Individual and Organizational Factors Associated With Intent to Leave the Job and Public Child Welfare Field Amid the COVID-19 Pandemic

The public child welfare system is plagued with high turnover, which is consistently associated with job-related stress. However, the COVID-19 pandemic introduced challenges that impact both the work and caseworkers' decision to stay in their job. To better understand stressors and intention to stay amid the COVID-19 pandemic, one state-level agency implemented a survey, completed by forty-eight percent of public child welfare caseworkers in the state. The current analysis employs multinomial logistic regression to predict intention to stay in the job and in the field and narrative analysis to describe caseworker experiences. Expanding on prior research, findings suggest that caseworker perception of an organization's response to COVID-19 challenges is associated with a caseworker's intent to leave. Further, this study highlights the distinction in commitment to the field compared to commitment to one's job, introduces challenges associated with work during the COVID-19 pandemic, and describes worker-identified benefits of those work changes.

Resilience in Nurses: The Reliability and Validity of the Resilience ScaleTM

Background and Purpose: The Resilience ScaleTM (RS) RS-25 and shortened RS-14 have measured resilience but not with nurses. Our purpose was to investigate both for nurses. Methods: A random sample of 345 registered nurses from the North Carolina Board of Nursing completed an online questionnaire. Parallel analysis, factor analysis, and receiver operating characteristic analysis were performed. Results: Previous RS factor models had poor confirmatory factor analysis fit. Exploratory factor analysis and item analyses suggested removing items. Good fit was found for an "RS-13" using a bifactor approach. Adequate internal consistency was demonstrated (omega = 0.77-0.90). The RS-13 general factor gave similar accuracy for bullying, physical and mental quality of life, stress, and intent to leave. Conclusions: A shortened RS is comparable in reliability, construct, and convergent validity. It measures nurse resilience well.

Factors Associated With Intent to Leave the Profession for the Allied Health Workforce: A Rapid Review

Shortages of satisfied and well-trained health care professionals are an urgent threat for health systems worldwide. Although numerous studies have focused on retention issues for nurses and physicians, the situation for the allied health workforce remains understudied. We conducted a rapid review of the literature on allied health workers to investigate the main reasons for leaving their profession. 1,305 original research articles were retrieved from databases MEDLINE, CINAHL, PsycInfo, and Epistemonikos, of which 29 were eligible for data extraction. Reviewed studies featured mainly pharmacists, psychologists, dietitians, physical therapists, emergency medical professionals, and occupational therapists. We categorized 17 typical factors of the intent to leave as organizational, psychological, team and management, and job characteristics. The relative importance of each factor was assessed by measuring its prevalence in the selected literature. By revealing common themes across allied health professions, our work suggests actionable insights to improve retention in these vital services.

Mediating effects of workgroup processes on the relationship between nurse turnover and nurse outcomes in hospitals

Background

Nurse turnover is often considered to be an outcome, and few studies have investigated its consequences in nursing care. The underlying mechanism of the nurse turnover-nurse outcome relationship has not been empirically investigated. Therefore, this study examines workgroup processes and nurse outcomes as the consequences of nurse turnover and the mediating effect of workgroup processes on the nurse turnover-nurse outcomes relationship.

Methods

A cross-sectional design was adopted to investigate the data collected from 264 staff nurses. Furthermore, six-month turnover rates, workgroup processes (nurse-nurse collaboration, team cohesion), and nurse outcomes (job satisfaction, intent to leave) were utilized in the multivariate regression models.

Results

Overall, 53 (24.4%) nurses had worked in nursing units with a zero six-month turnover rate. The average mean six-month turnover rate was 15.5%. Nurse turnover adversely affected nurses' job satisfaction and several subscales of team cohesion including task cohesion and social cohesion. Team cohesion partially mediated the relationship between nurse turnover and job satisfaction.

Conclusion

Nurse turnover decreased job satisfaction and team cohesion, and team cohesion partially mediated the nurse turnover-nurse outcomes relationship. These findings provide evidence supporting the significant adverse effects of nurse turnover and suggest the potential role of workgroup processes in explaining the underlying mechanism of the relationship between nurse turnover and nurse outcomes.

Implications for nursing and health policy

Healthcare organizations must create a positive work environment to reduce nurse turnover. Further, states and countries should try to develop and establish nursing and health policies to prevent turnover.

Retaining employment in the hospital setting: A descriptive phenomenological study of Indonesian nurses' experiences

Background

Losing competent nurses due to turnover can have adverse effects on healthcare administration, service delivery, and organizational dynamics. Frequent staff turnover can hinder optimal nursing practices, but some nurses remain committed. Therefore, understanding factors that foster sustained engagement and retention is crucial to create a retention strategy.

Objective

This study aimed to explore the current experience of Indonesian nurses who retain their jobs in the hospital setting.

Methods

A phenomenological design was employed in this study, with ten nurses selected using purposive sampling. Semi-structured interviews were used to gather data from a private hospital in Batam, Indonesia, between January and March 2022. A conventional content analysis was used to analyze the data.

