The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey

AIM

To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment.

BACKGROUND

Acute care hospitals face daily challenges to their efforts to achieve nurse workforce stability, safety, and quality of care. A body of knowledge shows a favourably rated nurse practice environment as an important condition for better nurse and patient outcome variables; however, further research initiatives are imperative for a clear understanding to support and guide the practice community.

DESIGN

Cross-sectional survey.

METHOD

Grounded on previous empirical findings, a structural equation model designed with valid measurement instruments was tested. The study population was registered acute care nurses (N=1201) in two independent hospitals and one hospital group with six hospitals in Belgium.

RESULTS

Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care. Analyses were consistent with features of nurses' work characteristics including perceived workload, decision latitude, and social capital, as well as three dimension of burnout playing mediating roles between nurse practice environment and outcomes. A revised model adjusted using various fit measures explained 52% and 47% of job outcomes and nurse-assessed quality of care, respectively.

CONCLUSION

The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended.

Factors influencing retention among hospital nurses: systematic review

BACKGROUND

Recruitment and retention of nursing staff is the biggest workforce challenge faced by healthcare institutions. Across the UK, there are currently around 50 000 nursing vacancies, and the number of people leaving the Nursing and Midwifery Council register is increasing.

OBJECTIVE

This review comprehensively compiled an update on factors affecting retention among hospital nursing staff.

METHODS

Five online databases; EMBASE, MEDLINE, SCOPUS, CINAHL and NICE Evidence were searched for relevant primary studies published until 31 December 2018 on retention among nurses in hospitals.

RESULTS

Forty-seven studies met the inclusion criteria. Nine domains influencing staff turnover were found: nursing leadership and management, education and career advancement, organisational (work) environment, staffing levels, professional issues, support at work, personal influences, demographic influences, and financial remuneration.

CONCLUSION

Identified turnover factors are long-standing. To mitigate the impact of these factors, evaluation of current workforce strategies should be high priority.

An intervention to decrease burnout and increase retention of early career nurses: a mixed methods study of acceptability and feasibility

AIMS

To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre.

BACKGROUND

Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the perspectives of stakeholders regarding the acceptability and feasibility of interventions to resolve the issue. This study reports an intervention comprising of mindfulness, psychological skills training and cognitive realignment to prepare participants for early careers as nurses.

METHODS

This is an explanatory sequential mixed methods study, conducted by a UK university and healthcare organisation. Participants were final year pre-registration nursing students (n = 74) and academics (n = 7) involved in the implementation of the intervention. Pre and post measures of acceptability were taken using a questionnaire adapted from the Theoretical Framework of Acceptability. Wilcoxon Signed Ranks test was used to assess change in acceptability over time. Qualitative data from semi-structured interviews, focus groups and field notes were thematically analysed, adhering to COREQ guidelines. Data were collected February to December 2019.

RESULTS

One hundred and five questionnaires, 12 interviews with students and 2 focus groups engaging 7 academic staff were completed. The intervention was perceived as generally acceptable with significant positive increases in acceptability scores over time. Student nurses perceived the intervention equipped them with skills and experience that offered enduring personal benefit. Challenges related to the practice environment and academic assessment pressures. Reported benefits align with known protective factors against burnout and leaving the profession.

CONCLUSION

Planning is needed to embed the intervention into curricula and maximise relationships with placement partners. Evaluating acceptability and feasibility offers new knowledge about the value of the intervention for increasing retention and decreasing burnout for early career nurses. Wider implementation is both feasible and recommended by participants.

Experienced pediatric nurses' perceptions of work-related stressors on general medical and surgical units: A qualitative study

BACKGROUND

Experienced pediatric nurses caring for increasingly sick and vulnerable children on medical and surgical units may be at particular risk for work-related stress. In view of their positive impact on quality of care, and the fact that they are particularly difficult to retain, it is imperative to understand the work-related stressors these nurses encounter in order to develop effective organizational interventions to minimize stressors and promote retention.

OBJECTIVE

To explore experienced pediatric nurses' perceptions of work-related stressors in medical and surgical units.

DESIGN

Qualitative descriptive design with semi-structured interviews.

SETTING

Medical and surgical units at a quaternary care pediatric hospital in Montreal, Canada.

PARTICIPANTS

Nurses recognized as experienced by the nursing leadership team as reflected by having been 'in charge' of the unit, or having trained junior staff, and who had been practicing full-time for three years or more on a general medical or surgical pediatric unit were eligible to participate. Purposive sampling was used, and nurses recruited until data saturation was reached (n=12). There were no refusals to participate.

