaluation of intention to leave and work climate.

RESULTS

The high level of intention to leave the profession was expressed by 23.70% of the participants; 25.10% of the participants had the moderate intention. Data analysis revealed that work climate, type of employment, marital status, and overtime working were significant predictors of nurses' intention to leave after controlling other independent variables (R2 = 0.10, p < 0.001).

CONCLUSIONS

It was found that work climate and some demographic characteristics can be seen as indicators for intention to leave among nurses; therefore, considering the so-called variables is required. Further studies are needed to identify other aspects of the issue.

The determinants and consequences of adult nursing staff turnover: a systematic review of systematic reviews

BACKGROUND

Nurses leaving their jobs and the profession are an issue of international concern, with supply-demand gaps for nurses reported to be widening. There is a large body of existing literature, much of which is already in review form. In order to advance the usefulness of the literature for nurse and human resource managers, we undertook an overview (review of systematic reviews). The aim of the overview was to identify high quality evidence of the determinants and consequences of turnover in adult nursing.

METHODS

Reviews were identified which were published between 1990 and January 2015 in English using electronic databases (the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, CINAHL plus and SCOPUS) and forward searching. All stages of the review were conducted in parallel by two reviewers. Reviews were quality appraised using the Assessment of Multiple Systematic Reviews and their findings narratively synthesised.

RESULTS

Nine reviews were included. We found that the current evidence is incomplete and has a number of important limitations. However, a body of moderate quality review evidence does exist giving a picture of multiple determinants of turnover in adult nursing, with - at the individual level - nurse stress and dissatisfaction being important factors and -at the organisational level - managerial style and supervisory support factors holding most weight. The consequences of turnover are only described in economic terms, but are considered significant.

CONCLUSIONS

In making a quality assessment of the review as well as considering the quality of the included primary studies and specificity in the outcomes they measure, the overview found that the evidence is not as definitive as previously presented from individual reviews. Further research is required, of rigorous research design, whether quantitative or qualitative, particularly against the outcome of actual turnover as opposed to intention to leave.

TRIAL REGISTRATION

PROSPERO Registration 17 March 2015: CRD42015017613 .

Testing a theoretical model of clinical nurses' intent to stay

BACKGROUND

Published theoretical models of nurses' intent to stay (ITS) report inconsistent outcomes, and not all hypothesized models have been adequately tested. Research has focused on cognitive rather than emotional determinants of nurses' ITS.

PURPOSE

The aim of this study was to empirically verify a complex theoretical model of nurses' ITS that includes both affective and cognitive determinants and to explore the influence of relational leadership on staff nurses' ITS.

METHODOLOGY

The study was a correlational, mixed-method, nonexperimental design. A subsample of the Quality Work Environment Study survey data 2009 (n = 415 nurses) was used to test our theoretical model of clinical nurses' ITS as a structural equation model.

RESULTS

The model explained 63% of variance in ITS. Organizational commitment, empowerment, and desire to stay were the model concepts with the strongest effects on nurses' ITS. Leadership practices indirectly influenced ITS.

PRACTICE IMPLICATIONS

How nurses evaluate and respond to their work environment is both an emotional and rational process. Health care organizations need to be cognizant of the influence that nurses' feelings and views of their work setting have on their intention decisions and integrate that knowledge into the development of retention strategies. Leadership practices play an important role in staff nurses' perceptions of the workplace. Identifying the mechanisms by which leadership influences staff nurses' intentions to stay presents additional focus areas for developing retention strategies.

Psychosocial work environment, stress factors and individual characteristics among nursing staff in psychiatric in-patient care

The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics--Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience--are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff's perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.

The relationships between safety climate, teamwork, and intent to stay at work among Jordanian hospital nurses

PURPOSE

The purpose of the present study is to examine the relationships among safety climate, teamwork, and intent to stay at work as perceived by Jordanian hospital nurses.

METHODS

A descriptive correlational design was used to investigate these relationships among a convenience sample of 381 hospital nurses. Data were collected through a self-administered questionnaire that included the Safety Climate and Teamwork Scale and the McCain's Intent to Stay Scale. Descriptive statistics, Pearson correlation, analysis of variance, and hierarchical regression analysis were used to analyze the data.

RESULTS

The findings showed (a) a strong positive correlation between safety climate and teamwork; and (b) moderate positive correlations between safety climate and intent to stay at work, and between teamwork and intent to stay at work. Moreover, the overall model of hierarchical regression showed that 45% of the variation in the level of intent to stay at work was explained by background variables, leadership styles, decision-making styles, and safety climate.

CONCLUSION

The findings emphasized the positive effect of safety climate and teamwork on the level of nurses' intent to stay.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators should design and implement strategies that create a culture of safety climate and teamwork in their organizations.

Work and non-work social support and intent to stay at work among Jordanian hospital nurses

PURPOSE

To examine (1) the level of intent to stay at work among Jordanian nurses; (2) the levels of at-work and non-work social support; and (3) the extent of variance in the level of intent to stay at work because of the demographic and social support variables.

DESIGN

A survey design was used to investigate the predictors of intent to stay at work among the population of Jordanian nurses in three public hospitals. Two hundred and seventy five participants submitted complete and usable questionnaires. The response rates were 50%, 55% and 70%, respectively.

METHODS

Data were collected using a questionnaire that included a scale for measuring social support, the McCain's Intent to Stay Scale and the demographic form.

FINDINGS

The results showed that support from supervisors, marital status, number of friends at work, number of children at home, gender, time commitment, support from co-workers and support from family accounted for 60% of the variation in the level of intent to stay. The results indicated that nurses who were females, had children at home, worked full time and perceived having more support from co-workers and supervisors tended to stay at work more than others. On the other hand, the results showed that marital status, number of friends at work and family support were associated negatively with intent to stay at work.

CONCLUSION

The findings of the study suggest the important role of workplace social support in enhancing the level of intent to stay at work.