Results

The participants had an average total work experience of 10.4 years and an average age of 35.6 years, ranging from 28 to 44 years. The majority of the participants were females, held bachelor's degrees, and were married. Three main themes were developed in this study: solid teamwork, adequate compensation, and professional career development.

Conclusion

Retaining experienced nurses in hospitals is influenced by antecedents such as teamwork, pay, and career growth. These findings offer nursing and hospital managers insights into developing policies and strategies to improve hospital nursing retention programs in Indonesia and beyond.

Factors Influencing Perioperative Nurse Turnover: A Classic Grounded Theory Study

Perioperative nurse turnover rates range from 12% to 18.8%, and approximately 75% of perioperative managers reported at least one vacancy in 2021. Perioperative leaders are challenged to mitigate nurse turnover effectively because factors contributing to a nurse's decision to leave their job are not well defined. The purpose of this qualitative study using classic grounded theory was to explore perioperative nurses' turnover decision-making processes. We used social media to recruit participants and then conducted 26 interviews to collect data. We completed comparative analysis of the data and developed the Perioperative Nurse Turnover Decision-Making Theory, which describes the influence of the dimensions of perioperative nurse well-being (ie, physical and emotional well-being, career development, work-life balance, compensation, workplace culture) on their decision to leave an OR position. Perioperative leaders should consider the nurses' decision-making process when developing and implementing interventions aimed at reducing turnover.

Family or otherwise: Exploring the impact of family motivation on job outcomes in collectivistic society

The motive of the current research is to determine the influence of family motivation on intent to leave and job performance using self-determination theory. Moreover, this study also explores the moderating role of collectivistic culture and the mediating role of psychological meaningfulness on the relationship between family motivation and work outcomes. The data (N = 175) were collected from paramedical staff working in Pakistani public hospitals, and data was analyzed using PROCESS method. The findings revealed that family motivation enhanced employee job performance and lessened employees' intent to leave. At the same time, family motivation and psychological meaningfulness are stronger in highly collectivistic cultures compared to less collectivist cultures. This study extends the investigation of the newly developed construct of family motivation by focusing on psychological meaningfulness and collectivistic culture. Moreover, this study is the first to introduce psychological meaningfulness as a mediator and collectivistic culture as a moderator for the relationship between family motivation and employee job outcomes. This study provides several critical insights for the hospitals by exploring the importance of family motivation as a potential motivational resource for maintaining high employee job-performance levels and lessening the intent of employees to leave.

Determinants of Stress, Depression, Quality of Life, and Intent to Leave in Washington State Emergency Medical Technicians During COVID-19

OBJECTIVES

This study characterizes determinants of stress, depression, quality of life, and intent to leave among emergency medical technicians (EMTs) in the Puget Sound region, Washington, during the COVID-19 pandemic and identifies areas for intervention on these outcomes.

METHODS

A cross-sectional survey measured stress, depression, quality of life, and intent to leave among EMTs ( N = 123). Regression models were developed for these outcomes.

RESULTS

A total of 23.8% of respondents were very likely to leave their position in the next 6 months. Job demands predicted stress and depression, and financial security predicted stress and quality of life. Intent to leave was predicted by stress, manager support, and length of employment.

CONCLUSIONS

Increased exposure to hazards has impacted EMT mental health. Emergency medical technicians are vital to healthcare, so improving EMT health and well-being is important, as attrition during a pandemic could impact public health.

Relationship between interprofessional teamwork and nurses' intent to leave work: The mediating role of job satisfaction and burnout

BACKGROUND

Reducing nurse turnover is a top priority for nursing management globally. While evidence has demonstrated that working in a favorable environment with greater interprofessional teamwork is essential in increasing nurse retention, few studies have explored the mechanism underlying this relationship.

AIM

To examine the direct and indirect effects of interprofessional teamwork on nurses' intentions to leave their jobs via the intermediary roles of job satisfaction and burnout.

METHODS

A cross-sectional study was conducted to collect data from 2113 nurses working in 21 hospitals in Oman. Data were collected using a survey questionnaire measuring teamwork, job satisfaction, burnout, and intention to leave. Logistic regression was used to investigate the direct effect of teamwork on intent to leave. A sequential mediation model was conducted to examine the mediating role of job satisfaction and burnout.

RESULTS

Interprofessional teamwork was directly associated with nurses' intentions to leave. The influence of teamwork on intention to leave was indirectly mediated by both job satisfaction and job burnout.

CONCLUSION

Findings illustrate the potential benefits of enhancing interprofessional teamwork in reducing nurses' intentions to leave. Interventions intended to foster teamwork could create satisfying workplaces, reduce perceived burnout, and ultimately contribute to organizational strategy for reducing nursing shortages.

