Validation of work pressure and associated factors influencing hospital nurse turnover: a cross-sectional investigation in Shaanxi Province, China

Mind over matter: mindfulness as a buffer against workplace incivility

This study examines the relationship between co-worker incivility, emotional exhaustion, mindfulness, and turnover intention among nurses in public and private hospitals in North Cyprus. Drawing upon the Job Demand-Resources theory, the research aims to contribute to the existing literature by investigating the mediating role of emotional exhaustion and the moderating effect of mindfulness on the relationship between co-worker incivility and turnover intention. Data were collected from 238 nurses through questionnaires, and structural equation modeling was employed for data analysis. The results indicate a positive association between co-worker incivility and emotional exhaustion, as well as between co-worker incivility and turnover intention. Emotional exhaustion was found to mediate the relationship between co-worker incivility and turnover intention. Furthermore, mindfulness was identified as a moderator, attenuating the negative impact of co-worker incivility on turnover intention. The findings underscore the importance of addressing workplace incivility and promoting mindfulness to mitigate turnover intentions among nurses. Practical implications include the implementation of interventions to foster a supportive work environment and enhance nurses' emotional wellbeing.

Predictive factors of turnover intention of newly graduated nurses in their first year of employment: a longitudinal study

BACKGROUND

The turnover of newly graduated nurses is a severe challenge for healthcare systems, and so it is essential to identify its predictive factors. This study investigates whether professional commitment, career adaptability, career self-efficacy, anxiety, and depression levels before and after internship can predict the turnover intention of newly graduated nurses after one year of employment.

METHODS

In a longitudinal study, 271 undergraduate nursing students recruited by convenience sampling were surveyed before internship (T1), after internship (T2), and after one year of employment (T3), with all surveys conducted on the Wenjuanxing survey platform ( www.wjx.cn ). Generalized linear models and restricted cubic spline models were used to explore possible linear and nonlinear relationships between turnover intention and the variables of interest.

RESULTS

Professional commitment both pre-internship (β = -0.060, p = 0.007, 95% CI [- 0.104, - 0.016]) and post-internship (β = -0.053, p = 0.015, 95% CI [- 0.096, - 0.010]) can negatively predict turnover intention. There is also a negative linear relationship between post-internship career self-efficacy and turnover intention (β = -0.308, p < 0.001, 95% CI [- 0.436, - 0.180]). In addition, professional commitment both pre-internship (adjusted R2 = 0.046, p = 0.004) and post-internship (adjusted R2 = 0.068, p < 0.001), career self-efficacy both pre-internship (adjusted R2 = 0.039, p = 0.008) and post-internship (adjusted R2 = 0.116, p < 0.001), career adaptability both pre-internship (adjusted R2 = 0.057, p < 0.001) and post-internship (adjusted R2 = 0.039, p = 0.008), anxiety both pre-internship (adjusted R2 = 0.035, p = 0.014) and post-internship (adjusted R2 = 0.048, p = 0.003), and depression levels both pre-internship (adjusted R2 = 0.031, P nonlinear = 0.021) and post-internship (adjusted R2 = 0.053, p = 0.002) are nonlinearly associated with turnover intention.

CONCLUSIONS

Nursing educators and clinical care administrators must take action to enhance the professional commitment and career self-efficacy of nursing students during their internship. It is also important to pay attention to their career adaptability, as well as to any anxiety or depression that they may experience during clinical practice. This can help to reduce the turnover intention during the first year of their nursing career.

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.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Challenges and coping experiences faced by nursing staff in long-term care facilities in China: a qualitative meta-analysis

Objective

The aim of this study is to discern the challenges and coping experiences encountered by nursing staff in long-term care facilities in China. This will be achieved through the identification, evaluation, and qualitative synthesis of comprehensive data.

Design

This is a qualitative meta-analysis.

Methods

The research systematically examined relevant literature sourced from six databases, concluding the search in August 2023. The inclusion criteria encompassed qualitative and mixed-methods studies in both Chinese and English, focusing on challenges faced by nursing staff in long-term care facilities and their corresponding coping strategies. The application of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework facilitated the qualitative meta-integration process. Three independent researchers meticulously screened and assessed the quality of the chosen studies. The synthesis process sought to amalgamate and structure analogous findings into novel categories through multiple readings of the original literature. These categories were subsequently distilled into comprehensive themes.

Results

Analyzed 15 articles revealed 14 sub-themes and 4 overarching analytical themes. These encompassed Sources of Challenges such as multitasking, clinical emergencies, workplace conflict, demand exceeding resources, and occupational discrimination. Psychological impacts included suppressed emotion, compassion fatigue, and self-doubt. Practical consequences involved damaged health, imbalanced life, and occupational disappointment. Coping strategies identified were self-adjusting, feeling validation and belonging, and finding support.

Conclusion

Our research identified the challenges faced by nursing staff in Chinese long-term care facilities and their coping experiences. We found that most challenges could be mitigated through appropriate adjustments in managerial strategies, such as reasonable human resources planning, and providing resource support, including material, emotional, and informational support. Similarly, institutions should have offered necessary emotional and psychological support to nursing staff to overcome the negative impacts of challenges and encourage them to adopt positive coping strategies.

New nurses' turnover intention and clinical belonging, based on latent class analysis (LCA)

AIM

To identify potential categories of clinical belonging among new nurses and explore the relationship between different categories and turnover intention.

DESIGN

A cross sectional study.

METHOD

A cross sectional study was conducted among 348 new nurses from tertiary hospitals in Hainan and Guangdong provinces. A general data questionnaire, clinical belonging scale and turnover intention scale were used for examination. Further, the potential categories were used to analyse the categories of clinical belonging, and latent class analysis was utilized to analyse the relationship between different categories of clinical belonging and turnover intention.

RESULTS

The clinical sense of belonging of new nurses were divided into three groups namely C1, C2 and C3. The C1: poor clinical sense of belonging (8.7%), C2: moderate clinical sense of belonging (57.9%) and C3: rich clinical sense of belonging (33.4%). The risk of the turnover intention of new nurses with 'poor clinical sense of belonging' was 0.62 times that of new nurses with 'rich clinical sense of belonging' (OR = 0.62, p < 0.01), which was 0.24 times that of 'moderate clinical sense of belonging' (OR = 0.24, p < 0.01), the risk of the turnover intention of new nurses with 'moderate clinical sense of belonging' was 0.13 times that of new nurses with 'rich clinical sense of belonging'(OR = 0. 13, p < 0.01).

CONCLUSIONS

The results of our study revealed that in order to enhance the new nurses' sense of belonging, support was most crucial when they were first encountering difficulties. To reduce turnover intention, more structured learning opportunities are also required to maximize learning for newly graduated nurses with various nursing degrees.

PATIENT OR PUBLIC CONTRIBUTION

There are no patient or public contributions in this study.

