Magnitude of turnover intention and associated factors among nurses working in emergency departments of governmental hospitals in Addis Ababa, Ethiopia: a cross-sectional institutional based study

Age and expertise: The effects of ageism on professional recognition for senior nurses

This study explores the dual challenges of ageism and professional recognition faced by senior nurses in healthcare settings. Utilizing a phenomenological approach, we conducted semi-structured interviews with 20 registered nurses aged 50 and older in Abha City, Saudi Arabia. The analysis revealed four key themes: experiences of ageism, its impact on professional roles, discrimination and stigmatization, and the need for organizational support. Findings indicate that age-related biases lead to significant professional marginalization, reduced job satisfaction, and emotional distress among senior nurses. The study highlights the critical need for comprehensive policies, organizational support, and cultural changes to address ageism and recognize the valuable contributions of senior nurses. Promoting an inclusive work environment and equitable professional development opportunities can enhance the overall quality of care and job satisfaction for older nurses.

Factors that contribute to turnover and retention amongst emergency department nurses: A scoping review

BACKGROUND

Internationally, the emergency nursing workforce shortage is of critical concern.

AIM

To synthesise the evidence and assess the scope of literature regarding factors that contribute to turnover and retention amongst emergency nurses.

METHOD

A scoping review using the Joanna Briggs Institute approach was undertaken. Fivedatabases (Embase, MEDLINE, PsycINFO, CINAHL, and Business Source Complete) were searched for papers published in English between January 2011 and June 2023 where the population was nurses, context was the emergency department, and the concept was turnover or retention. A quality appraisal was performed on included studies.

RESULTS

A total of 31 articles met the inclusion criteria. Twenty-six studies focussed on turnover and five studies focussed on retention. Factors that contribute to ED nursing turnover included workplace violence, personal aspects (e.g., burnout or depression), organisational characteristics, and environmental/ job characteristics. Factors that contributed to ED nursing retention included mentoring programs, the advancement in nursing skills, and the transition to practice speciality (emergency) programs.

CONCLUSIONS

A large body of literature exists regarding ED nurses' reasons for leaving their area of practice, yet limited evidence exist on retention. Research exploring factors that promote retention of emergency nurses that leads to subsequent stability and growth in the emergency nursing workforce is needed.

Turnover intention and its associated factors among nurses in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Nurses turnover intention, representing the extent to which nurses express a desire to leave their current positions, is a critical global public health challenge. This issue significantly affects the healthcare workforce, contributing to disruptions in healthcare delivery and organizational stability. In Ethiopia, a country facing its own unique set of healthcare challenges, understanding and mitigating nursing turnover are of paramount importance. Hence, the objectives of this systematic review and meta-analysis were to determine the pooled proportion ofturnover intention among nurses and to identify factors associated to it in Ethiopia.

METHODS

A comprehensive search carried out for studies with full document and written in English language through an electronic web-based search strategy from databases including PubMed, CINAHL, Cochrane Library, Embase, Google Scholar and Ethiopian University Repository online. Checklist from the Joanna Briggs Institute (JBI) was used to assess the studies' quality. STATA version 17 software was used for statistical analyses. Meta-analysis was done using a random-effects method. Heterogeneity between the primary studies was assessed by Cochran Q and I-square tests. Subgroup and sensitivity analyses were carried out to clarify the source of heterogeneity.

RESULT

This systematic review and meta-analysis incorporated 8 articles, involving 3033 nurses in the analysis. The pooled proportion of turnover intention among nurses in Ethiopia was 53.35% (95% CI (41.64, 65.05%)), with significant heterogeneity between studies (I2 = 97.9, P = 0.001). Significant association of turnover intention among nurses was found with autonomous decision-making (OR: 0.28, CI: 0.14, 0.70) and promotion/development (OR: 0.67, C.I: 0.46, 0.89).