Perceptions of US nurses and nurse leaders on authentic nurse leadership, healthy work environment, intent to leave and nurse well-being during a second pandemic year: A cross sectional study

AIM

The main aim of this study was to determine the perceptions of clinical nurses and nurse leaders about authentic nurse leadership, work environment, pandemic impact, well-being and intent to leave their position and profession during the second year of the pandemic.

BACKGROUND

This research team studied the variables pre-pandemic and in year one of the pandemic. As the pandemic continued, subsequent reports of workforce instability, deteriorating work environment and vulnerable well-being called for an understanding of the current state to inform needed actions by leadership.

METHODS

This study is a cross-sectional, descriptive, correlational analysis using national survey data from 1795 US clinical nurses and nurse leaders in the fall of 2021.

RESULTS

Pandemic impact was high, authentic nurse leadership was present, healthy work environment was not present and nurse well-being was at-risk and negatively correlated to both healthy work environment and authentic nurse leadership. Within our sample, 61.8% of nurses had no intention to leave their positions, and 82.5% had no intention to leave the profession. Compared with clinical nurses, nurse managers had significantly higher scores on all instruments.

CONCLUSIONS

The findings of this study support leadership as positively related to a healthy work environment. Authentic nurse leadership, a healthy work environment and nurse well-being are all critical components of efforts to stabilize the nursing workforce as we recover and rebuild post-pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

This is a call to action for leadership that will serve the goals of retaining nurses, rebuilding work environments and improving well-being.

Burnout and intent to leave during COVID-19: A cross-sectional study of New Jersey hospital nurses

Aim

The aim of this work is to examine staffing, personal protective equipment (PPE) adequacy and physical exhaustion that contributed to burnout and intent to leave among hospital nurses during the first peak of the COVID‐19 pandemic.

Background

Burnout is associated with adverse nurse and patient outcomes. Identifying the magnitude of burnout that occurred during the pandemic can prepare managers for the long‐term mental health effects on nurses.

Methods

A cross‐sectional, electronic survey was administered to examine perceptions of burnout and intent to leave among all New Jersey hospital nurses from October 6 to October 26, 2020.

Results

A total of 3030 nurses responded with 64.3% reporting burnout and 36.5% reporting intent to leave the hospital within a year. There was a significant association between high levels of burnout and intent to leave (χ² = 329.4; p = .001). There was no association between staffing and burnout; however, reporting inadequate PPE (OR = 1.77 [95% CI: 1.34–2.34]) and physical exhaustion (OR = 3.89 [95% CI: 3.19–4.76]) remained predictors of burnout among nurses.

Conclusion

Inadequate PPE and physical exhaustion coupled with short staffing contributed to burnout and intent to leave.

Implications for Nursing Management

Managers should continue to utilize evidence‐based mental health interventions and advocate within their nursing professional organizations for relief funds to reduce burnout.

Advanced practice nurse work environments and job satisfaction and intent to leave: Six-state cross sectional and observational study

AIMS

To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States.

DESIGN

The study used a cross-sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States.

METHODS

We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018-2019. The work environment was measured using the Nurse Practitioner-Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner-Administration Relations, Nurse Practitioner-Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed-effect proportional-odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave.

RESULTS

Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one-unit increase in the organizational-level Nurse Practitioner-Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational-level Nurse Practitioner-Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave.

CONCLUSION

Improvements in work environments may improve nurse practitioner job satisfaction and retention.

IMPACT

This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity.

Understanding the factors that affect retention within the mental health nursing workforce: a systematic review and thematic synthesis

There are over 41 000 vacant nursing posts across the United Kingdom's National Health Service (NHS), with more people leaving the profession that joining it. Despite mental health being acknowledged as a priority area, some of the most significant staff shortages are occurring within mental health services. Urgent action is needed to retain the mental health nurses (MHNs) currently in post to ensure the profession is fit for purpose and aid future recruitment efforts. This review set out to identify the individual factors that affect the retention of MHNs. A systematic search of six databases was conducted (CINAHL, PsychINFO, MEDLINE, Web of Science (Core collection), EMBASE and the British Nursing Index). Studies were systematically screened for inclusion based on predetermined eligibility criteria. The studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). Findings were synthesized using Thematic Synthesis. A total of 23 studies consisting of a range of study designs were included in the review. Four key themes emerged from the synthesis: Individual characteristics, Working within mental health services, Training and skills and Work environment. The findings from this review suggest that MHNs encounter some factors unique to working in mental health services, which suggests that retention strategies should be specific to each nursing speciality. Beyond nursing speciality, the factors identified vary between clinical settings in mental health due to the differences in work environments and services they provide. Future studies should now set out to explore what factors exist in which clinical settings to inform better tailored retention strategies to generate better outcomes.

The relationship between paediatric nurses' quality of life and intent to leave: The moderating role of hospital type

Background

Different types of hospitals exist in Jordan, and each type has its own leadership style. This might affect the nursing workforce in terms of quality of life and intent to leave.

