Factors Associated With Intent to Leave in Registered Nurses Working in Acute Care Hospitals: A Cross-Sectional Study in Ontario, Canada

Coping Measures for Hospital Nurses' Turnover: A Qualitative Meta-Aggregation (2018-2023)

AIM

To identify and synthesise the qualitative evidence that is available regarding reducing the turnover of hospital nurses from their own perspectives.

DESIGN

A qualitative systematic review using the meta-aggregation design.

DATA SOURCES

Qualitative studies either in English or in Chinese, dating from 2018 to 2023, were obtained from eight databases, including CINAHL, PubMed, Web of Science, Embase, Ovid, and Chinese National Knowledge Infrastructure (CNKI), Wanfang Database and the China Biomedical Database.

METHODS

Studies were screened using pre-determined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines.

RESULTS

Sixteen papers were included that explored nurses' perspectives on enhancing their retention or reducing staff turnover. We developed three synthesised findings and 12 categories from 64 identified findings, including (1) individual adjustment strategy: professional pride, self-growth and psychological adjustment; (2) social support strategy: constructive workplace relationships, balancing work life and recognition of nursing and (3) organisational change strategy: embracing management and leadership, promote nursing professionalisation, workload management and support, flexible work patterns and opportunities, supporting personal career development and competitive salary.

CONCLUSION

This review provides an in-depth and meaningful understanding of nurses' own perceptions and suggestions for enhancing nursing turnover, which will call for a wide range of measures targeting the individual, social and organisational levels.

IMPLICATIONS FOR NURSING MANAGEMENT

This study contributes important knowledge to help improve hospital nurse's turnover, which can provide evidence to support nurse managers, other stakeholders and policymakers in correspondingly developing effective measures to address nurse turnover.

PATIENT OR PUBLIC CONTRIBUTION

There was no direct contribution from patient or caregiver to this study because the data of this study originated from published papers.

Understanding the Experiences of Nurses' Work: Development and Psychometric Evaluation of an End of Shift Survey

AIM

To explore and validate an end of shift survey with a low response burden, practical application and generated evidence of related associations between workload, quality of work and patient care, missed care and job satisfaction.

DESIGN

A retrospective cross-sectional survey of the experiences of nursing staff.

METHODS

Data were collected from 265 nurses who responded to a questionnaire at the end of their shift in 2022. Exploratory factor analysis was undertaken using IBM SPSS v.27 and confirmatory factor analysis was undertaken using IBM AMOS v27. Hypotheses testing was undertaken using IBM SPSS v.27 using multiple regression analyses.

RESULTS

All of the hypotheses were supported. There was a negative association between workload and quality of work and job satisfaction. Quality of work was negatively associated with workload and missed care and positively associated with job satisfaction. The association between missed care and job satisfaction was negative.

CONCLUSION

The EOSS is a valid and reliable tool with a low response burden. The tool supports previous research which demonstrated there is a negative relationship between level of workload and shift type with satisfaction, quality of work and potentially nurse retention.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

In the context of a global nursing shortage nursing leaders must ensure that care we provide is of the highest quality. We must take every action to address high workload to reduce the risk that fundamental care is not sacrificed, job satisfaction is improved and nurses remain in the profession. The EOSS gives nurse leaders a reliable, practical, consistent, applied tool that will better enable associations to be observed between resource configuration, workload and critical impacts on nursing and patient care.

REPORTING METHOD

We have adhered to the relevant EQUATOR guidelines using the STROBE reporting method.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Evidence-based practice knowledge, attitude, practice and barriers as predictors of stay intent among Jordanian registered nurses: a cross-sectional study

AIM

This study aimed to identify factors influencing stay intent among Jordanian registered nurses, with a specific focus on the role of evidence-based practice (EBP) knowledge, attitudes, practices and barriers.

METHODS

A descriptive cross-sectional study of 311 nurses from 5 hospitals was conducted from January 2022 to June 2022. Participants completed data about stay intent and knowledge, attitude, practice and barriers of EBP. Data were analysed using SPSS program V.24.

FINDINGS

EBP attitudes, practices, knowledge and barriers significantly predicted stay intent, controlling for participants and workplace characteristics. Private hospitals (t=-4.681, Β=-0.287, p<0.001), having a library in the healthcare institution (t=-2.018, Β=-0.118, p<0.001) and adopter barriers (t=-1.940, Β=-0.105, p=0.05) were significantly associated with stay intent.

CONCLUSION

Our findings show that EBP influences Jordanian nurses' intent to stay. It highlights the importance of addressing EBP barriers, especially in private hospitals as well as library access issues, in enhancing nurse retention and healthcare outcomes in Jordan.