METHODS

Semi-structured interviews were conducted between August and December 2013.

RESULTS

Nurses described a strong sense of responsibility for providing excellent patient care, and identified stressor that negatively impacted their ability to do so. Stressors are reflected in three themes: (1) "The kids are getting sicker and sicker": Difficulty ensuring excellent patient care to an increasingly vulnerable population, (2) Feeling powerless to provide quality care, and (3) Being a "Jack-of-all-trades": Struggling with competing demands.

CONCLUSION

Experienced pediatric nurses felt powerless to provide quality care to an increasingly acute and vulnerable population. Dealing with multiple and diverse responsibilities, and limited resources and support, were important stressors. Nurse Managers and educators could mitigate stressors and improve retention of experienced pediatric nurses by offering targeted continuing education to those newly responsible for additional roles, and building supportive working environments that encourage collaboration and empower experienced nurses.

How to keep registered nurses working in New Zealand even as economic conditions improve

BACKGROUND

Many registered nurses (RNs) increased their participation in the New Zealand health workforce during the Global Financial Crisis (GFC), resulting in low vacancy rates. However, based on the documented impact of improving economies, a mean RN age of about 50, and just-agreed substantive increases in RN pay rates, it is likely that many will soon leave or reduce the hours they work. This study aims to investigate whether improved financial security will encourage RNs to leave or reduce their work commitment and to identify the factors that influence such intentions.

METHODS

An exploratory study using a cross-sectional survey design. Data were collected in 2014-2015 via an e-survey of 2,910 RNs in New Zealand. Data were analysed by regression.

RESULTS

We found that due to "burnout" and low "work engagement", both of which are strongly affected by workload and work-life interference, 22.6% of the RNs surveyed plan to leave work altogether and a further 32% plan to reduce their workforce participation when their financial situations improve.

CONCLUSIONS

The findings justify the urgent cooperative development, implementation and evaluation of a comprehensive suite of RN 'retention' measures involving national nursing organisations, the RN regulator and health system employers and funders.

Evaluation of a graduate nurse residency program: A retrospective longitudinal study

BACKGROUND

There is an urgency to retain nurses globally. Evidence has shown that nurse residency programs promote retention of new graduate nurses. However, there is a dearth of studies examining the impact of nurse residency programs longitudinally.

AIM

To evaluate the impact of a transition-to-practice program on new graduate nurses' practice confidence and job satisfaction over 24 months.

DESIGN

A retrospective longitudinal study.

SETTING

A 1200-bed public tertiary academic hospital.

PARTICIPANTS

New graduate nurses from local universities who joined the hospital and were enrolled in the Graduate Nurse Residency Program (n = 104).

METHODS

The program was conducted for 24 months and consisted of modules on bedside knowledge and skills, and a mentorship program with senior nurse leaders. Practice confidence and job satisfaction were measured using the Casey-Fink graduate nurse experience survey. The survey was administered four times over the 24 months as part of the program. Data was analyzed using repeated measures ANOVA.

RESULTS

Practice confidence increased and job satisfaction decreased over the 24 months. Practice confidence total score at 6 months and an extended probation period were factors associated with attrition during the 24-month clinical practice.

CONCLUSIONS

This is the first longitudinal study to demonstrate the impact of a transition-to-practice program in a multiethnic Asian setting. The Graduate Nurse Residency Program enhanced the practice confidence of new graduate nurses.

The Job Embeddedness instrument: an evaluation of validity and reliability

A cross sectional correlational mailed survey was used to assess the validity and reliability of the Job Embeddedness (JE) instrument for predicting nurse retention. A regression model using the variables of JE and age were predictive of nurse retention in a sample of Registered Nurses (RNs) working in long term care (LTC) settings. This study supports the multi-dimensionality, validity and reliability of the underlying JE construct. However a different factor structure was suggested that better fit the data. Long term care organizations (LTC) may benefit from a strategy of increasing the embeddedness of their existing employees in order to increase nurse retention. Job embbededness could be used as a foundation to provide effective nurse retention strategies in LTC settings.

Giving nurses a voice through 'listening to staff' conversations to inform nurse retention and reduce turnover

Health and social care employers in the UK cannot afford to lose nurses given the current nursing workforce crisis. A variety of staff engagement initiatives aim to improve employee retention. This article describes how Listening to Staff (L2S) events were used as part of a service review to inform nurse retention strategies in one acute hospital trust. Over a 3-year period, 576 nurses took part in L2S events that examined nurses' perspectives of teamworking and support as well as career plans in areas with high nurse turnover rates. Comparative content analysis was used to analyse narrative data, which informed managers' retention plans. Examination of retention data before and after L2S events showed nursing turnover decreased, suggesting a variety of strategies to retain staff may have improved nurse retention. Findings imply capturing nurses' perceptions through staff engagement events may offer solutions for nurse retention.