Aim

This study aimed at (1) assessing the relationship between paediatric nurses' quality of life and intent to leave, (2) examining the moderating effect of the hospital type on this relationship, (3) comparing the quality of life of paediatric nurses working at ministry of health and the University‐Affiliated hospitals and (4) exploring the determinants of nurses' intent to leave.

Design

A cross‐sectional, comparative and correlational design was used in this study.

Methods

A multi‐site sample was selected from two types of hospitals in Jordan; the ministry of health and the University‐Affiliated hospitals. A sample of 225 paediatric nurses responded to the brief quality of life questionnaire by the World Health Organization in addition to a group of sociodemographic and work‐related questions.

Results and conclusion

Nurses' quality of life and intent to leave were negatively correlated. This correlation was moderated by the type of hospital. Nurses' quality of life was significantly different in the two types of hospitals. Both salary and nursing care model predicted paediatric nurses' intent to leave. The managerial style and work environment of the ministry of health hospitals should be benchmarked against the University‐Affiliated hospitals.

The impact of personality on intention to leave the nursing profession: A structural equation model

AIMS AND OBJECTIVES

To test a mediating effect of compassion satisfaction on the relationship between personality traits (Big Five) and intent to leave.

BACKGROUND

Nursing professionals work in high-stress environments and exhibit more emotional distress and mental health disorders than other hospital professionals. This translates to increased intention to leave their profession. Evidence suggests that compassion satisfaction reduces intention to leave. Research also indicates that personality factors are associated with compassion satisfaction and intent to leave.

DESIGN

Using a cross-sectional design, we collected data from 536 nurses in a maximum-care hospital in Germany via questionnaires; the analyses included 518 participants.

METHOD

We applied the structural equation model and followed the STROBE checklist.

RESULTS

30% of our study participants reported high intent to leave. Compassion satisfaction mediated the relationship between agreeableness and intent to leave. Openness to experience and neuroticism had positive direct effects on intent to leave.

CONCLUSIONS

The results suggest that high compassion satisfaction levels may decrease intention to leave levels. Personality traits impact compassion satisfaction and intention to leave.

RELEVANCE TO CLINICAL PRACTICE

Nursing professionals' compassion satisfaction needs to be improved, for example by resilience training. As personality factors remain relatively stable over time, caregivers need to consider them when identifying appropriate areas of work and responsibility.

Associations between person-centred care and job strain, stress of conscience, and intent to leave among hospital personnel

AIM

To determine the associations between person-centred care (PCC) and job strain, stress of conscience and intent to leave among healthcare professionals in Swedish hospital departments.

BACKGROUND

Hospitals have experienced difficulty in retaining qualified healthcare personnel. Previous studies have shown that working in a person-centred environment could offset this challenge, but research is scarce.

DESIGN

A cross-sectional survey design using the STROBE checklist.

METHODS

Healthcare professionals (n = 94) in six hospital departments in Sweden completed a survey measuring perceived PCC, job strain, stress of conscience and intent to leave. Data were collected from April 2019 to April 2020. Bivariate analysis was used to describe the sample and correlations between the explanatory variables and perceived PCC and its subscales. Regression analyses were performed to explore the associations between perceived PCC and job strain, stress of conscience and intent to leave.

RESULTS

The organisational and environmental support subscale of perceived PCC showed significant correlations with all explanatory variables, while the extent of personalising care subscale only correlated with job strain and intent to leave. The regression analyses showed that higher perceived PCC was associated with higher job strain, less stress of conscience and less intent to leave.

CONCLUSION

Higher perceived PCC is associated with work-related factors in hospital departments. There is scope for further research in this area.

Comparing the Impact of COVID-19 on Nurses' Turnover Intentions before and during the Pandemic in Qatar

Background: Although several studies examining nurses’ turnover intentions have been conducted, few studies have been conducted to explore how COVID-19 contributes to nurses’ turnover intentions. This study aims to compare nurses’ turnover (TO) intentions before and during COVID-19. Methods: The cross-sectional study was conducted using the Turnover Intention Scale (TIS-6) and a convenience sample of participants from the largest healthcare provider in Qatar between August and September 2020. Results: A total of 512 nurses were included in the final analysis. The majority were between 31 and 40 years of age (61.5%), 67.6% were females, 76.4% were married, 79.7% had a BSN, 43% had less than 5 years of experience, and 60.4% had worked in COVID-19 designated facilities. The turnover intentions were higher compared with before COVID-19 (p < 0.01). Conclusion: Nurses in Qatar have higher TO intentions during COVID-19. The participants’ characteristics and stress levels are playing a major role in nurses’ decision to leave during COVID-19. Understanding the factors that contribute to turnover intentions is crucial for workforce planning, especially during pandemics.

Surveys conducted pre- and post-implementation of a synergy tool: Giving voice to emergency teams

AIM

To investigate the impact of a patients' needs assessment (synergy tool) on emergency department nurses' perceptions of quality, safe care delivery and morale.