Healing Touch: A Strategy for Acute Care Nurses' Stress Reduction

The purpose of the study is to determine whether administering healing touch (HT) is more effective than deep breathing (DB) for reducing acute care nurses' stress during a shift. A randomized cluster trial assessed 150 nurses' vital signs and Visual Analog Scale for Stress (VASS) levels pre, post, and at follow-up to achieve a power of .7 and medium affect size. Open-ended questions following the intervention enriched quantitative findings describing the experience, facilitators, and barriers to potential use in nursing. The generalized estimating equation 1 (GEE1) comparisons of mean change over time, found that nurses in the HT intervention, had significantly lower VASS stress scores at posttreatment (-0.95, p  =  .0002) and at follow-up (-0.73, p  =  .0144) than the DB group, and the respiratory rate (RR) rate differences were nearly significant at post-intervention and significant at follow-up, respectively (1.36, p  =  .0568 and -2.28, p  =  .0011), indicating lower RR after HT. These findings support the use of HT as an effective stress reduction strategy as a relevant strategy to sustain a viable nurse work force post-COVID-19.

A lack of nurse autonomy impacts population health when compared to physician care: an ecological study

This study highlights that the contribution of nursing is secondary to physicians in overall population health (indexed with life expectancy at birth, e₍₀₎). Scatter plots, bivariate correlation and partial correlation models were performed to analyse the correlations between e₍₀₎ and physician healthcare and nursing healthcare respectively. Affluence, urbanization and obesity were incorporated as the potential confounders. The Fisher's r-to-z transformation was conducted for comparing the correlations. Multiple linear regression analyses were implemented for modelling that physicians' contributions to e₍₀₎ explain nurses'. Nursing healthcare correlated to e₍₀₎ significantly less strongly than physician healthcare in simple regressions. Nursing healthcare was in weak or negligible correlation to e₍₀₎ when physician healthcare was controlled individually or together with the three confounders. Physician healthcare remains significantly correlational to e₍₀₎ when nursing healthcare alone was controlled or when the three confounders were controlled. Linear regression revealed that nursing healthcare was a significant predictor for e₍₀₎ when physician healthcare was "not added" for modelling, but this predicting role became negligible when physician healthcare was "added". Our study findings suggested that nurses still work under the direction of physicians due to lack of autonomy. Without correction, health services will continue to transmit the invisibility of nursing healthcare from one generation of nurses to another.

The relationships between burnout, general wellbeing, and psychological detachment with turnover intention in Chinese nurses: a cross-sectional study

Background

It is critical to minimize nurse turnover to improve the quality of care and patient safety. In-depth investigation is required to better understand the factors related to nurses' turnover intentions.

Aim

This study aimed to determine the relationships between burnout, general wellbeing, and psychological detachment with turnover intention among nurses in China.

Methods

A cross-sectional survey using convenience sampling was conducted in one hospital in China between January 2023 and March 2023. A total of 536 nurses were surveyed using the General Wellbeing Schedule (GWB), the Maslach Burnout Inventory scale (MBI), the Psychological Detachment scale, and the Turnover Intention scale. The collected data were analyzed using SPSS 26.0 statistical software. The chi-square test and binary logistic regression analysis were used to explore the factors related to turnover intention.

Results

Our data demonstrated that the turnover intention scores were 13 (10, 15.75), with 56% of nurses exhibiting a high level of turnover intention. Binary logistic regression analysis results indicated that being on a contract (OR = 4.385, 95% CI = 2.196-8.754), working in the pediatrics (OR = 2.392, 95% CI = 1.267-4.514) or obstetrics (OR = 2.423, 95% CI = 1.145-5.126) department, and experiencing burnout (OR = 1.024, 95% CI = 1.008-1.041) were associated with a heightened level of turnover intention. Conversely, organizational satisfaction (OR = 0.162, 95% CI = 0.033-0.787) and general wellbeing (OR = 0.967, 95% CI = 0.946-0.989) were identified as factors that hindered the intention to leave.

Conclusions

Findings from this study suggest that nurses were employed on a contract basis, working in pediatric or obstetric departments, expressing dissatisfaction with the organization, reporting low general wellbeing, and experiencing high levels of burnout that require special attention. The identification of these risk factors can inform targeted interventions and support programs aimed at improving the wellbeing and retention of nurses in these settings.

Bibliometric analyses of turnover intention among nurses: implication for research and practice in China

Objective

The aim of this study was to analyze the current status of research on nurses' turnover intention and to provide suggestions and references for promoting research on turnover intention and for promoting hospital talent development.

Methods

We used the bibliometric method "turnover intention" or "intention to leave" and "nurse*" as subject terms, and 1543 articles from 2017 to 2021 were retrieved from the WoS database using VOSViewer and CiteSpace software. Article based on this descriptive statistical analysis was performed on the year of publication, region, institution, journal of publication, and cited articles.

Results

A total of 1,500 articles met the inclusion criteria. There is an overall upward trend in the number of articles published in the field of nursing in terms of turnover intention from 2017 to 2021. The United States has the highest number of publications and the highest number of institutions, while China ranks second in terms of publications, but there are no Chinese research institutions in the top 10. The top three journals in terms of the number of articles published are the Journal of nursing management, the Journal of advanced nursing, and the Journal of clinical nursing; Oman's League had the highest number of citations for their article in 2021; the most frequently occurring keywords are burnout, stress, satisfaction, model, work environment, organizational commitment, perception, predictor, mental health, and mediating role.

Conclusion

There is a great need for further research on how to develop sound measures to tackle nurse turnover intention. The following improvements should be made, such as to enhance research institutional settings for nurses' turnover intention in China and to increase attention to nurse burnout and possible mediating influences in future studies.

Turnover intention and its associated factors among nurses: a multi-center cross-sectional study

Aim

The purpose of our study was to assess the turnover intention of nurses in China and examine the associated factors.

Background

Since the world population ages, the demand for nurses has kept growing, and the shortage of nurses and high turnover rates are concerned with the quality of care. Thus, understanding nurses' turnover intention and the relevant factors could provide nurse managers with strategies to address the modifiable factors to decrease the turnover rate of nurses.

Methods

A multi-center cross-sectional study was conducted on a total of 1,854 nurses working in 15 hospitals in China. Data were collected using a self-designed demographic questionnaire, the Turnover Intention Scale, the Job Satisfaction Scale, the Pay Level Satisfaction Scale, the Interpersonal Conflict at Work Scale, and a single question on the sense of belonging to the hospital.

Results

Most nurses (n = 1286, 69.4%) had a high level of turnover intention. Multilevel logistic regression analysis demonstrated that nurses being single (OR = 1.366, p < 0.05), with a junior college or below (OR = 0.381, p < 0.01), being a clinical nurse (OR = 1.913, p < 0.01), having higher pay level (OR = 0.596, p < 0.001), having higher job satisfaction (OR = 0.406, p < 0.001), having conflicts with colleagues (OR = 1.400, p < 0.05), and having a higher sense of belonging to the hospital (OR = 0.532, p < 0.001) proved to affect nurses' turnover intention.

Conclusion

This study extended the knowledge about the factors associated with nurses' intention to leave, which led to the turnover of nurses, and is one of the main contributors to the current shortage of nurses.