Do preceptorship and clinical supervision programmes support the retention of nurses?

BACKGROUND

The reasons for nurse shortages are the ageing healthcare workforce, increasing demand for services, employee dissatisfaction, life-work imbalance and burnout.

AIM

To review the literature to find out whether there is evidence to support preceptorship and clinical supervision programmes in retaining nurses, and particularly newly qualified nurses (NQNs), in clinical practice.

METHODS

A search of databases, as well as other sources, was carried out, with six studies selected for data analysis.

FINDINGS

Thematic analysis was used to synthesise the results and produced seven themes: increase satisfaction, gain competence and feel more confident; competencies of preceptors and supervisors; framework or model required; the challenge to the programmes; intention to stay and staff retention; voluntary withdrawal from the nursing profession; and further support for development.

CONCLUSION

Training (preceptorship and clinical supervision programmes) is effective in retaining NQNs, increasing satisfaction, improving skills and competency and staff engagement; however, more support for both preceptors/supervisors and NQNs is needed to maximise the success of these programmes in the future.

The evolution of professional identity in intensive care nurses during COVID-19 - An interpretive phenomenological study

OBJECTIVES

This study explored the meaning behind professional identity in intensive care nurses who cared for patients with COVID-19.

RESEARCH METHODOLOGY/DESIGN

The exploration was conducted using a qualitative interpretive phenomenological approach with guidance from hermeneutics.

SETTING

Semi-structured audiovisual interviews were conducted with intensive care unit nurses (n = 20) throughout the United States of America, spanning nurse experiences of caring for patients with COVID-19 between 2019 and 2022.

OUTCOME MEASURE

Outcome measures were codes and themes which emerged from data using Benner's interpretive phenomenology method for nursing and Heidegger's hermeneutic circle.

FINDINGS

Four critical findings of this study were the themes a) Keep Them Alive, b) We Are Survivors, c) I Am An Intensive Care Unit Nurse, and d) I Was Meant For This.

CONCLUSION

Findings suggest that professional identity is evolving for nurses as they care for patients in the intensive care and that evolution affects nursing professionals' quality of life.

IMPLICATIONS FOR CLINICAL PRACTICE

The findings of this study have important implications for nursing practice. These themes highlight intensive care nurses' deep commitment and strong professional identity, which can positively impact nurse retention and foster a sense of purpose and fulfillment. Understanding the meaning attached to nurses' experiences can allow nurse leaders and mentors to enhance their roles and aid in the preparation of future intensive care nurses, helping future nurses find focus and satisfaction in their professional identities. Recognizing and nurturing nurses' strong professional identity may positively impact nurse retention and fulfillment. To achieve this, nurse leaders must comprehend and support nurses' experiences, cultivating an environment that empowers these caregivers to thrive and make a lasting impact on patient care.

The Effect of Nurses' Job Characteristics on Missed Nursing Care in Medical and Surgical Departments in Selected Slovenian Hospitals-A Cross-Sectional Study

Aim

The aim was to examine the extent of missed nursing care (MNC), the reasons behind it and the contribution of nurses' job characteristics to MNC in Slovenian hospitals.

Methods

A cross-sectional explorative research was conducted. The BERNCA-R and part B of the MISSCARE questionnaire were used. A total of 880 nurses from 10 hospitals in Slovenia participated with completed questionnaires; of those, 57.6% were healthcare assistants and 42.4% were registered nurses. Univariate, bivariate and multivariate analyses were performed.

Results

In the five-component solution of the MNC, the activities of 'Monitoring' (M=2.09; SD=0.909) and 'Caring, support, activation, education' (M=2.03; SD=0.822) were the most frequently missed, with the leading item being 'Conversation with a patient or their family' (M=2.45; SD=0.940). Labour resources (M=3.44; SD=0.642) were the most common reason for MNC, with inadequate number of staff (M=3.75; SD=0.660) as the leading item. The stepwise multiple regression model showed that the more significant the labour resources are, the more frequently MNC occurs in all five dimensions (p=0.000-0.002). Most job characteristics proved to be significant; however, as satisfaction with wages, years of employment and assessment of the quality of nursing care increase, MNC decreases in all five dimensions.