Intent to stay, moral distress, and nurse practice environment among long-term care nurses: A cross-sectional questionnaire survey study

BACKGROUND

Many long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment.

OBJECTIVE

The purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress.

DESIGN

This study was a descriptive, cross-sectional survey using targeted sampling.

PARTICIPANTS

A total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting.

METHODS

This study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses.

RESULTS

The mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (β = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (β = 0.46). The moral distress had a significant, moderately negative association with intent to stay (β = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001).

CONCLUSION

Since the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

CLINICAL RELEVANCE

Our study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Effectively and Efficiently Reengineering the Nursing Work Environment by Applying a Conceptual Framework for Nurse Retention

The nursing shortage that is upon us is the result of a confluence of factors, some simple and some complex. Legacy solutions are not working. Recovery from the current situation involves examining and reshaping the nursing work environment. Creative and innovative solutions are being developed and tested. The call for addressing the work environment is surfacing in the literature, yet methods for doing so in an orderly, progressive manner have been elusive. To solve complex problems, structure helps lead to clear thinking. This work presents a conceptual framework for nurse retention derived from concept analysis of initiatives with empirical outcomes for intent to stay, intent to leave, turnover, and retention. It layers in 2 simple theorists and presents an intuitive, understandable model to guide strategic planning and decision making. The Framework has been used for several applications, one of which is a unit-based action planning method that is systematic, cyclic, and uses data relevant to specific unit culture. Improvements occurred in retention and engagement metrics, work effectiveness scores, and cost. Nurse managers extol the process's simplicity and ease of use, and the role the Framework plays in shaping the way they think about nurse retention.

Nurse Managers' Professional Quality of Life During the COVID-19 Pandemic

BACKGROUND

Health systems cannot effectively support nurse managers without understanding psychosocial effects of the COVID-19 pandemic.

OBJECTIVE

The objective of this study was to describe the professional quality of life of frontline nursing management during the COVID-19 pandemic.

METHODS

A cross-sectional online survey of 54 nurses in management positions at a large Midwest academic medical center during 2022 was conducted. Participants completed an electronic survey including demographics, Professional Quality of Life Measure Version 5, and items assessing past consideration of and future intent to leave their position, organization, or profession.

RESULTS

Most participants had previously considered changing roles (80%) or leaving the organization during the pandemic (76%). Fewer respondents reported that changing role (24%) or organization (20%) was likely during the upcoming 6-12 months. Most participants scored in moderate ranges of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress scales (85%, 89%, and 74%, respectively). Higher Compassion Satisfaction was associated with extreme unlikelihood of leaving for an internal non-management role. Higher Burnout scores were associated with more time working and past consideration or future likelihood of leaving for an external non-nursing position. Secondary Traumatic Stress scores were higher for nurse managers and house operation managers than assistant nurse managers and associated with past consideration of moving to an internal non-management role or external non-nursing position and future likelihood of moving to an external non-nursing position.

CONCLUSIONS

Nurse management occupies a demanding position between frontline staff needs and administrative requirements, profoundly impacted by COVID-19. Health care researchers, administration, and policymakers must learn how to support, retain, and sustain nursing management in a post-pandemic world.

Collaboration between occupational health professionals in smoking cessation treatment and support

BACKGROUND

Promoting health is an important part of occupational health (OH) professionals' daily practice. Occupational health services (OHS) support work ability and prevent both work-related diseases and lifestyle-related illnesses.

OBJECTIVE

We focused on how interprofessional collaboration (IPC), regardless of whether the OHS provider is public, private or in-house, influences the implementation of smoking cessation treatment and support (SCTS). We studied IPC of OH professionals in SCTS and whether they differ depending on OHS providers.

METHODS

We collected data through an online survey of a cross-sectional sample of OH professionals of physicians (n = 182), nurses (n = 296) and physiotherapists (n = 96) at two different time-points, in 2013 and 2017. The questionnaire contained questions on interprofessional SCTS practices, so that we could assess how the professionals' experiences differed from each other. We used explanatory factor analysis to study the collaboration, and the Kruskall-Wallis test to detect the differences between the OH professional groups as a post-hoc data analysis.

Background

OH physicians (mean 3.4, SD 1.2) and OH nurses (mean 3.2, SD 1.1) experienced smooth collaboration in SCTS whereas OH physiotherapists (mean 2.5, SD 1.1) felt excluded from IPC. In-house OH centres (mean 3.5, SD 1.0) seemed to offer the best opportunities for implementing IPC in SCTS comparing to public (mean 3.1, SD 0.9) or private (mean 2.9, SD 0.9) OHS.