Implications for nursing management

This study provided new approaches to decreasing the turnover rate of nurses. Effective management strategies may mitigate nurses' turnover intention.

High-Risk Symptom Cluster Groups for Work-Life Quality and Turnover Intention among Nurses

This cross-sectional study aims to identify high-risk symptom cluster groups for assessing the quality of nursing work life (QNWL) and turnover intention among Korean nurses who have experienced workplace violence. Nurses were recruited for an online survey in May 2021 (n = 203). The following four symptom clusters are extracted: (a) depression-anxiety, (b) shame-somatization, (c) nightmare-loss of appetite, and (d) anger-shock. Three symptom cluster groups were identified. Group 1 had the highest score for the anger-shock symptom cluster, as well as the highest symptom scores and turnover intention. Group 2 had the highest score for the nightmare-loss of appetite symptom cluster and the lowest QNWL. Group 3 had a similar symptom cluster pattern to Group 1 but lower scores for all symptom clusters. Symptom monitoring and programs tailored to symptom cluster groups at the institutional level could be useful for managing QNWL and turnover intention.

Psychological stress and psychological support of Chinese nurses during severe public health events

The domestic health care system has been facing a difficult task, especially in medical care, and Chinese nurses are under tremendous psychological pressure. Psychological support is a protective factor to relieve stress. This study examined the stress level and characteristics of Chinese nurses with different psychological support-seeking behaviours. Data from online questionnaires for this cross-sectional study were collected between January 2020 and February 2020 and yielded 2248 valid questionnaires for analysis with a response rate of 99.8%. General information of the respondents was also collected. The nurses' stress levels were assessed using the Perceived Stress Scale (PSS-10). T tests, chi-square tests, and linear regression were used to examine the relationships among the factors. The results of this survey showed that between January and February 2020, 26.9% of nurses received psychological counselling, and the proportion was higher among men and nurses with lower education. The PSS-10 was related to gender, age group, provincial severity, and confidence in the control of the epidemic. The results showed that psychological support can effectively improve the confidence of domestic nurses in the face of arduous work and effectively relieve the psychological pressure caused by a heavy workload.

Changes in distress and turnover intentions among hospital-based nurses working during the first eight months of the COVID-19 pandemic in Denmark. A prospective questionnaire study

Aim

To describe changes in distress among Danish hospital‐based nurses during the early month of the COVID‐19 pandemic and to examine predictors of distress and turnover intentions.

Background

Outbreak of infectious diseases such as the COVID‐19 pandemic can increase the likelihood that health professionals suffer from poor mental health even after the outbreak.

Methods

A prospective study among 426 Danish hospital‐based nurses during the early month of the pandemic. Participants completed self‐administered questionnaires regarding mental health and COVID‐19 worries, as well as turnover intentions.

Results

Nurses with brief work experience reported higher increase in distress. Feeling unsafe at work, having low trust in management and being anxious for relatives were associated with increased distress. Finally, feeling unsafe at work, being anxious for relatives and having low trust in management were predictors of intention to change job.

Conclusion

This study suggests that the subjective experiences of uncertainty in work during the COVID‐19 pandemic have more impact on nurses' distress than COVID‐19 related conditions at hospitals. Finally, the study provides empirical support for the association between COVID‐19‐related worries and turnover intentions.

Implication for nursing management

Knowledge of risk factors for psychological distress as well as predictors of turnover intention is necessary and may provide nurses and health‐care systems with the ability to respond better against future pandemics and to retain nurses in the organization and in the profession.

The relationship between public service motivation and turnover intention: the mediating role of work stress and task performance

BACKGROUND

The shortage of health care workforce is a common problem all over the world and one of the main reasons for the shortage is the high turnover rate. Based on the characteristics of medical work, this study explored the relationship among public service motivation (PSM), work stress, task performance and turnover intention.

METHODS

Medical personnel in public hospitals were selected by stratified random sampling in Jilin province of China and validated scales from previous studies were applied to measure the variables. Besides, a structural equation model of turnover intention was constructed to demonstrate the relationship.

RESULTS

A total of 3191 valid questionnaires were collected. The results showed that the score of turnover intention was 2.02 ± 1.13. There are significant differences in turnover intention among medical staff of different genders and departments. At the same time, PSM had direct and negative effects on the turnover intention (β = -0.292, P < 0.001), work stress had direct and positive effects on the turnover intention (β = 0.479, P < 0.001), whereas task performance had no significant effect on turnover intention (β = 0.044, P < 0.142). The results showed an acceptable fit model.

CONCLUSION

The greater the PSM, the lower the turnover intention, and the higher the work stress, the higher the turnover intention. In addition, work stress and task performance play a mediating role between PSM and turnover intention. This paper provides theoretical support for the measures to reduce the turnover intention of medical staff.

The Importance of Monitoring the Psychological Wellbeing and Mental Health of Nursing Staff for Sustainable Management

This study examines the psychological wellbeing and mental health of nursing staff and determines workplace factors that affect them. Wellbeing and sustainable workload are important for the quality of work life. A cross-sectional study of employees in nursing was conducted at Slovenian hospitals. The response was 35%. The main findings were that more than half of employees are satisfied or very satisfied with their job and with their leaders’ support, but they are often exposed to stress. Quality of work life, work–life balance, and managing stress at the workplace affect the psychological wellbeing and mental health of nursing staff. Management should identify the importance of monitoring and improving workplace factors that can affect the employees. At the same time, they should also be aware of the importance of sustainable development of nursing employees at the local and national levels to improve the working conditions and quality of work life for better psychological wellbeing and mental health for employees.

Work stress in nurses returning to tertiary a general hospitals in China after the delivery of their second child: a cross-sectional study

OBJECTIVE

To investigate the current situation of work stress in nurses returning to work in Chinese tertiary A general hospitals after giving birth to their second child and to analyze influencing factors.

METHODS

From January to April 2021, 448 nurses returning to work after the birth of their second child, working in 23 general hospitals in China, were investigated and completed the postpartum work stress scale and self-rating depression scale.

RESULTS

The total work stress score of returning nurses after giving birth to their second child was 90.40 ± 18.29, and the dimension with the highest score was the role commitment of the mother. Multiple linear regression analysis showed that family monthly income, turnover intention, time since returning to work, age of the first child, and depressive symptoms were the influencing factors on work stress.

CONCLUSION

It is important to reduce the work stress of the nurses returning to work after the birth of their second child. Nursing managers should pay attention to this group of postpartum nurses and formulate targeted measures to alleviate their work stress.

Self-reported turnover intention and associated factors among health professionals in Kafa Zone, Southwest Ethiopia

Objective

The aim of this study was to assess turnover intention and its associated factors among health professionals in Kafa Zone, Southwest, Ethiopia, 2018.

Methods

Cross-sectional study design relied on institution that was employed from 1-30 May 2019. Questionnaires were distributed to 427 participants who were selected by simple random sampling technique from selected health facilities. Epi Data Statistical software version 3.1 for data entry and Statistical Package for Social Sciences software version 21.0 for data analysis were used. Binary logistic regression analysis was used to identify factors associated with turnover intention. Odds ratios with 95% confidence intervals were used to examine associations, and a p-value less than 0.05 was considered significant.