Conclusions

This study enables healthcare decision makers and managers at the national level and in healthcare organisations to understand the problem of missed nursing care and to plan and implement changes accordingly.

Understanding Nurse Burnout in the Context of Alarm Fatigue

Burnout is a pervasive issue in nursing, influenced by factors like patient acuity, nurse-to-patient ratios, and the working environment. Alarm fatigue occurs when high rates of clinical alarms lead to desensitization among staff, creating unsafe patient conditions. Nearly all critical care nurses involved in this study reported high levels of burnout, particularly in the Emotional Exhaustion and Depersonalization domains. These nurses also experienced moderately high levels of alarm fatigue. A majority of nurses indicated that alarm fatigue significantly contributed to their burnout. More research is needed to clarify the relationship between alarm fatigue and burnout.

Factors influencing the turnover of nurses in French intensive care unit-A multicenter interview survey

BACKGROUND

Nurse retention is a major concern in healthcare settings, especially among intensive care units (ICU), in which nurses are highly specialized. The objective was to describe the nurse courses after their entrance into the ICU, their motivation for leaving the ICU, and to identify the independent factors that influenced the nurse resignation from their units.

METHODS

In 3 different centers, every ICU nurse working between 2013 and 2023 was telephonically contacted and was asked to describe their career and, when appropriate, the reasons that influenced their resignation from their units; they rated on a Likert scale of 14 factors that influenced their decision.

RESULTS

Among the 405 nurses who worked in these ICUs between 2013 and 2023, 265 (65.0%) were included in the study, and 93 (35.1%) were still working in their unit. The median time of professional experience of the nurses in their ICU was 5.8 [5.0-7.0] years, and at 10 years, 26.3% [20.4-33.9] of the nurses remained in their unit, 23.8% [17.3-32.8] left the ICU but were still in-hospital nurses, and 22.4% [15.8-31.7] underwent specialization. A minority of nurses resigned and changed their careers (9.5% [5.3-17.0]). The main factors influencing the nurse's resignation from their unit were belonging to Generation Y or Z (HR 1.89 [1.35;2.64]), experiencing symptoms of burnout (2.37 [1.63;3.46]), and pregnancy during the ICU (1.77 [1.41;2.23]). The COVID-19 period was inconsistently associated with nurse resignation depending on the center. The main motivations to leave the unit were organizational (variability of schedule, night shift), personal (willingness to change, personal event), and related to the ICU workload.

CONCLUSION

Nurse retention is an increasing concern, associated with the generational aspects and increased prevalence of burnout. Structural changes will have to be made to reduce the turnover.

Factors influencing acceptance or decline of a hospital-sponsored scholarship by nursing students in Taiwan: a qualitative descriptive study

Background

Maintaining sufficient nursing personnel is critical for healthcare systems worldwide. Improving retention of nurses is one means of addressing this shortfall. To foster retention, some hospitals in Taiwan provide nursing scholarships contingent on recipients signing a 3-year employment contract. However, it is unclear what factors influence students’ decisions to accept or reject a scholarship.

Methods

The purpose of this exploratory qualitative descriptive study was to obtain an understanding of the subjective experiences of fourth-year nursing school students (N = 87) who accepted (n = 43) or declined (n = 44) a hospital-sponsored nursing school scholarship. Students were selected by purposive sampling from the department of nursing of a private university in northern Taiwan. Data were collected between 2013 and 2014 using face-to-face-in-depth interviews.

Results

The mean age of participants was 22.7 years; most (94%) were female (n = 82). Analysis of the interview data showed the choice to accept or decline the scholarship and making career decisions occurred in three stages for both groups: the considering their options, making the decision, and assessment of their decision.

Conclusions

Although the variables at each of these stages differed between groups, both sponsored and non-sponsored students felt a responsibility to continue as employees of the hospital after graduation. Financial status, the hospital environment, and future long-term career goals were important factors affecting the acceptance or rejection of the hospital scholarship. These results could provide insight into factors students consider important for making long-term commitments as a nursing professional, which could not only improve retention of nurses, but also serve as a guideline for career planning.

Enhancing the retention of newly qualified nurses

The retention of newly qualified nurses (NQNs) is a pressing issue in healthcare systems, particularly in high-pressure environments such as acute care. This article explores the key challenges faced by NQNs, including lack of career development opportunities, negative workplace cultures and burnout, all of which contribute to high turnover rates. Strategies such as structured preceptorship and mentorship programmes, emotional wellbeing initiatives, and leadership support are examined. The article underscores the importance of building a positive work environment to retain NQNs, thereby improving workforce sustainability and patient care. Additionally, recommendations are provided to enable a proactive approach to improving NQN retention.