BACKGROUND

The synergy tool provides real-time data on types of patients, their arrival, management and discharge. This tool was introduced to two urban emergency departments in response to government priorities to reduce emergency department wait times and improve patient flow.

METHOD

This survey, a component of participatory action research, measures perceptions of 158 nurses pre-introduction and 91 nurses post-introduction of the synergy tool.

RESULT

Responses were consistent regarding intent to leave, workload/staffing, spirit at work and quality/safety. One question describing staff as working in 'crisis mode' indicated a significant improvement.

CONCLUSION

Critical patient care may be missed during periods of overload, placing patients and staff at risk, leading to an increase in intent to leave. The synergy tool provides an objective means in real time for staff to identify their patients' care needs, assisting management with staffing decisions. Ongoing staff and management communication using tools such as the synergy tool may reduce perceptions of working in 'crisis mode'.

IMPLICATIONS FOR NURSING MANAGEMENT

This research suggests that when managers employ a collaborative process and use evidence-based tools and approaches to addressing nurses' workload concerns, nurses' perceptions of working in 'crisis mode' diminish.

The Impact of Organizational Support on Practice Outcomes in Nurse Practitioners in Taiwan

BACKGROUND

Nurse practitioners (NPs) in Taiwan have practiced mainly in acute care hospitals since 2006. Although organizational support and level of support have been associated with the successful integration of NP roles and effective practice outcomes, organizational support in the context of NPs in inpatient settings is an area that has been rarely explored in the literature.

PURPOSE

The purpose of this study was to investigate the relationship between organizational support and the practice outcomes of job satisfaction, care effectiveness, and intention to leave in NPs.

METHODS

A national survey of 512 NPs was conducted that included a demographic characteristics datasheet, the Nurse Practitioner Primary Care Organizational Climate Questionnaire, the Misener Nurse Practitioner Job Satisfaction Scale, and the Nurse Practitioner Care Effectiveness Scale. Multiple regression analysis was applied to explore the specific factors associated with job satisfaction. The statistical significance level was set at .05 with a two-tailed test. All statistical analyses were conducted using SPSS Statistics Version 22.0 software.

RESULTS

More than half of the participants were found to be dissatisfied with their hospital managers (54.8%) and with each dimension of organizational support. Overall, 82.1% of the participants were satisfied with their current practice. A multiple regression analysis showed that the participants who perceived higher levels of organizational support in the workplace (β = .53, p < .001), expressed satisfaction with working with their managers (β = .25, p < .001), or perceived better care outcomes (β = .10, p < .001) reported higher job satisfaction. In addition, the participants who expressed intention to leave within 1 year (β = -.09, p < .001) and those with higher patient loads (β = -.09, p < .001) reported lower job satisfaction. Organizational support was found to explain 50% of the variance in job satisfaction.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results of this study highlight organizational support as the most important factor affecting job satisfaction in NPs. Therefore, administrators work to promote organizational support and improve the work environment to enhance the job satisfaction, increase the clinical practice retention, and improve the care outcomes of NPs.

Intensive care nurse staffing and nurse outcomes: A systematic review

BACKGROUND

Intensive care units (ICU) are associated with significant work stress and exert continuous physical and emotional demand upon health care providers. The health and well-being of care providers, including ICU nurses, is a matter of great concern. However, to the researcher's knowledge, there have been no reviews synthesizing the evidence about the relationship between nurse staffing and nurse outcomes in the ICU.

PURPOSE

The purpose of this systematic review was to examine nurse staffing in the ICU and synthesize literature to examine the relationship with nurse outcomes such as job satisfaction, burnout, fatigue, and intent to leave.

METHODS

This review was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed articles published between January 2000 and September 2019 were identified via eight electronic bibliographic databases. Articles were included and reviewed if they were correlational studies examining the relationships between nurse staffing and nurse outcomes in the ICU, and were published in peer-reviewed journals written in either English or Korean. The Quality Assessment and Validity Tool for Correlation Studies was used for quality appraisal.

RESULTS

From 5086 articles, eight published between 2006 and 2019 were included in this review. Three studies found expected relationships between worse nurse staffing and adverse nurse outcomes (high burnout, fatigue state, emotional exhaustion, depersonalization, and stress). However, the relationships between nurse staffing and other adverse nurse outcomes were not significant. Perceived adequate staffing was negatively related to adverse nurse outcomes. However, a non-significant relationship also was found.

CONCLUSION

This study found limited evidence on relationships between nurse staffing and nurse outcomes in the ICU. More studies are needed to conduct to find a conclusive relationship.

RELEVANCE TO CLINICAL PRACTICE

Given high demands and workload in the ICU, nurse staffing levels should be closely monitored to prevent adverse nurse outcomes.

Person-Centered Care Environment Associated With Care Staff Outcomes in Long-Term Care Facilities

BACKGROUND

Although a general implementation of person-centered care in Korean long-term care delivery systems would be challenging, person-centered care has the potential to improve resident and staff outcomes through changes in current care services. However, little empirical evidence currently supports a positive relationship between person-centered care environments and staff outcomes.