CONCLUSION AND RECOMMENDATION

Our meta-analysis on turnover intention among Ethiopian nurses highlights a significant challenge, with a pooled proportion of 53.35%. Regional variations, such as the highest turnover in Addis Ababa and the lowest in Sidama, underscore the need for tailored interventions. The findings reveal a strong link between turnover intention and factors like autonomous decision-making and promotion/development. Recommendations for stakeholders and concerned bodies involve formulating targeted retention strategies, addressing regional variations, collaborating for nurse welfare advocacy, prioritizing career advancement, reviewing policies for nurse retention improvement.

The mediating role of organizational commitment between workplace bullying and turnover intention among clinical nurses in China: a cross-sectional study

BACKGROUND

Workplace bullying experienced by clinical nurses is a critical and pervasive issue that not only detrimentally impacts nurses but also poses a significant threat to the overall quality of nursing services and patient care. This study aimed to determine the mediating role of organizational commitment in the relationship between workplace bullying and turnover intention among clinical nurses in China.

METHODS

Participants were recruited from 40 hospitals in various provinces of China from December 2, 2021 to February 25, 2023, using convenience sampling. After obtaining hospital ethical approval and participants' informed consent, clinical nurses (n = 585) from different nursing departments in different hospitals completed the questionnaire. The Socio-demographic Questionnaire, Negative Acts Qestionnaire, Chinese Workers' Organizational Commitment Scale and Turnover Intention Questionnaire were used to collect general demographic data of nurses and assess workplace bullying they experienced, their level of organizational commitment and turnover intention. Descriptive statistics, Pearson correlation analyses and structural equation model were adopted to analyze the data.

RESULTS

Pearson's correlation analysis showed that that workplace bullying was significantly negatively correlated with organizational commitment (r = - 0.512, P<0.01) and significantly positively correlated with turnover intention (r = 0.558, P<0.01), organizational commitment was significantly negatively correlated with turnover intention (r = - 0.539, P<0.01). Mediation analysis indicated organizational commitment partially mediated the association between workplace bullying and turnover intention. The total effect (β = 0.69) of workplace bullying on turnover intention consisted of its direct effect (β = 0.41) and the indirect effect mediated through organizational commitment (β = 0.280), with the mediating effect accounting for 40.58% of the total effect.

CONCLUSION

Organizational commitment mediated the associations of workplace bullying and turnover intention. Therefore, healthcare organizations and nursing managers should develop appropriate strategies to enhance nurses' organizational commitment in order to reduce their turnover intention.

Work engagement among health professionals in public health facilities of Bench-Sheko zone, southwest Ethiopia

BACKGROUND

The level of health professional work engagement affects retention, burnout, job satisfaction, patient satisfaction, and outcomes; however, there is a paucity of evidence that benefit health professional work engagement. Therefore, this study aimed to assess work engagement and associated factors among health professionals at public health facilities in the Bench-Sheko zone in southwest Ethiopia.

METHODS

Facility-based cross-sectional study was conducted among 605 health professionals from 29 March to 29 April 2021. A simple random sampling technique was used to select the participants. Data were collected using a self-administered questionnaire. Linear regression was fitted and those variables with p-value < 0.2 in simple linear regression were entered into multiple linear regression analysis. Unstandardized β-coefficient with 95% CI and p-value < 0.05 were used as the cut of points to determine the factors associated with work engagement.

RESULTS

Mean score percentage of work engagement was 71.8%. Health center staff (β = 0.31; 95% CI: 0.22, 0.40), married professionals (β = 0.10; 95% CI: 0.005, 0.17), co-worker support (β = 0.06; 95% CI: 0.004, 0.11), role clarity (β = 0.14; 95% CI: 0.07, 0.21), reward (β = 0.10; 95% CI: 0.05, 0.15), resilience (β = 0.14 95%; CI: 0.07, 0.21), self-efficacy (β = 0.24; 95% CI: 0.16, 0.31) and optimism (β = 0.20; 95% CI: 0.15, 0.26) were positively associated with work engagement. On the contrary, cognitive demand (β= -0.06; 95% CI: -0.11, -0.01) was negatively associated with work engagement.