Interventions to retain emergency department nurses: A scoping review

INTRODUCTION

Globally, the nursing workforce is facing significant shortages, exacerbated by the COVID-19 pandemic. Emergency departments (ED) are dynamic environments that expose nurses to high levels of stress. Retention of existing nurses is vital, however the efficacy of interventions to improve the retention of ED nurses is limited. This review aimed to explore the evidence surrounding interventions focussed on addressing the retention of ED nurses.

METHOD

A scoping review of the literature was undertaken, guided by the Joanna Briggs Institute framework. A search of five electronic databases was conducted. Original research published between 2012 and 2023 regarding the population of nurses, the concept of interventions to decrease turnover/improve retention and the context of the emergency department were considered for inclusion.

RESULTS

Five articles met the criteria for inclusion; three evaluated educational programs to ease the transition to becoming ED nurses, two assessed locally developed 'ad hoc' interventions. All the transitional education programs reported an increase in retention rates, while the ad hoc interventions produced minimal to no improvement in retention or reduction of turnover intent. All studies were conducted in high-income countries.

CONCLUSION

There is a dearth of evidence for organisations to draw upon to increase the retention of ED nurses. Additional research is warranted, especially regarding the long-term effects of interventions aimed at improving ED nurse retention, as well as evaluating interventions implemented in a wider variety of contexts.

Co-worker relationships and their impact on nurses in Irish public healthcare settings

This article presents the findings of a secondary analysis of data arising from a quantitative study of 3769 nurses on co-worker relationships and their impact on nurses working in public healthcare settings in Ireland. The overall findings from this analysis suggest moderate to high levels of satisfaction with co-worker relationships, with an average scale mean of 77%. Statistically significant lower scale means were identified in respect of nurses whose basic nursing qualification was awarded in a country outside the EU, among students and among those working in the west of Ireland. Respondents intending to leave the healthcare workforce reported significantly lower scores (74%) on this index compared with those intending to stay (79%). Significant positive correlations between co-worker relationships and workplace engagement (0.233), job satisfaction (0.225), organisational commitment (0.221) and perception of managers (0.259) were identified. These findings have implications for the retention of nurses working in Irish public healthcare services.

Critical incident experiences, related stress and support among Finnish paramedics: A cross-sectional survey study

INTRODUCTION

Paramedics work in diverse, demanding prehospital settings. We examined the prevalence of critical incident (CI) experiences, critical incident stress (CI-S), and CI-S association with the intention to leave the paramedic profession, as well as the needed and received support for CI-S among Finnish paramedics.

METHODS

In 2022, n = 427 Finnish paramedics from eight different organizations responded to a modified Emergency Medical Services (EMS) Critical Incident Stress Inventory and reported the CIs experienced during their EMS careers and the related CI-S within the last six months. Statistical analyses were stratified by gender.

RESULTS

All the listed 31 CIs had been experienced by the Finnish paramedics, and the experiences increased with work experience, especially among men. CI-S had wide variation, seemed to increase with work experience, and was mainly not associated with the intention to leave the profession. Support for coping with CI-S was most often received from colleagues, then from family members, friends, and to some extent, managers.

CONCLUSIONS

Because of the inherent nature of the demands and features of the paramedic work, experiencing CIs is unavoidable. Examining effective coping strategies, organizational support, and managerial practices are needed to support highly skilled paramedics in their demanding work.

Total rewards preferences: A cross-sectional study among two generations of nurses in rural and remote Thailand

BACKGROUND

Nursing and health policy focus on retaining nurses in practice, especially because the world lacks more than 6 million nurses. Rewards are believed to be an effective strategy to attract, retain, and improve the performance of nurses in rural and remote areas where nursing shortages are more severe. However, Generations X and Y have been found to have different preferences for rewards in various settings, so a one-size-fits-all approach may not work for rewarding work.

OBJECTIVE

To examine the perceptions of satisfaction and the importance of rewards among two generations of Thai registered nurses.

METHODS

Using the Total Reward Scale, a descriptive comparative study design was employed and the data was collected from 354 nurses in rural and remote Thai community hospitals. This study is reported using the STROBE checklist. Descriptive statistics and the Mann-Whitney U test were used to analyze data.