Result

Overall, 427 questionnaires were distributed, and 389 were returned making 91.1% response rate. Majority of the respondents were between the age of 21 and 30 years and more than half were male. More than half, 219 (56.3%), of the participants reported that they intended to leave their institution. Being female (adjusted odds ratio 2.65, 95% confidence interval (1.62-4.33)), married (adjusted odds ratio 0.57, 95% confidence interval (0.34-0.96)), degree holders (adjusted odds ratio 0.55, 95% confidence interval (0.34-0.89)), autonomous (adjusted odds ratio 0.51, 95% confidence interval (0.31-0.84) and not satisfied with living place condition (adjusted odds ratio 1.68, 95% confidence interval (1.0-2.83)) were found to have statistically significant association with intention to leave among health professionals in Kafa Zone.

Conclusion

Turnover intention of health professionals was high in study area. Sex, educational status, marital status, autonomous, and living place condition were the identified predictors of turnover intention among health professionals. The health managers and stakeholders at different levels should have a discussion session with staff to cut the intention to leave the organization.

Impacts of Nursing Work Environment on Turnover Intentions: The Mediating Role of Burnout in Ghana

Background

The nursing practice environment supports excellence and decent work and has the influence to entice and retain the quality nursing workforce. Appreciating the dynamics that affect the turnover intention of RNs offer reasonable solutions to the challenges of the nursing shortage, which directly influence the quality of nursing care. There is a paucity of information on the impacts of these concepts among RNs in Sub-Saharan African. The study therefore aimed at determining the impacts of work environment and burnout on turnover intentions among RNs in Ghana.

Methods

A descriptive cross-sectional design using a simple random and proportionate stratified sampling with a sample of 232 RNs from Municipal and Regional Hospitals, Sunyani, West-Central part of Ghana completed validated instruments measuring work environment, burnout, and turnover intentions. Descriptive analysis was done to find out RNs' perceptions of their work environment and turnover intentions. Mediation analysis by Baron and Kenny's approach was used to determine the mediating effect of burnout on the relationship between the domains of PPE and the turnover intention of RNs. STROBE checklist was used as the reporting tool.

Results

While most RNs had a positive perception about their work environment, greater number of them had turnover intentions. There were significant associations between some nursing work environment facets and turnover intention. The results also showed a statistically significant relationship between nurse-physician relation (β = .353, t = 5.476, p ≤ .001), nurse manager leadership (β = -0.485, t = -8.192, p ≤ .001), nursing foundation for quality care (β = .400, t = 7.059, p ≤ .001), staffing and resource adequacy on (β = 0.485, t = 8.183, p ≤ .001), and turnover intention as mediated by burnout.

Conclusion

Burnout resulting from an unsafe work environment impact RNs' turnover intention. This phenomenon can potentially affect the human resource management and quality of nursing care. Policy strategies aimed at ensuring a professional practice environment and decreased burnout can therefore improve retention of RNs at their workplace.

The impact of nurses' sense of security on turnover intention during the normalization of COVID-19 epidemic: The mediating role of work engagement

BACKGROUND

COVID-19 pandemic has entered a normal stage in China. During this phase, nurses have an increased workload and mental health issues that threaten the sense of security. Poor sense of security may have a considerable impact on turnover intention through low work engagement. It was challenging to maintain the nurse workforce. Fewer studies have been conducted on the effect of nurses' sense of security on their turnover intention in that phase. This study aimed to investigate the interrelationship between nurses' sense of security, work engagement, and turnover intention during the normalization phase of the epidemic in China and to explore the impact of sense of security on turnover intention.

METHODS

A cross-sectional survey was conducted from September 2020 to May 2021 in Guangdong Province, China. Data were collected online using Sense of Security Scale for Medical Staff (SSS-MS), Utrecht Work Engagement Scale (UWES), and Turnover Intention Scale. Pearson's correlation analysis was used to assess the correlation between sense of security, work engagement, and turnover intention. The hypothesis model used multiple linear regression models and the bootstrapping procedure to analyze the relationship between these variables.

RESULTS

Data were collected from 2,480 nurses who met the inclusion criteria. Over half(64.5%) of nurses had a high and very high turnover intention. After controlling the demographic and working variables, sense of security (β = 0.291, P < 0.001) had a direct positive effect on work engagement. Sense of security (β = -0.447, P < 0.001) and work engagement (β = -0.484, P < 0.001) had a direct negative effect on turnover intention. Sense of security and all of its components were associated with turnover intention through the partially mediating effects of work engagement.

CONCLUSIONS

Nurses' turnover intention was at a high level during the normalization phase of the epidemic. Sense of security and its components act as positive resources to reduce turnover intention by improving work engagement. Policy makers and managers may pay attention to the needs of nurses' sense of security, which may be a new perspective to help managers reduce their turnover intention and stabilize the nurse team.

Study on the associated factors of turnover intention among emergency nurses in China and the relationship between major factors

BACKGROUND

In China, the demand for emergency medical services is increasing. However, there is a shortage of nurses and a high turnover rate. The study has three purposes: (1) to investigate the turnover intention of emergency nurses in China; (2) to analyze the associated factors of turnover intention; and (3) to clarify the relationship between work stress, job burnout, perceived organization support, job satisfaction and turnover intention.

METHODS

A cross-sectional study was conducted to investigate 56 hospitals with independent emergency departments in Chongqing. A total of 522 emergency nurses were included. Descriptive statistics, One-way analysis of variance, Pearson correlated analysis and a mediation regression analysis were used to analyze the turnover intention, associated factors, and the relationship between the major study variables.

RESULTS

The score of turnover intention was 2.38 ± 0.57, and the proportion of nurses with high turnover intention was 40.61%. Age, working years in emergency department (ED), marital status, employment forms, professional title, promotion opportunities, weekly working hours, monthly night shifts and exposure to workplace violence during the year influenced turnover intention of emergency nurses. Work stress and job burnout were positively correlated with turnover intention (r = 0.189, r = 0.391), while perceived organization support and job satisfaction were negatively correlated with turnover intention (r = - 0.349, r = - 0.485). perceived organization support plays a mediating role between work stress and job burnout, between work stress and job satisfaction, and between work stress and turnover intention.

CONCLUSION

Work stress, job burnout, perceived organization support and job satisfaction are important associated factors of emergency nurses' turnover intention in China. It is suggested to take intervention measures to reduce work stress and job burnout and to improve perceived organization support and job satisfaction.

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.

The Impact of the COVID-19 Pandemic on Future Nursing Career Turnover Intention Among Nursing Students

Introduction

A shortage of nurses has been a major global concern, particularly during pandemics. Nursing students turning away from the nursing profession upon graduation may exacerbate nursing workforce shortfalls. The main objective of this study was to assess perceived occupational turnover intention among nursing students and associated factors (fear of COVID-19 and life satisfaction). Students were also asked to provide suggestions that could enhance their intention to join the nursing profession.