CONCLUSION

In this study, health professionals had a moderate level of work engagement. Health facilities shall improve their culture of co-worker support, role clarity, reward, resilience, self-efficacy, and optimism to enhance work engagement. Future researchers shall be done further studies to evaluate the relationship between cognitive demand and work engagement among health professionals.

Turnover intention among healthcare workers in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

To determine the pooled prevalence of turnover intention among healthcare workers in Ethiopia.

DESIGN

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

DATA SOURCES

Electronic databases of Science Direct, Medline, African Journals Online, Excerpta Medica Database, Scopus and Google Scholar were searched to identify studies published in the English language before 31 December, 2021.

ELIGIBILITY CRITERIA

Studies were included with following criteria: (1) studies conducted or published until 31 December 2021; (2) observational studies; (3) Studies conducted on healthcare workers; (4) reporting turnover intention; (v) studies conducted in Ethiopia and (vi) tudies published in the English language were included.

DATA EXTRACTION AND SYNTHESIS

Three independent reviewers screened all the papers for eligibility criteria. Data were extracted by two independent investigators using a standardised data extraction format. Random effects model meta-analysis using STATA V.14.0 statistical software was conducted to estimate the pooled prevalence of turnover intention with 95% CI. Funnel plot and Forest plot were used to check publication bias and heterogeneity between studies, respectively. Leave-one-out sensitivity analysis was done.

PRIMARY OUTCOME

Prevalence of turnover intention.

RESULT

A total of 29 cross-sectional studies with 9422 participants met the inclusion criteria. The estimated pooled prevalence of turnover intention among healthcare workers in Ethiopia was 58.09% (95% CI 54.24 to 61.93; p value <0.001, I²=93.5%).

CONCLUSION

The finding of this systematic review and meta-analysis showed high prevalence of turnover intention among healthcare workers in Ethiopia. The Government and policy makers should come up with different mechanisms including a wide variety of healthcare workers retention strategies in order to reduce turnover intention of healthcare workers and retain them.

How work-family conflict influences emergency department nurses' turnover intention: The mediating role of positive and negative affect

BACKGROUND

Turnover has significant impact on nursing management and nursing safety. Nurses working in the Emergency Department are especially vulnerable to high turnover intention because of their increased risk of work-family conflict associated with the work characteristics.

OBJECTIVE

This study aimed to investigate the effects of work-family conflict on emergency nurses' turnover intention and the role of positive and negative affect between work-family conflict and turnover intention.

METHODS

A cross-sectional study. Data were collected from 17582 nurses working in emergency department in China. We employed a standardized questionnaire to collect sociodemographic information and target work-family conflict, affect and turnover intention. Mediation analyses were performed for the data analyses.

RESULTS

On turnover intention, work-family conflict exerted both direct effect and indirect effect. The results also indicated that positive and negative affect partially mediated the effect of work-family conflict on turnover intention, and that 35.7% of this effect could be explained by mediating effects totally.

CONCLUSIONS

The findings highlight positive and negative affect concern during the process of nursing management and nursing managers should take active measures to reduce negative affect and improve positive affect in order to reduce turnover intention and maintain the stability of the emergency nursing workforce.

Organizational culture and barriers to change in University of Gondar Comprehensive Specialized Hospital Cardiac Unit

BACKGROUND

Cardiovascular disease is a major contributor to high mortality in Ethiopia. Hospital organizational culture affects patient outcomes including mortality rates for patients with cardiovascular disease. Therefore, the purpose of this study was to assess organizational culture and determine barriers to change in the Cardiac Unit of University of Gondar Comprehensive Specialized Hospital.

METHODS

We used a mixed methods approach with a sequential explanatory design. We collected data through a survey adapted from a validated instrument measuring organizational culture (n = 78) and in-depth interviews (n = 10) with key informants from different specialty areas. We analyzed the quantitative data using descriptive statistics and the qualitative data through a constant comparative method of thematic analysis. We integrated the data during the interpretation phase to generate a comprehensive understanding of the culture within the Cardiac Unit.