PURPOSE

This study was designed to examine the relationship between person-centered care environments and staff outcomes, including job satisfaction and turnover intention, among care staff in Korean long-term care facilities.

METHODS

This descriptive, correlational study used data from 235 care staff (94 nursing staff and 141 personal care workers) in 13 long-term care facilities in Korea. Data were collected using structured survey questionnaires, including items related to the person-centered care environment, job satisfaction, and turnover intention. Multilevel linear and logistic regression analyses were performed using Mplus Version 7.0.

RESULTS

After controlling for individual (age, education, monthly income, position, shift work, and job tenure) and organizational (type of facility, location, ownership, bed size, and staffing levels) characteristics, a significant relationship was found between the person-centered care environment and job satisfaction and turnover intention among staff in Korean long-term care facilities.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The study findings indicate that working in a person-centered care environment is key to higher job satisfaction, which is a significant predictor of turnover intention among staff in long-term care facilities. To recruit and retain qualified staff to provide high-quality person-centered care in long-term care facilities, a supportive work environment is crucial. Fostering a person-centered care environment will ultimately improve quality of care for residents.

The importance of organizational commitment in rural nurses' intent to leave

Aims

To examine determinants of intention to leave a nursing position in rural and remote areas within the next year, for Registered Nurses or Nurse Practitioners (RNs/NPs) and Licensed Practical Nurses (LPNs).

Design

A pan‐Canadian cross‐sectional survey.

Methods

The Nursing Practice in Rural and Remote Canada II survey (2014–2015) used stratified, systematic sampling and obtained two samples of questionnaire responses on intent to leave from 1,932 RNs/NPs and 1,133 LPNs. Separate logistic regression analyses were conducted for RNs/NPs and LPNs.

Results

For RNs/NPs, 19.8% of the variance on intent to leave was explained by 11 variables; and for LPNs, 16.9% of the variance was explained by seven variables. Organizational commitment was the only variable associated with intent to leave for both RNs/NPs and LPNs.

Conclusions

Enhancement of organizational commitment is important in reducing intent to leave and turnover. Since most variables associated with intent to leave differ between RNs/NPs and LPNs, the distinction of nurse type is critical for the development of rural‐specific turnover reduction strategies. Comparison of determinants of intent to leave in the current RNs/NPs analysis with the first pan‐Canadian study of rural and remote nurses (2001–2002) showed similarity of issues for RNs/NPs over time, suggesting that some issues addressing turnover remain unresolved.

Impact

The geographic maldistribution of nurses requires focused attention on nurses' intent to leave. This research shows that healthcare organizations would do well to develop policies targeting specific variables associated with intent to leave for each type of nurse in the rural and remote context. Practical strategies could include specific continuing education initiatives, tailored mentoring programs, and the creation of career pathways for nurses in rural and remote settings. They would also include place‐based actions designed to enhance nurses' integration with their communities and which would be planned together with communities and nurses themselves.

Physician-Nurse Practitioner Teamwork in Primary Care Practices in New York: A Cross-Sectional Survey

BACKGROUND

Primary care practices increasingly rely on the growing workforce of nurse practitioners (NPs) to meet primary care demand. Understanding teamwork between NPs and physicians in primary care practices is critically important.

OBJECTIVE

We assessed teamwork between NPs and physicians practicing within the same primary care practice and determined how teamwork affects their job satisfaction, intent to leave their current job, and quality of care.

DESIGN

A cross-sectional survey design was used to collect data from both NPs and physicians in New York State in 2017.

PARTICIPANTS

584 participants (398 NPs and 186 physicians) from 476 primary care practices completed the survey yielding a 27% response rate for NPs and 12% for physicians.

MAIN MEASURES

The survey tool contained validated measures of teamwork and three outcomes: job satisfaction, intent to leave, and perceived quality of care. Simple and multi-level multivariable regression models were built.

KEY RESULTS

Most participants (76%) were either moderately satisfied or very satisfied with their job (NP sample: 75%; physician sample: 77%) and about 10% intended to leave their current job (NP sample: 11%; physician sample: 9%). The average perceived quality of care was the same across NP and physician samples with a mean of 8.5 on a 11 point scale. After controlling for confounders, a higher organizational-level teamwork score was associated with higher job satisfaction (cumulative OR: 3.00; 95% CI: 1.85-4.88), lower odds of intent to leave (OR: 0.25; 95% CI: 0.09-0.74), and higher perceived quality of care (b=1.00; 95% CI: 0.77-1.23).

CONCLUSIONS

This study produced evidence about NP-physician teamwork in primary care practices. We found the vast majority of NPs and physicians reported favorable teamwork, and that teamwork affects clinician job satisfaction and intent to leave as well as perceived quality of care in their practices.

Organizational Support for Nurse Practitioners in Primary Care and Workforce Outcomes

BACKGROUND

Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners.

OBJECTIVE

We investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care.