Methods

An online survey was sent to all registered undergraduate nursing students at Fujian Medical University, China. The partial least squares structural equation model (PLS-SEM) was used to investigate key factors influencing turnover intention.

Results

A total of 1020 complete responses were received (response rate: 86.2%). Nearly half (49.1%) reported that they would choose not to be on a nursing course if given a choice, 45.4% often think of not going into the nursing profession in the future, and 23.7% would consider entering a healthcare industry that has zero contact with patients. The total turnover intention score range was 3 to 15, and the mean ± standard deviation (SD) was 9.2 (SD ± 2.5). PLS-SEM path analysis revealed that fear of COVID-19 (β = 0.226, p < 0.001) had a positive effect on turnover intention. Satisfaction with life (β = −0.212, p < 0.001) had a negative effect on turnover intention. Analysis of open-ended survey data on students’ perspectives on how to encourage nursing students to enter the nursing workforce revealed five central themes: 1) professional role, respect, and recognition; 2) higher wages; 3) reduce workload; 4) enhance occupational health and safety; and 5) career advancement opportunities.

Conclusion

Factors influencing turnover intention and suggestions to reduce students’ apprehension towards joining the nursing profession found in this study should be seriously taken into consideration in initiatives to address the nurse shortages.

Exploring the mediating role of flexible working hours in the relationship of supervisor support, job and life satisfaction: A study of female nurses in China

Aims

To examine the mediating role of flexible working hours on the relationship between supervisor support, job and life satisfaction among female nurses in China.

Design

A cross‐sectional, quantitative study was conducted with online survey questionnaires.

Methods

Convenience sampling was implemented with 171 female nurses from two tertiary public hospitals in 2019.

Results

The mediation analysis demonstrates that flexible working hours significantly and positively mediate the relationship between supervisor support to job (β = 0.775, p < .001) and life satisfaction (β = 0.745, p < .001). In addition, supervisor support and flexible working hours significantly and positively influence job (r = 0.520, p < .01; r = 0.520, p < .01) and life satisfaction (r = 0.487, p < .01; r = 0.487, p < .01). The study suggested that flexible working hours iarean indicator of what supervisor support (r = 0.656, p < .01) is to improve nurses’ job and life satisfaction. The study revealed that flexible working hours and supervisor support are crucial to female nurses who face high demands at both work and home.

Nurses' intention to leave their job in sub-Saharan Africa: A systematic review and meta-analysis

INTRODUCTION

Nurses' intention to leave their job is a worldwide concern. Internal and external brain drain factors are the main reason for nurses' intention to leave their job. So far, in Sub Sahara Africa, several observational studies have been done on nurses' intention to leave their job. However, a comprehensive review that would have a lot of evidence for designing an intervention is lacking. Hence, this study aimed to the pooled status of nurses' intention to leave their job.

METHODS

In the current meta-analysis, the target variables were searched from different electronic databases. These electronic databases are Pub Med, Google Scholar, Science Direct, African Index Medicus, African Journal Online, EMB ASE, and the Cochran Library. To determine the pooled proportion of intention to leave their job in Sub- Saharan Africa, all the necessary data was extracted by using a standardized data extraction format. We analyzed the data by using Stata 15 statistical software. Heterogeneity between the primary studies assessed by Cochran Q and I-square tests. A random-effect model computes to estimate the pooled nurses' intention to leave their job.

RESULT

We included fifteen full-text studies in the current meta-analysis. The findings of this meta-analysis revealed that the pooled proportion of nurses' intention to leave their job in sub-Saharan Africa was 50.74% (95% CI; 41.33, 60.14; I2 = 95.80%). The subgroup analysis showed that the highest pooled proportion of intention to leave their job (58.03% (95% CI: 47.93, 68.12)) in East Africa. The lowest pooled estimation to leave their job among nurses showed that South Africa (33.04% (95%CI: 20.45, 45.63)).

CONCLUSION

In the current study, there was a high proportion of nurses indentation to leave their job. Nurses' intention to leave their job also varied from region to region in the study area. Therefore, health managers and stakeholders focus on design sufficient development and career opportunities, positive working atmosphere, and secure their autonomy.

Registered nurses' perceptions on the factors affecting nursing shortage in the Republic of Vanuatu Hospitals: A qualitative study

BACKGROUND

Registered nurse has a vital role in delivering healthcare services to individual, family and community. One of the main challenges that health system facing globally is the shortage of nursing workforce. Vanuatu as a Pacific county is also facing the shortage issue and the impact on the registered nurses' performance.

METHODS

A qualitative study was used to collect data from 25 registered nurses in three randomly selected hospitals in Vanuatu between 4th to 14th September, 2020. A semi-structured open-ended questionnaire was used to collect data using face-to-face in-depth interviews. The data were transcribed and analyzed using thematic analysis process.

RESULTS

Four themes were identified including; Difficult working conditions, Reinforcing factors and Perceived risks. Sub themes for difficult working condition were heavy workload, lack of workforce and unusual working hours. Sub themes for reinforcing factors were lack of support, lack of opportunities and advancement in nursing practice. Sub themes for perceived risks were stress, physical and mental risk, and social and family risks.

CONCLUSION

This study has identify factors affected shortage of current nursing workforce and the impact it has on registered nurses. Broad themes and sub-themes were identified which highlighted the impact of nursing shortage to registered nurses and the effects on their performance which includes stress or moral distress from work overload and lengthy hours shift which impact the nurses' physical, psychological, social, and family relationship, and lack of leadership support. The findings can be helpful to policy makers at the decision-making level to resolve the nursing workforce shortage and its effects in the future by refining and developing relevant policies that will address and strengthen the nursing workforce to meet the demand and improve delivery of quality health services to all individual.

The prevalence of compassion satisfaction and compassion fatigue among nurses: A systematic review and meta-analysis

BACKGROUND

Compassion fatigue is a consequence of chronic work-related stress exposure among healthcare providers. Nursing is a high-risk, stressful profession which increases nurses' vulnerability to compassion fatigue symptoms compared to other healthcare workers. Compassion fatigue has serious consequences for nursing staff, patients and healthcare organizations. Though several studies on the prevalence of compassion fatigue among nurses have been published, the reported data vary considerably across studies; and few meta-analysis have examined the prevalence of compassion satisfaction and compassion fatigue among nurses with large sample sizes.

OBJECTIVES

To systematically assess the prevalence of compassion satisfaction and compassion fatigue among nurses, and to evaluate the effect of different geographical regions, years and departments on the prevalence of compassion fatigue.

DESIGN

Systematic review and meta-analysis DATA SOURCES: The Cochrane Library, PubMed, EMbase, Web of Science, CINAHL, PsyclNFO, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched in the systematic review. The time frame for the searches included all literature before January 31st, 2020.

REVIEW METHODS

The reviewers independently completed study selection, quality assessments, data extraction and analysis of all included literature. The mean scores and standard deviations of the three subscales of the Professional Quality of Life (ProQOL) scale were pooled using random effects meta-analysis in Stata 16.0 software package. Finally, subgroup analyses were conducted to explore the sources of between-study heterogeneity.