RESULTS

The quantitative results indicated poor psychological safety and learning and problem solving aspects of culture. On the other hand, there were high levels of organizational commitment and adequate time for improvement. The qualitative results also indicated resistance to change among employees working in the Cardiac Unit as well as other barriers to organizational culture change.

CONCLUSION

Most aspects of the Cardiac Unit culture were poor or weak, signaling opportunities to improve culture through identifying culture changing needs, implying the need to be aware of the subcultures within the hospitals that influence performance. Thus, it is important to consider hospital culture in planning health policy, strategies, and guidelines.

RECOMMENDATIONS

It is of paramount importance to strengthen organizational culture through fostering a safe space that enables workers to express divergent views and actively considering such views to improve the quality of care, supporting multidisciplinary teams to think creatively to address problems, and investing in data collection to monitor changes in practice and patient outcomes.

Determinants of health professionals' engagement at Mizan-Tepi University Teaching Hospital in Southwest Ethiopia

Background

Employee engagement, undoubtedly, is one of the top priorities for organizations today, especially for service organizations where labor accounts for a large ratio of what customers pay for. Therefore, this study aimed to assess the determinants of employee engagement at Mizan-Tepi University Teaching Hospital in Southwest Ethiopia.

Methods

A hospital-based cross-sectional study was conducted at Mizan-Tepi University Teaching Hospital from January 1-30, 2020. A total of 212 study participants were recruited using a simple random sampling technique. The data were collected using a pretested self-administered questionnaire. The collected data were entered into SPSS version 21. Descriptive statistics such as mean and standard deviation were used. Inferential statistics of multiple linear regressions were done to analyze the effect of independent variables.

Results

The mean age of respondents was 26.6 (±3.37 SD) years, ranging from 19 to 45 years. One hundred sixty-six (78.3%) were degree holders, 30 (14.2%) were diploma holders, 12 (5.7%) and 4 (1.8%) were masters holders and specialists respectively. The mean service year of respondents was 3.82 (±2.58 SD) years, ranging from 1 to 15 years. The study also found that working environment, perceived supervisory support, team and co-worker relationship, job characteristics, and reward and recognition affect employees' engagement with a p-value < 0.05.

Conclusion

all the explanatory variables used to explain employees' engagement were found to be capable of explaining the engagement of the employees in the health sector as well. Therefore, health institutions should work on the identified explanatory variables to increase their employees' engagement at work.

Work Stressors and Intention to Leave the Current Workplace and Profession: The Mediating Role of Negative Affect at Work

The first aim of this study was to determine whether organisational constraints, interpersonal conflicts at work, workload and negative affect at work have a positive relationship with intention to leave a current job or profession. The second aim was to investigate whether negative affect at work mediates the relationship between work stressors and intention to leave a current job or profession. The study was a quantitative cross-sectional design in nature. Data were collected between March and April 2022. The sample consisted of 306 midwives working in the Polish public health service. The theoretical model was tested using structural equation modelling. The results confirmed positive direct relationships between workload and negative affect with intention to leave the current workplace and intention to leave the midwifery profession in general. The relationships between organisational constraints and interpersonal conflicts at work and intention to leave a job or profession were found to be completely mediated by negative affect at work. Our study revealed that workload is the strongest direct predictor of intention to leave the current job or profession. Organisational constraints and interpersonal conflicts at work lead to an intention to leave a job or profession by inducing negative affect at work. Interpersonal conflicts at work are the strongest predictor of negative affect at work.

Magnitude of job satisfaction and intention to leave their present job among nurses in selected federal hospitals in Addis Ababa, Ethiopia

Background

Job dissatisfaction issues and health workers’ intention to leave is an increasing problem that threatens the function of the health care sector worldwide, especially in developing countries, including Ethiopia. As part of future evidence, this study was intended to assess nurses’ job satisfaction and intention to leave their current work and its associated factors in federal public hospitals in Addis Ababa, Ethiopia.