METHODS

A cross-sectional survey design was used to collect survey data from nurse practitioners (n = 398) in primary care practices in New York State in 2017. Nurse practitioners completed mail surveys with validated measures of organizational support, job satisfaction, intent to leave, and quality of care. Information on participant demographics and work characteristics was also collected. Multilevel regression models assessed the relationship between organizational-level organizational support and resources measure and job satisfaction, intent to leave, and quality of care.

RESULTS

The organizational-level organizational support and resources measure had a mean of 3.31 on a 4-point scale. Twenty-five percent of the participants were either moderately dissatisfied or very dissatisfied with their jobs, and about 11% intended to leave their current jobs within 1 year. The average quality of care rated by participants was 8.51 out of 10-10 being the best quality of care. After adjusting for covariates, higher organizational-level organizational support and resources measure score was associated with higher job satisfaction category, lower odds of intent to leave, and higher quality of care.

DISCUSSION

Nurse practitioners from primary care practices with higher levels of organizational support are more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care. Thus, in order to promote nurse practitioner job satisfaction, retain them in clinical positions, and improve quality of care, administrators should take actions to promote organizational support for them. Our findings are consistent with existing literature regarding the relationship between organizational support and clinician outcomes.

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

Background: The work environment factors associated with nurses' intention to leave their jobs are not well understood because most studies have used non-probabilistic sampling methods, thus restricting the generalizability of the results. This study examined the relationship between work environment factors and intent to leave among nurses working in acute care hospitals in Ontario, Canada. Methods: This study included a random sample of 1,427 registered nurses who were part of a larger cross-sectional study and who responded to a mailed survey that included measures of resource availability, interprofessional collaboration, job satisfaction, and demographics. Results: Most of the respondents were female (94.8%), with an average age of 45.6 years, and 14.5 years of nursing experience at their current workplace, which included mostly urban (94.6%) and non-teaching hospitals (61.8%). In the multivariate model, we observed that the work environment variables explained 45.5% of the variance in nurses' intent to leave scores, F(9, 1362) =125.41, p < .01, with an R² of .455 or 45.5%. Job satisfaction (p < .01), flexible interprofessional collaborative relationships (p = .030), and resource availability (p < .01) were significantly associated with nurses' intent to leave scores. Conclusion/Application to Practice: Nurses who reported greater job satisfaction, flexible interprofessional relationships, and resource availability were less likely to express an intent to leave their hospital workplaces. Employers and health policy makers may use these findings as part of a broader strategy to improve the work environment of nurses. Occupational health nurses are ideally positioned to demonstrate leadership in promoting retention efforts in the workplace by advocating for the importance of job satisfaction, flexible interprofessional relationships, and resources.

Nurse Burnout Revisited: A Comparison of Computational Methods

BACKGROUND AND PURPOSE

To examine computational measures of job-related burnout to determine the best computation to estimate job satisfaction and intent to leave in Brazilian nursing professionals.

METHODS

Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used assess burnout in 452 hospital-based nursing professionals. Adjusted logistic regression models were fit using different computations of burnout to estimate outcomes of interest.

RESULTS

Total mean score of burnout subscales was the best estimate of job satisfaction (Cox-Snell R² = 0.312; Nagelkerke R² = 0.450) and intent to leave (Cox-Snell R² = 0.156; Nagelkerke R² = 0.300), as was high emotional exhaustion (Cox-Snell R² = 0.219; Nagelkerke R² = 0.316).

CONCLUSION

We have provided evidence that different computations of data from the Portuguese (Brazil) MBI-HSS can be used in to estimate the effect of job-related burnout on nurse outcomes.

Relationship between authentic leadership and nurses' intent to leave: The mediating role of work environment and burnout

AIM

The aim of this study was to explore the mediating effects of work environment and burnout on the relationship between authentic leadership and the intention of nurses to leave their job.

BACKGROUND

Authentic leadership can contribute to a good work environment. Burnout is a critical factor that affects nurses‧ intent to leave. The mediating roles of work environment and burnout on the relationship between authentic leadership and intent to leave is unclear.

METHODS

A cross-sectional design was used, and 946 nurses from three different levels of hospital (medical center, regional, and district), defined in terms of the number of beds and type of medical care provided, responded to four self-report questionnaires.

RESULTS

Work environment and burnout mediated the effect of authentic leadership on intent to leave among nurses. The mediating effects of burnout on authentic leadership was present both for junior (β = 0.073) and senior (β = 0.081) nurses.

CONCLUSION

Authentic leadership can affect nurses‧ intent to leave but the work environment and burnout are important mediators of this influence.

IMPLICATIONS FOR NURSING MANAGEMENT

Administrators should adopt authentic leadership practices and make efforts to improve the work environment and decrease burnout in order to decrease nurses‧ intent to leave.

Work-related factors, job satisfaction and intent to leave the current job among United States nurses

AIMS AND OBJECTIVES

To examine the relationships of work-related factors (e.g., autonomy, work schedule, supervisory and peer support) to nurses' job satisfaction and intent to leave their current position.