RESULTS

A total of 79 studies were included in the systematic review and meta-analysis, consisting of 28,509 nurses worldwide from 11 countries. In our studies, the pooled mean scores of compassion satisfaction, burnout and secondary traumatic stress were 33.12 (95% CI: 32.22-34.03), 26.64 (95% CI: 26.01-27.27) and 25.24 (95% CI: 24.69-25.79), respectively. In addition, the Asian region had the lowest levels of compassion satisfaction but the highest levels of compassion fatigue symptoms, while the Americas and Europe had the lowest levels of compassion fatigue but highest compassion satisfaction. Levels of compassionate fatigue in nurses increased gradually from 2010 to 2019, reaching the highest level in 2019; and nurses from ICU had the highest levels of compassion fatigue symptoms among all nurses.

CONCLUSION

The levels of compassion satisfaction and compassion fatigue among nurses are moderate. Nurses from the Asian region and in ICUs suffer from severe compassion fatigue symptoms, and the prevalence of compassion fatigue has increased over time. These findings may provide hospital administrators with the theoretical basis for the management and treatment of compassion fatigue.

REGISTRATION NUMBER

PROSPERO [CRD42020164327].

Servant leadership, organizational identification and turnover intention: an empirical study in hospitals

Purpose

This paper aims to study the relationship between servant leadership (SL), employee turnover intention (TI) and organizational identification (OI) in hospitals.

Design/methodology/approach

The study uses a quantitative approach to investigate the relationships between SL, OI and TI, using data collected from a sample of 266 front-facing employees in a private Indian hospital setup. Structural equation modeling is used to analyze the data and test the hypotheses.

Findings

The findings reveal that servant leadership has a positive relationship with organizational identification and negatively impacts turnover intentions of the front-facing employee. Further, the study also reveals, contrary to expectations, organizational identification has no significant mediating effect between servant leadership and turnover intentions.

Research limitations/implications

This research is limited to front-facing employees in hospitals and the study may be extended to other industries in the service sector. Future studies may consider other mediating and moderating variables to fully understand the mechanism of impact of servant leadership on turnover intention. Multi-level studies can also be carried out.

Practical implications

With the ever-increasing expectations for better patient care, robust leadership models have required that address front-facing employee’s well-being, enabling their attention toward patients. This paper provides the impetus for the development and adoption of servant leadership specifically within hospitals and the service sector.

Originality/value

This study is one of the few studies that empirically examines servant leadership in the health-care domain. The study also contributes to the extant literature on servant leadership by empirically examining the mediation effect of organizational identification between SL and TI. To the authors’ best of knowledge, this study may be the first of its kind, providing evidence of servant leadership’s impact on turnover intention and organizational identification in hospitals using data from the Indian context.

Relationship between workplace ostracism and turnover intention among nurses: the sequential mediating effects of emotional labor and nurse-patient relationship

This study aimed to elaborate on the mechanism by which workplace ostracism influences turnover intention through exploring the sequential mediation effects of emotional labour and nurse-patient relationship. Using a sample of 379 nurses collected from a time-lag survey in a tertiary public hospital in China, we applied structural equation modelling techniques to test our hypothesized model. Our findings revealed that workplace ostracism positively influenced surface acting and deep acting. Workplace ostracism influenced turnover intention through the sequential mediation of surface acting and nurse-patient relationship. The findings of this study imply that nurses should receive education and training in emotional management skills to deal with workplace ostracism. Besides, fostering positive nurse-patient relationships may help reduce nurses' turnover intention.

Turnover among foreign nurses in Saudi Arabia

Background: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon.

Design and methods: The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals.

Results: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores.

Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted.

Exploring the relationships among professional quality of life, personal quality of life and resignation in the nursing profession

AIM

To explore the relationships between nurses' quality of life, personal quality of life, intention to stay (ITS) and resign and factors related to resignation.

DESIGN

Prospective cohort design.

METHODS

The participants were recruited from three different levels of hospital in central Taiwan. The survey instruments were structured questionnaires including demographics, Professional Quality of Life Scale, Short Form Health Survey (SF-36) and the Scale of ITS. The survey data were collected from December 2017-August 2018. Data on nurses' resignation were collected from the hospital systems 3 months after the survey. Descriptive analysis and multiple logistic regression were used to analyse the factors predicting participants' resignation.

RESULTS

Five hundred and fifty-three participants were recruited. Forty-nine out of 553 participants resigned (8.9%). Higher scores in compassion satisfaction were related to a greater ITS (p < .05). Employment units, burnout and ITS were the predictors for resignation (p < .05). We also found that compassion satisfaction moderated the relationship between ITS and resignation.

CONCLUSION

Compassion satisfaction of nursing professionals strengthened the effect of ITS on resignation. Programmes to reinforce satisfaction and stress management could be strategies for increasing nurses' professional quality of life and retention in clinical practice.

IMPACT

The study was the first to explore the relationships between professionals' quality of life, personal quality of life, ITS and resign. The study showed that compassion satisfaction increased the effect between ITS and resignation. Sense of achievement and satisfaction were the most important factors influencing nurses to stay in clinical practice. It is important to enhance nurse compassion satisfaction in nursing career, their job identity and gratification. The effective supportive environment and self-reflection may enhance compassion satisfaction, ameliorate nurse retention and improve the quality of care.

Nurses' turnover intention and associated factors in general hospitals in China: A cross-sectional study

AIM

To measure nurses' turnover intention and identify associated factors in general hospitals in China.

BACKGROUND

Understanding nurses' turnover intention is important to retain nurses, but factors associated with turnover intention require elucidation.

METHOD

A cross-sectional survey was conducted across 23 hospitals in China to investigate nurses' (N = 12,291) turnover intention and its associated factors. Associated factors were explored by univariate and multilevel multiple logistic regression analysis.

RESULTS

The mean total score for nurses' turnover intention was 13.97 ± 3.63. High proactive personality score, a seriously ill family member, experience of negative workplace events, high work pressure and high work-family conflict increased the risk for turnover intention. A low turnover intention was associated with being a non-local resident nurse, position title, high salary level, good person-organisation fit and person-group fit, and high family-work facilitation.

CONCLUSION

Nurses with a proactive personality, heavy family care burden, experience of negative workplace events, no position title and a low salary may merit special consideration.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses' personality traits should be further focused on, and it is important to build a nurse-oriented organisation atmosphere, including protecting nurses from workplace violence, establishing friendly relationships with their families and expanding career paths.

Influencing factors and strategy to the career planning of operating room nurses

Aim

This study aims to investigate the status quo of self‐career planning of nurses working in operating rooms (OR) and analyse the influencing factors.

Methods

A total of 1,418 nurses working in OR were selected and surveyed using a general data questionnaire, a nurse career planning questionnaire and an organizational career management questionnaire.

Results

Multiple linear regression analysis showed that organizational career management perception, hospital‐grade and monthly income were the influencing factors of self‐career planning score of nurses working in OR, which could explain the 56.6% variation of career organization management.