CONCLUSION

The IPC of OH professionals in SCTS interventions need to be rearranged. This requires boundary-crossing SCTS practices involving all professionals. All OH professionals should implement IPC in SCTS and share their specific competence.

Nurses' motivations to leave the nursing profession: A qualitative meta-aggregation

AIM

To systematically provide an overview of the qualitative evidence available on the motivations for nurses to leave the nursing profession.

DESIGN

A qualitative systematic review using the meta-aggregation design of the Joanna Briggs Institute.

DATA SOURCES

Qualitative studies in English, dating from 2010 until January 2023, were obtained from CINAHL, PsycINFO and PubMed.

REVIEW METHODS

Studies were selected using predetermined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The assessment of confidence in the review findings was done according to the ConQual approach.

RESULTS

Nine papers that investigated nurses' motivations to leave the profession were included. We developed four synthesized findings from 11 synthesized categories and 31 categories to reflect nurses' motivations to leave the profession, including (1) challenging work environment, (2) emotional distress, (3) disappointment about nursing reality, and (4) culture of hierarchy and discrimination.

CONCLUSION

This review provides an in-depth and meaningful understanding of motivations for nurses to leave the profession. Among others, poor working conditions, a lack of opportunities for career development, a lack of support from managers, work-related stress, a discrepancy between nursing education and practice and bullying behaviour were motivations to leave the profession, which calls for targeted action to retain nurses in the profession.

IMPACT

Findings of this study shine a light on reasons why nurses leave the profession, providing evidence to support nurse managers and policymakers to develop retention strategies to move out of current crisis into recovery of sustainable global healthcare.

PATIENT OR PUBLIC CONTRIBUTION

There was no direct patient or caregiver contribution to this study because this study originated from the process of a Master study. However, two of the authors are still involved in clinical nursing practice and provided the necessary link between research and practice.

Nursing undergraduates' media competence in the context of health communication and its relationship to professionalism

AIMS

To investigate the association between professionalism and social media competence among Chinese mainland nursing undergraduates.

DESIGN

This study employed a cross-sectional descriptive correlation design.

PARTICIPANTS

From June to July 2021, 797 nursing students from four nursing colleges in Jiangsu Province, China, were chosen using stratified cluster sampling.

METHODS

The questionnaire included the Chinese version of the Nursing Professionalism Scale and the Social Media Competency Scale. The association between professionalism and social media competency was examined using Pearson's correlation analysis.

RESULTS

The professionalism of nursing undergraduates (average scores:70.44 ± 8.82) was at a medium level. Social media self-efficacy, performance expectancy, facilitating conditions and social influence (3.76 ± 0.75, 3.87 ± 0.60, 3.53 ± 0.69, 3.41 ± 0.76) were at a medium-high level, while social media experience and effort expectancy (3.03 ± 0.72, 2.60 ± 0.59) were at medium and low levels. Among nursing undergraduates, professionalism was related to social media competence, among which, professionalism was positively correlated with social media self-efficacy (r = 0.40, p < 0.01), social media experience (r = 0.50, p < 0.01), performance expectancy (r = 0.34, p < 0.01), facilitating conditions (r = 0.41, p < 0.01), but negatively correlated with effort expectancy (r = -0.10, p < 0.01).

CONCLUSION

The professionalism of nursing undergraduates is related to social media. The scores of social media self-efficacy, social media experience, performance expectancy and facilitating conditions of nursing students with high professionalism were higher than those of nursing students with low professionalism.

IMPACT

This study suggests that developing a course on health communication on social media can help nursing students improve their professionalism.

PATIENT OR PUBLIC CONTRIBUTION

Participants completed a survey via the online survey platform Wenjuangxing.

Effectiveness of health communication courses on professionalism and social media competence among nursing students: A randomized controlled trial

BACKGROUND

The shaping and cultivation of professionalism of nursing students is very important for the improvement and retention of nursing workers' quality. In the context of social media, it is challenging for nursing students to use social media for health education. Health communication course has the potential to cultivate professionalism and social media competence of nursing students, but its role still needs to be explored.

OBJECTIVE

To evaluate the effectiveness of health communication course intervention on improving the professionalism and social media competence of nursing students.

DESIGN

A randomized controlled trial.