BACKGROUND

Low job satisfaction and high turnover of nurses are major problems for health care. To improve nurse retention, work-related factors associated with job satisfaction and intent to leave should be investigated.

DESIGN

A cross-sectional secondary data analysis.

METHODS

Data were obtained in 2004 from Wave 3 of the Nurses' Worklife and Health Study. A random sample of 5000 actively licenced nurses in Illinois and North Carolina (two U.S. states) were sent the survey in wave 1, of which 1641 actively working bedside nurses participated in wave 3. We examined associations of various work-related factors with job satisfaction and intent to leave the current position.

RESULTS

Nurses who were dissatisfied with their job reported significantly higher psychological demands and lower autonomy than nurses who were satisfied. Nurses were significantly less satisfied with their jobs when they worked longer hours with inadequate breaks or sick days. Lack of support from peers and supervisors was also related to significantly lower odds of job satisfaction. For intention to leave, nurses who said they planned to leave their current job reported significantly lower autonomy and less support from their peers than nurses who intended to stay.

CONCLUSION

A variety of modifiable work-related factors were significantly related to job satisfaction and intention to leave the current job among nurses. Future research should focus on developing interventions that could mitigate these factors (e.g., by improving work schedules, increasing autonomy and/or nurse support). The impact of such interventions on job satisfaction and intention to leave the current position could then be evaluated.

RELEVANCE TO CLINICAL PRACTICE

To increase nurse retention, improved schedules, autonomy and supportive work environments should be promoted.

Identifying the key predictors for retention in critical care nurses

AIMS

The aim of this study was to explore the key predictors of retention in nurses working in critical care areas.

BACKGROUND

The shortage of critical care nurses is reaching crisis proportions in Canada and throughout the industrialized world. Identifying the key influencing (i.e. person and organizational) factors and intermediary factors (i.e. job satisfaction, engagement, professional quality of life and caring) that affect intent to leave is central to developing optimal retention strategies for critical care nurses.

DESIGN

As part of a larger mixed-methods study, we used a quantitative, cross-sectional research design. A novel framework: the Conceptual Framework for Predicting Nurse Retention was used to guide this study.

METHODS

On-line survey data were collected from on a convenience sample of 188 registered nurses working in critical care areas of hospitals in the province of Manitoba, CANADA in 2011.

RESULTS

Twenty-four per cent of the respondents reported that they would probably/definitely leave critical care in the next year. Based on bivariate and regression analyses, the key influencing factors that were significantly related to the intermediary factors and intent to leave critical care and nursing included: professional practice, management, physician/nurse collaboration, nurse competence, control/responsibility and autonomy. Of the intermediary factors, all but compassion satisfaction were related to intent to leave both critical care and nursing.

CONCLUSION

This study highlights the importance of exploring multiple organizational and intermediary factors to determine strategies to retain critical care nurses. The findings also support the Conceptual Framework for Predicting Nurse Retention as a theoretical basis for further research.

Nurse manager job satisfaction and intent to leave

An electronic survey was used to collect data from 291 nurse managers working in U.S. hospitals. Seventy percent were satisfied or very satisfied with their jobs and 68% were either likely or very likely to recommend nursing management as a career choice. Seventy-two percent of these nurse managers were also planning to leave their positions in the next 5 years. The four most common reasons reported for intent to leave included burnout, career change, retirement, and promotion. Burnout was the most common reason cited by the entire sample but the fourth most common reason for leaving cited by those nurse managers who were planning to leave and also satisfied or very satisfied with their positions. Recommendations for nursing leaders include evaluating the workload of nurse managers, providing career counseling, and developing succession plans.

Nurse burnout in China: a questionnaire survey on staffing, job satisfaction, and quality of care

AIM

The investigators examined how nurse staffing affects nurse job satisfaction and quality of care.

BACKGROUND

Inadequate nurse staffing is a worldwide issue with profound effects on nurse job satisfaction and quality of care. Few studies have examined the relationship between nurse staffing and job satisfaction and quality of care in China.

METHOD

A cross-sectional design was adopted, wherein 873 nurses were surveyed on demographics, nurse staffing, job-related burnout, job dissatisfaction, intent to leave, and quality of care.

RESULT

The median patient-nurse ratio was five; 45.1% nurses reported high levels of job-related burnout, and 55.6%, job dissatisfaction. In adjusted regression models, patient-nurse ratios of four or less were related to a decrease in the odds of job dissatisfaction (odds ratio 0.55, 95% confidence interval 0.36-0.85) and increase in the odds of quality of care (odds ratio 1.78, 95% confidence interval 1.02-2.82).

CONCLUSION

Nurse staffing is associated with job dissatisfaction and quality of care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should maintain an adequate level of nurse staffing, referring to the patient-nurse ratio. They should create new initiatives to increase job satisfaction among nurses and to evaluate their effects.