Conclusion

The status quo of self‐career planning in OR nurse was at the middle level, and the scores of different dimensions were not balanced. Reasonable self‐career planning helps the OR nurses improve their professional skills and increase their commitment to work and satisfaction.

Burnout in nurses working in China: A national questionnaire survey

AIM

This study aimed to assess the overall status of burnout in nurses in China on a national scale and investigate the demographic characteristics related to burnout and the relationships between demographics, job satisfaction and burnout.

METHODS

This was a national cross-sectional study conducted by the Chinese Nursing Association between July 2016 and July 2017. Data were collected using a structured, self-administered questionnaire.

RESULTS

A total of 51 406 registered nurses in 311 Chinese cities completed the questionnaire. Fifty per cent of the participants suffered burnout, and 33.8% of nurses had high scores on emotional exhaustion, 66.6% had high scores on depersonalization and 93.5% had low scores on personal accomplishment; 16.2% reported a high level of job satisfaction, only 0.4% was satisfied with their jobs and 70.7% intended to leave their jobs. Marital status, educational level, income and years of working experience affected job burnout. Nurses with a high level of burnout were more likely to have a high degree of job dissatisfaction and intend to leave their jobs.

CONCLUSION

We found a high prevalence of burnout among nurses in China. Nursing managers need to pay more attention to job burnout and its influencing factors. Interventions to reduce nurse burnout should be implemented.

Changes in nurse job outcomes after 4 years of a Best Practice Spotlight Organization® programme implementation in the Spanish National Health Context

AIM

To evaluate the changes produced after the application of the Best Practice Spotlight Organization® (BPSO^® ) Program on the attitude towards the evidence-based practice, the nurses' perception of the organisational climate and nurse outcomes in a health area of the Spanish National Health System.

BACKGROUND

There is limited research that associates strategies of evidence-based practice implementation with changes on the work environment and nurse outcomes.

METHODS

Cross-sectional study that compared data on the nurses' perception of the work environment. Five guidelines were implemented between 2012 and 2015 in a health area. Data were collected in 2012 and 2016/2017, using a questionnaire consisting of five previously validated tools. X² , t test, ANOVA and multivariate analysis were carried out.

RESULTS

A total of 451 nurses participated. Compared with the baseline evaluation in 2012, several outcomes changed significantly (p < .001), nurses were younger and were more satisfied with "salary", "annual leaves" and "sick leave". The rest of the nurse outcomes were not modified.

CONCLUSIONS

Nurses' perception of the work environment is favourable, although the application of the BPSO^® Program has not produced any major changes.

IMPLICATIONS FOR NURSING MANAGEMENT

Measures are suggested that are oriented towards the planning of staffing and the increase in the participation of the nursing staff in programmes of implementation of guidelines.

Recovery Experience: A Concept for Maintaining Quality of Life and Its Mediating Effect Among Female Nurses in China

Purpose

Nurses are high-risk groups for job burnout, which affect their quality of life (QOL). Recovery experience, a conceptualization of positive psychological resources, can combat the negative impacts of job burnout on health and QOL. The aim of this study was to examine the mediating effect of recovery experience on the relationship between job burnout and QOL among female nurses in China.

Participants and Methods

QOL information was captured from 1068 female nurses from December 2017 to February 2018 in tertiary hospitals in Shenyang, Liaoning Province of China. A structural equation model was employed to examine the mediating effect of recovery experience on the relationship between job burnout and QOL.

Results

Job burnout had a significant impact on both the mental component summary and the physical component summary of a 36-item Short-Form Health Survey. However, mental component summary scores were significantly lower than physical component summary scores in female nurses. Recovery experience played a mediating role in the relationship between job burnout and QOL.

Conclusion

Job burnout could result in a reduction in QOL among Chinese female nurses. Recovery experience, as a mediating factor, could alleviate the impact of job burnout on QOL. Recovery experience should be strengthened to attenuate job burnout and enhance QOL.

Predictors of nurses' turnover intention at one and five years' time

AIM

This study examined the role of job dimensions, job satisfaction, psychological stress and job burnout in predicting turnover intention at one and five years' time among professional nurses in the Philippines.

METHODS

A cross-sectional design was utilized in the study using a convenience sample of 549 registered nurses from six hospitals in the Central Philippines during the period of October 2018 to January 2019. Five self-report scales were used in this study.

RESULTS

Overall, 46.1% (n = 253) and 78.9% (n = 433) of nurses reported planning to leave the organization at one and five years' time, respectively. The type of hospital, job satisfaction and job burnout explained variances for turnover intention at one and five years' time. Separately, hospital bed capacity and job stress predicted turnover intention at five years' time. None of the job dimensions accurately predicted turnover intention in nurses.

CONCLUSION

Higher turnover intention results at one and five years' time were dependent on nurses' psychological stress, job burnout and job satisfaction.

IMPLICATIONS FOR NURSING PRACTICE AND POLICY

Organizational measures aimed at reducing stress and burnout and increasing job satisfaction in nurses are critically important to enhance the retention of nurses and ensure continued quality of nursing care.

[Effects of Hospital Characteristics on Employment Rate, Working Period and Retirement of Ward Nurses in Korea: A Retrospective Cohort Study Based on HIRAS Data]

PURPOSE

The purpose of this study was to investigate the effects of hospital characteristics on employment rate, working period, and retirement of ward nurses in Korea through a retrospective cohort study based on HIRAS data.

METHODS

Data were obtained from a report on medical care institutions of Health Insurance Review & Assessment Service (HIRAS). Data from 259,941 nurses who were working for a day or more from January 1, 2012, to December 31, 2016, at 2,942 medical care institutions were analyzed. Life table method analysis, Kaplan-Meier analysis, and Cox proportional hazard regression analysis were conducted.

RESULTS

The employment rates of 5 yeas and 10 years for the total sample were 38% and 28%, respectively. The estimated mean value of the working period was 3,642.7 days (SE: 17.4 days). Cox proportional hazard regression analyses revealed that nurses who were working at the general hospital/hospital, clinic, and nursing hospital were more likely to leave the hospital compared to those who were working at the 3rd general hospital. Nurses who were working at the medical institutions which were located in cities and countries, established by the private foundation, rated lower levels of nursing, and owned an insufficient number of beds, nurses and doctors were more likely to leave their workplace compared to those of the counterparts.

CONCLUSION

This study indicates that hospital characteristics may play a significant role in retirement and working period of ward nurses in Korea. The improvement of hospital conditions to reduce ward nurses' retirement are needed.

A Stress Relief App Intervention for Newly Employed Nursing Staff: Quasi-Experimental Design

Background

Most newly employed nurses have limited practical experience, lack problem-solving abilities, and have low resistance to stress, and therefore often opt to resign from the nursing profession.

Objective

This study aimed to assess the effectiveness of a stress relief app (SR_APP) to monitor the stress levels of newly employed nurses.

Methods

We conducted a quasi-experiment to assess changes in stress levels of newly employed nurses at a case hospital, in which the experimental group used the SR_APP and the control group did not. In-depth interviews were conducted to reveal insights regarding their stress. The app usage experiences of experimental group members were assessed via a questionnaire.