Method

An institutional based cross-sectional study design was used to conduct the study. A simple random sampling technique was employed to select 408 nurses from selected federal hospitals in Ethiopia. Self-administered questionnaire was used to collect the data. Logistic regression was employed to identify the predictor variables with consideration of statistical significance at P <0.05 adjusted odds ratios calculated at 95% CIs.

Result

The magnitudes of job satisfaction and intention to leave their current job among nurses in this study were 47.7% and 80.6%, respectively. Salary is imbalanced with demands [AOR = 2.85 (1.24, 6.57)], managers who have no personal plan for developing skills [AOR = 3.74 (1.58, 8.87)], stressful jobs [AOR = 0.28 (0.11, 0.71)], health problems are a reason for having thoughts about changing jobs [AOR = 3.02 (1.17, 7.79)], and a lack of development [AOR = 4.13 (1.51, 11.3)] were identified as determinant factors for intention to leave.

Conclusion

The overall intention to leave their current job among nurses working in selected federal hospitals in Ethiopia was high. The government of Ethiopia should balance the salary of nurses with the current market level. Hospital leaders should plan the way nurses develop their educational and job carrier levels.

An app for predicting nurse intention to quit the job using artificial neural networks (ANNs) in Microsoft Excel

Background:

Numerous studies have identified factors related to nurses’ intention to leave. However, none has successfully predicted the nurse’s intention to quit the job. Whether the intention to quit the job can be predicted is an interesting topic in healthcare settings. A model to predict the nurse’s intention to quit the job for novice nurses should be investigated. The aim of this study is to build a model to develop an app for the automatic prediction and classification of nurses’ intention to quit their jobs.

Methods:

We recruited 1104 novice nurses working in 6 medical centers in Taiwan to complete 100-item questionnaires related to the nurse’s intention to quit the job in October 2018. The k-mean was used to divide nurses into 2 classes based on 5 items regarding leave intention. Feature variables were selected from the 100-item survey. Two models, including an artificial neural network (ANN) and a convolutional neural network, were compared across 4 scenarios made up of 2 training sets (n = 1104 and n = 804 ≅ 70%) and their corresponding testing (n = 300 ≅ 30%) sets to verify the model accuracy. An app for predicting the nurse’s intention to quit the job was then developed as a website assessment.

Results:

We observed that 24 feature variables extracted from this study in the ANN model yielded a higher area under the ROC curve of 0.82 (95% CI 0.80-0.84) based on the 1104 cases, the ANN performed better than the convolutional neural network on the accuracy, and a ready and available app for predicting the nurse’s intention to quit the job was successfully developed in this study.

Conclusions:

A 24-item ANN model with 53 parameters estimated by the ANN was developed to improve the accuracy of nurses’ intention to quit their jobs. The app would help team leaders take care of nurses who intend to quit the job before their actions are taken.

Key Points

Relationships among basic psychological needs, organizational commitment, perceived authentic leadership, and turnover intention in Korean nurses: A cross-sectional study

AIM

This study determined the relationships of satisfaction and frustration with basic psychological needs, organizational commitment, perceived authentic leadership, and turnover intention in nurses in South Korea.

BACKGROUND

Minimizing nurse turnover is essential for improving the quality of nursing care and patient safety.

METHODS

This was a cross-sectional, correlational pilot study of 216 nurses at a university hospital in South Korea. Data were collected with a self-report questionnaire, from September 1 to 15, 2020. Collected data were analyzed using SPSS 24.0.

RESULTS

Multiple regression analysis revealed that clinical experience (3 to 5 years, β=2.35, p=.019; 5 to 10 years, β=2.23, p=.026), subjective workload (severe, β= 2.10, p=.036; extreme, β=2.84, p=.005), psychological needs frustration (β=0.35, p<.001), organizational commitment (β=-0.17, p=.011), and perceived authentic nurse leadership (β=-0.14, p=.030) were found to have significant effects on nurses' turnover intention.

CONCLUSIONS

A strategy is needed for efficient nursing staffing management and reduction of nurses' turnover intentions.