RESULTS

Generations X (born in 1965-1980) and Y (born in 1981-2000) were most satisfied with and rated base salary as the most important reward. However, these generations significantly differed in their perspective about importance of healthcare, leadership, long-term incentives, time-off leave, and variable pay.

CONCLUSION

Different types of rewards were satisfying and essential for Thai nurses in Generations X and Y.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

National reward policies and management should be designed on priorities regarding reasonable base salary, and retirement benefits to address nursing shortages in rural and remote areas. Policymakers in health and nursing must invest in developing funded policies that consider the needs of different generations of nurses if they want success in retaining them on the job.

New insights on a recurring theme: A secondary analysis of nurse turnover using the National Sample Survey of Registered Nurses

BACKGROUND

Registered nurse (RN) turnover is a recurring phenomenon that accelerated during COVID-19 and heightened concerns about contributing factors.

PURPOSE

Provide baseline RN turnover data to which pandemic and future RN workforce turnover behaviors can be compared.

METHODS

A cross-sectional, secondary analysis of RN turnover using U.S. National Sample Survey of Registered Nurses 2018 data. Responses from 41,428 RNs (weighted N = 3,092,991) across the United States were analyzed. Sociodemographic, professional, employment, and economic data and weighting techniques were used to model prepandemic RN turnover behaviors.

DISCUSSION

About 17% of the sample reported a job turnover, with 6.2% reporting internal and 10.8% reporting external turnover. The factors common across both internal and external turnover experiences included education, employment settings, and years of nursing experience.

CONCLUSIONS

Baseline RN turnover data can help employers and policymakers understand new and recurring nursing workforce trends and develop targeted actions to reduce nurse turnover.

Identifying and managing fatigue in nurses completing on-call work

Specialist nurses working in Therapeutic Apheresis Services (TAS) at NHS Blood and Transplant participate in an on-call rota. This means working above and beyond their rostered hours and can lead to them working 24 hours in one period. There is a noted risk of fatigue for people who work more than 13 hours in one stretch, and therefore it is important to understand how to recognise and manage the signs of fatigue. A literature review was performed to understand fatigue in various industries and how this was managed. This was then coupled with TAS internal data collection, exit interview data and sickness data to inform the design of a Fatigue Identification Questionnaire filled out by nurses during on-call working. Due to the strong link between fatigue and the hours worked, it is recommended that further work is undertaken to implement fatigue-management processes.

Assessing factors associated with nurses leaving the profession: A secondary analysis of cross-sectional data

Background

Nurse turnover is a global challenge affecting workforce stability, financial sustainability of healthcare systems, and the quality of care. Despite extensive research, a limited number of researchers have explored the actual reasons behind nurses leaving the profession as opposed to leaving their job, particularly in relation to demographic variables.

Objective

We aimed to explore how demographic factors-age, sex, and work area-influenced nurses' experiences of key turnover factors, providing insights to inform tailored retention strategies.

Design

Secondary cross-sectional analysis of national survey data.

Settings

Data were collected by Statistics Sweden through a mail survey.

Participants

The sample consisted of 2,860 individuals with nursing qualifications who had left the profession between 2005 and 2013 and responded to a 2016 survey.

Methods

The analysis involved exploratory factor analysis and structural equation modeling to identify and examine five latent factors contributing to nurses leaving the profession. The researchers assessed the impact of demographic variables on these factors.

Results

Five primary factors were identified: compensation and fairness, psychosocial work environment, career development constraints, non-clinical workload, and support and safety. Younger nurses and those outside primary care reported greater dissatisfaction across multiple factors, while female nurses faced heightened psychosocial strain. Work area differences also influenced perceptions of support and workload.

Conclusions

We have underscored the significant role of demographic variables associated with leaving the nursing profession. Tailored interventions, such as structured mentorship for younger nurses, family-supportive policies for female nurses, and workload optimization in high-stress areas, may be helpful. The results are limited by the age of the data, which predates recent healthcare shifts, emphasizing the importance of regular workforce monitoring.

Registration

Not registered.

Supporting and Retaining Nurses in Trying Times

The nursing profession has witnessed its share of challenging and trying times including toxic or unhealthy work environments, unsustainable workloads, an aging workforce, inadequate staffing, nurse burnout, staff retention, inadequately trained staff, an increase in workplace violence, and several pandemics. Both individually and collectively, these thorny issues have placed a heavy burden on nurses. Unfortunately, many capable and competent nurses have left the profession altogether, which further compounds an already problematic situation. This article highlights several important strategies for recruiting, retaining, and supporting a high functioning nursing workforce in challenging and trying times.