Results

All the participants appreciated the experiment and were interested to know more about managing their stress. The experimental group members showed significant differences in heart rate variability scores before and after using the SR_APP, and they reported high levels of intention to use and satisfaction with regard to the SR_APP.

Conclusions

The SR_APP can be effective in helping newly employed nurses to manage their stress.

Predictors of nursing workers' intention to leave the work unit, health institution and profession

OBJECTIVE

to identify the factors related to the nursing workers' intention to leave the work unit, health institution and profession.

METHOD

cross-sectional study with quantitative approach was carried out with 267 nursing workers from seven emergency units in Brazil. For data collection, we used the Questionnaire of socio-demographic, life style and work and health aspects as well as the Work Ability Index, Workplace violence questionnaire, questions about intention to leave and the Turnover Intention Scale. The predictors of intentions to leave were evaluated through Poisson regression models.

RESULTS

workplace violence increased and better satisfaction with current job decreased the probability of greater intention to leave the unit, institution and profession. Better work ability decreased the probability of greater intention to leave the unit and profession. The more qualified workers and those who had been working in the institution longer was more likely to greater intention to leave the profession.

CONCLUSION

promoting job satisfaction, work ability and a violence-free environment is possible to decrease the workers' intention to leave the job or profession, but nursing managers need to understand the three phenomena of intention to quit individually for retention strategies.

Role of Coping Styles in the Relationship Between Nurses' Work Stress and Well-Being Across Career

OBJECTIVES

This study examines the mediating role of stress coping styles-problem-focused coping and emotion-focused coping-on the relationship between work stress and psychological well-being in clinical nurses according to career experience.

METHODS

A cross-sectional survey design was used. Data were collected from February to March 2016. The study population was composed of 399 nurses working at two university hospitals with over 500 beds located in Seoul and Gyeonggi-do in South Korea. Self-report questionnaires were administered to measure work stress (Work Stress Scale), stress coping styles (Korean version of The Ways of Coping Checklist Scale), and psychological well-being (Ryff's Psychological Well-being Scale). A multiple-group path analysis was performed using SPSS version 21.0.

RESULTS

In the path model analysis (N = 399), work stress directly influenced psychological well-being. Both problem-focused coping and emotion-focused coping were indirectly influenced in the relationship between work stress and psychological well-being. In the group of nurses with 3 years or less of career experience (n = 202), work stress was significantly related to psychological well-being. Only emotion-focused coping exerted a partial mediating effect on the relationship between work stress and psychological well-being. On the other hand, in the group of nurses with over 3 years of career experience (n = 197), work stress was not significantly related to psychological well-being. Both problem-focused coping and emotion-focused coping exerted a full mediating effect on the relationship between work stress and psychological well-being.

CONCLUSIONS AND CLINICAL RELEVANCE

This study's path analysis displayed a distinct pathway in the relationships among work stress, stress coping styles, and psychological well-being between nurses with 3 years or less and nurses with over 3 years of experience. The intervention with decreasing work stress and emotion-focused coping could be effective for nurses with less career experience, whereas the intervention with focusing on improving emotion- and problem-focused coping could be effective for nurses with more career experience. The practical implications of the results suggest that nurses need different stress management programs according to their career experience, as the appropriate use of stress coping styles would improve the psychological well-being of nurses as influenced by their work stress.

A cross-sectional study on nurse turnover intention and influencing factors in Jiangsu Province, China

Background

Nurses' turnover has been a major concern globally, which is strongly influenced by nurses' intent to leave. However, only a few large sample studies on the predictive factors associated with nurses' turnover intention were conducted in Jiangsu Province. This study mainly aims to examine the level and factors that influence nurses to leave their work in Jiangsu Province of Eastern China.

Methods

A cross-sectional survey of 1978 nurses was conducted at 48 hospitals in 14 key cities throughout Jiangsu Province. The turnover intention in nurses was measured by the scale of intent to leave the profession. The work environment of nurses was measured by the Chinese version of the Practice Environment Scale. A multiple linear regression model was applied to analyse the factors associated with turnover intention.

Results

The resignation rate of nurses in the hospitals of Jiangsu Province ranged from 0.64% to 12.71% in 2016.The mean scores were 15.50 ± 3.44 for turnover intention, and 3.06 ± 0.51 for work environment. Involvement in hospital affairs, resource adequacy, age, professional title, year(s) working, employment type and education level were the predictors of nurse intent to leave(P < 0.05).

Conclusion

The work environment of nurses in hospitals must be improved in staffing and resource and nurses' involvement in hospital affairs. The current study corroborates that nurses have high turnover intention. Thus, effective measures are needed to improve nurse accomplishment, professional status, participation in hospital affairs and career planning to reduce their turnover intention.

Factors related to intention to stay in the current workplace among long-term care nurses: A nationwide survey

BACKGROUND

Keeping long-term care nurses employed is necessary to sustain the current and future demand for high-quality long-term care services. Understanding the factors relating to intention to stay among long-term care nurses is limited by the scarcity of studies in long-term care settings, lack of investigation of multiple factors, and the weakness of existing explanatory models.

OBJECTIVE

To identify the factors associated with long-term care nurses' intention to stay in their current workplace.

DESIGN

A cross-sectional questionnaire survey.

SETTING

Two hundred and fifty-seven hospitals with long-term care wards across Japan.

PARTICIPANTS

A total of 3128 staff nurses and 257 nurse managers from the long-term care wards of the participating hospitals.

METHOD

The questionnaire assessed nurses' intention to continue working in the current workplace as well as potential related factors, including individual factors (demographic data, reason for choosing current workplace, burnout, work engagement, somatic symptom burden) and unit factors (unit size, nurse-manager-related data, patients' medical acuity, average number of overtime hours, recreational activities, social support, perceived quality of care process, educational opportunities, feeling of loneliness, and ability to request days off). Multilevel logistic regression analysis was used to determine which variables best explained nurses' intention to stay in their workplace.

RESULTS

Only 40.1% of the respondents reported wanting to continue working at their current workplace. The regression analysis revealed that long-term care nurses' intention to stay was positively associated with nurses' age (odds ratio [95% confidence interval]: 1.02 [1.01-1.03]), work engagement (1.24 [1.14-1.35]), getting appropriate support from nurse managers (2.78 [1.60-4.82]), perceived quality of care process (1.04 [1.01-1.06]), educational opportunities (1.06 [1.0-1.13]), and various specific reasons for choosing their workplace (e.g., a good workplace atmosphere, being interested in gerontological nursing, and a high salary). By contrast, intention to stay was negatively associated with emotional exhaustion (0.93 [0.91-0.95]) and depersonalization (0.91 [0.89-0.93]). Intention to stay was associated with neither nurses' qualifications nor patient medical acuity.

CONCLUSION

Reason for choosing the workplace, work engagement, getting support from the nurse manager, and perceived quality of care process are significant predictors of long-term care nurses' intention to stay in the workplace. Promoting such nurses' work engagement, provision of high-quality care, and access to educational opportunities might augment long-term care nurses' intention to stay.