METHODS

The recruited nursing students were randomly divided into the intervention group (N = 50) and the control group (N = 51). The control group received routine nursing education. Intervention group received routine nursing education and health communication education courses. Both groups were required to submit a health communication work on any topic. The Nursing Professionalism Scale、Social Media Self-efficacy Scale and Social Media Experience Scale were used to evaluate the professionalism and social media competence of nursing students. The primary analysis used linear mixed models and followed the intention-to-treat principle.

RESULTS

The professionalism, social media self-efficacy and social media experience of students in the two groups were significantly improved, and the improvement of nursing students in the intervention group was higher than that in the control group. After the intervention of health communication course, there were significant differences in professionalism (p < 0.001), social media self-efficacy (p = 0.006) and social media experience (p = 0.013) between the two groups. Social media self-efficacy have an effect on professionalism (ꞵ = 0.22, p < 0.001, 95 % CI 0.17-0.26).

CONCLUSION

The health communication course significantly improved social media competence and professionalism, which was significantly different from the control group, revealing the educational value of the intervention.

TRIAL REGISTRATION NUMBER

ChiCTR2200058425.

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.

The Outcomes of Organizational Fairness among Precarious Workers: The Critical Role of Anomie at the Work

Precarious workers usually have some of the most unstable working conditions in any country. In this research, we firstly investigated the influence of organizational fairness on the emotional exhaustion and leave intentions of Peruvian precarious workers. Then, we tested the mediating role of anomie at work in the relationship between organizational fairness and the emotional exhaustion and leave intentions of precarious workers. To identify the impact of organizational fairness on these workers, we conducted a cross-sectional survey among 206 precarious workers in Peru. Our results showed that treating precarious workers fairly reduced their emotional exhaustion and leave intentions. Furthermore, we found that anomie at work mediate the relationship between organizational fairness and the emotional exhaustion and the relationship between organizational fairness and leave intentions of precarious workers. We provide empirical evidence of the critical role of organizational fairness in the reduction of emotional exhaustion and leave intentions among precarious workers. Examining the consequences of precarious workers’ perceptions of organizational fairness is needed for owners and managers of companies to have a clear understanding of how precarious workers’ working environments may shape their attitudes and work behaviors.

Developing and validating an instrument to measure: the medical professionalism climate in clinical settings

This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach's alpha and ICC. At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of "personal behavior", "collegiality" and "respect for patient autonomy" in a 25-item questionnaire for service providers and a single factor of "professional behavior" in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers' questionnaire and the single factor explained 63.9% of the variance for patients' questionnaire. The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.

Generational Differences in Nurses' Intention to Leave

There are many studies about nurses' intention to leave their jobs and contributing factors. However, there is a lack of research about generational differences in nurses' intention to leave. This evidence may help with workforce planning and targeting specific generations of nurses with retention interventions. Using the National Database of Nursing Quality Indicators 2018 Annual Registered Nurse Survey, we used descriptive statistics and multivariate logistic regression to examine the prevalence of and reasons for nurses' intention to leave in the next year by generational age group. Our sample included 207,636 hospital nurses from across the United States. We found that 21% of nurses (n = 44,082) reported intention to leave. When comparing generations, there were differences in intention to leave, as well as differences in potentially preventable, career advancement, and personal intention to leave reasons. Workload/staffing was a common reason across generations, indicating that certain interventions may be applicable regardless of generation.

Salutary factors and hospital work environments: a qualitative descriptive study of nurses in Sweden

BACKGROUND

Extensive research describes how nurses experience their work environment. The conditions are described as stressful and dissatisfying with nurses intending to leave their workplace. Knowledge about the personal perception regarding why nurses consider leaving the hospital workplace is limited. The purpose of this study was to understand why hospital nurses remain in their workplace, which facilitates their continuation in the profession.

OBJECTIVE

The objective was to explore and describe factors explaining why hospital nurses remain in the workplace.

METHODS

This was a descriptive qualitative study with a purposive sample of hospital nurses in Sweden. The salutogenic theory was the basis for the interview guide and the semi-structured questions. Individual interviews were conducted in a hospital in western Sweden. Content analysis was performed to organize the coded data according to the sense of coherence.

RESULTS

Data saturation was achieved with 12 interviews. Within the three themes of coherence (comprehensibility, manageability, and meaningfulness), ten subthemes were categorized from the data as follows: job satisfaction and fun at work, acknowledgement and productivity, togetherness and team security, manageable workload, variable work and challenging situations, workplace and personal space balance, collaboration and supportive leadership, valued role and good work, commitment and involvement, and pride in the professional role.

CONCLUSIONS

The main findings of this study have shown the critical importance of being in a meaningful, comprehensible and manageable work context that supports nurses in maintaining their professional identity.