IMPLICATIONS FOR NURSING MANAGEMENT

This study offers a new approach to reducing nurses' turnover. The results suggest that it is necessary to create a transparent work environment based on authentic leadership and consider individual frustrations with regard to basic psychological needs and organizational commitments.

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.

The Impact of the Coronavirus Disease (COVID-19) Pandemic on Nurses' Turnover Intention: An Integrative Review

The COVID-19 pandemic has increased the demand and workload on nurses. In addition, the number of critical cases, the uncertainty about the disease, and the incidence rate of death from the disease impose a psychological stress on nurses. Considering the alarming issues of stress, burnout, and turnover among nurses even before the pandemic, the pandemic might have amplified such issues. Thus, the impact of the COVID-19 pandemic on nurses' turnover and turnover intention warrants investigation. The aim of this review is to appraise and integrate the current pre- and post-coronavirus disease (COVID-19) literature on nurse turnover, published between 2016 and 2021. Forty-three studies on nurses' turnover intention were appraised and synthesized. The reviewed literature suggested that nurses' turnover intention increased significantly after the COVID-19 pandemic. Post-COVID-19-pandemic studies focused more on predicting nurses' turnover intention through the pandemic's negative impact on the nurses' psychological wellbeing. The findings of this review should be considered by nurse managers and leaders in the development of policies and programs to reduce the negative impact of COVID-19 on nurse retention.

Mediating effects of nurses 'personal and organizational values between organizational commitment and turnover: Cross-sectional study

Background

The values of individuals and organizations are the core factors driving and guiding nurses’ decision-making and actions. Previous studies mainly focused on the impact of organizational commitment and other influencing factors on turnover intention.

Aim

To explore the mediating effect of personal and organizational values matching the relationship between organizational commitment and turnover intention of nursing staff.

Methods

A cross-sectional survey of 490 subjects in four tertiary hospitals in Tianjin was conducted by convenient sampling. Multivariate regression analysis and structural equation models were used to test each hypothesis.

Results

The results showed that there is a negative correlation between personal and organizational values, organizational commitment and turnover intention, and personal and organizational values played an indirect intermediary role between organizational commitment and turnover intention.

Conclusions

Organizational commitment reduces nurses’ turnover intention indirect through personal and organizational values paths. Leaders can improve nurses’ values as members of the organization, so as to participate in their own work more actively.

Implications for nursing management

Managers should effectively reduce the turnover rate and stabilize the nursing team by improving the organizational commitment and personal and organizational values of clinical nurses.

The Impact of Burnout on Emergency Nurses' Intent to Leave: A Cross-Sectional Survey

INTRODUCTION

Emergency nurses work in one of the busiest and most stressful departments in a hospital and, as such, may experience burnout more often than nurses working in other nursing units. This study examined the relationship among orientation, burnout (emotional exhaustion, depersonalization, and low sense of personal accomplishment), and intent to leave.

METHODS

A cross-sectional survey design was used. Emergency nurses who were members of the Emergency Nurses Association were invited to participate in an anonymous survey. The Maslach Burnout Inventory tool was used to explore emotional exhaustion, depersonalization, and sense of personal accomplishment. Emergency nurses' intent to leave was assessed with the Turnover Intention Scale. A logistic regression analysis was used to investigate the odds of intent to leave for those who scored at or above versus below the median on each burnout subscale.

RESULTS

The findings revealed that a formal orientation enhanced emergency nurses' sense of personal accomplishment and was associated with lower intent to leave. The odds of intent to leave were almost 9 times greater for participants with 5 or more years of experience, approximately 13 times greater for those with above-median emotional exhaustion, and more than 6 times lower for those with above-median sense of personal accomplishment.

DISCUSSION

Emotional exhaustion and low sense of personal accomplishment were key factors influencing emergency nurses' intent to leave. Emergency nurse leaders may find that a formal orientation program enhances sense of personal accomplishment and decreases intent to leave. Creating work environments to help emergency nurses find joy in their work may be critical to work-life balance and staff retention.