A causal model of voluntary turnover among nursing personnel in long-term psychiatric settings

Leaving it at the gate: A phenomenological exploration of resilience in mental health nursing staff in a high-secure personality disorder unit

AIMS AND DESIGN

This study reports a qualitative phenomenological investigation of resilience in nursing staff working in a high-secure personality disorder service.

METHOD

Interviews were carried out with six nursing staff, and these captured the richness and complexity of the lived experience of nursing staff.

RESULTS

Four superordinate themes emerged from the analysis: Management of emotions: participants showed an awareness that their job is about giving care to patients who may present with very challenging behaviours. The care that they offered was conceptualized as something that needed to be provided in a measured way, with boundaries. A clear distinction was drawn between 'caring personally' for patients, and 'providing care'. Teamwork: teamwork was cited as a major influencing factor by all participants. This was seen as directly impacting the smooth running of the ward, and therefore on the well-being of nursing staff, but also of patients. Understanding: nursing staff were acutely aware that they were working in an environment where everyday interactions would be open to intense scrutiny and possible misinterpretation by patients. Work-life balance: All the participants spoke of making a conscious effort to have a separate work and home life, which was influenced by a number of factors.

CONCLUSION

The article has discussed the themes of managing emotion, team understanding and work-life balance, illustrating how each contributes to the resilience of nursing staff in this challenging environment. New insights - applicable in both national and international contexts - have been produced.

IMPACT

In secure environments, mental health nursing staff need organizational support and assistance to develop ways of managing difficult experiences with patients, systems that promote recovery, and educational and supervisory support to help understand and process the effects on them. This article provides evidence to support the work of managers and clinicians in these environments. No Patient or Public Contribution.

Factors affecting child welfare and protection workers' intention to quit: a cross-sectional study from Norway

INTRODUCTION

High turnover rates have been a problem for Norwegian child welfare and protection services for years. The main aim of this study was to identify which factors affect Norwegian child welfare and protection (CWP) workers intention to quit their job and whether there is a difference between experienced (< 3 years) and less experienced workers.

METHODS

A cross-sectional survey was performed among 225 Norwegian child welfare and protection workers. Data were collected using a self-report questionnaire. Turnover intention was examined using a variety of job demands and resources as possible predictors. T tests were used to study mean differences in variable scores between experienced and less experienced workers and linear regression analysis was employed determining predictors of intention to quit.

RESULTS

For the total sample (N = 225) the most important predictors for intention to quit were workload, burnout, engagement, and views on leadership. Higher emotional exhaustion and cynicism, and low professional efficacy predicted a higher score on the intention to quit scale. High engagement and leadership satisfaction predicted lower scores. The effect of workload was moderated, such that intention to quit among less experienced workers increased more with high workload than it did among more experienced child welfare workers.

CONCLUSIONS

The conclusions are that job demands affect experienced and less experienced CWP workers differently and that when designing preventive efforts to reduce turnover this must be considered.

Why do Social Workers Leave? A Moderated Mediation of Professionalism, Job Satisfaction, and Managerialism

Turnover has been a serious concern to social service organizations. A lack of committed social workers is a risk to organizational performance and service quality. Therefore, it is vital to better understand the leaving process of social work practitioners. The study constructed a moderated mediation model to examine the mediating role of job satisfaction between employees' professionalism and turnover intention and the moderating role of the perceived level of managerialism in the context of social work organizations. A total of 667 participants from Guangzhou, Shenzhen, and Shanghai in China were recruited to complete the survey. Results presented that job satisfaction plays a full mediation role in the relationship between professionalism and turnover intention. In addition, the positive relationship between professionalism and job satisfaction, as well as the negative relationship between professionalism and turnover intention were moderated by managerialism. The findings enrich knowledge about turnover among social workers in the context of China and inspire to foster professionalism among service workers to improve job satisfaction and alleviate turnover intention and actual turnover as well as to apply management techniques and structures properly to strengthen the effect of professionalism on promoting job satisfaction and on preventing turnover intention.

Effect of risky decision-making and job satisfaction on turnover intention and turnover behavior among information technology employees

Purpose

Turnover in high-tech companies has long been a concern for managers and executives. Recent meta-analyses from the general turnover literature consistently show that job satisfaction is a major attitudinal antecedent to turnover intention and turnover behavior. Additionally, the available research on information technology (IT) employees focuses primarily on turnover intentions and not on a risky decision-making perspective and actual turnover (turnover behavior). The paper aim is to focus on that.

Design/methodology/approach

This study uses hierarchical ordinary least squares, process (Preacher and Hayes, 2004) and logistic regression.

Findings

The main predictor of actual turnover is risky decision-making, whereas job satisfaction is the main predictor of turnover intention.

Originality/value

The joint effects of risk and job satisfaction on turnover intention and behavior have not been studied in the IT domain. Hence, this study extends our understanding of turnover in general and particularly among IT employees by studying the combined effect of risk and job satisfaction on turnover intentions and turnover behavior. The study’s theoretical and practical implications are likewise discussed.

Predictors of the intentions to leave among nurses in an academic medical center

Aim

Nurses are an essential human resource for the healthcare system. However, high turnover of nurses is a current issue. Reducing the high turnover of nurses is crucial for facilitating the sustainable provision of care in hospitals. The purpose of this study was to explore the factors affecting nurses' intentions to leave among nurses in an advanced medical center.

Methods

Using a cross-sectional design, we conducted a questionnaire survey of nurses working at an academic medical center in August 2020. Of the 1063 distributed questionnaires, there were 821 (77.2%) valid responses. The questionnaire included items on the Kessler 6 (K6), New Brief Job Stress Questionnaire (New BJSQ), Organizational Justice Questionnaire (OJQ), and intention to leave a hospital job.

Results

Overall, the mean age of the nurses was 34.3 ± 10.1 years and 87.8% (721/821) of them were female. Among respondents, 19.5% (160/821) had a strong intention to leave. After adjusting for all the variables, a logistic regression analysis revealed that longer working hours, job rank (staff nurse), work-self-balance positive (imbalance), workplace harassment (no bullying), and interactional justice (unfair supervisor) were determinants associated with strong intentions to leave.

Conclusions

Approximately one-fifth of nurses working at advanced medical center had a strong intention to leave. However, our findings can help managers predict the turnover of nurses by understanding occupational characteristics. Managing work-self-balance and treating staff fairly could improve work environments. Further research focusing on the outcome of actual turnover rather than intention to leave is needed.

The Hybrid Multiple-Criteria Decision-Making Model for Home Healthcare Nurses’ Job Satisfaction Evaluation and Improvement

Objectives: To investigate and evaluate the key factors related to job satisfaction performance of home healthcare nurses (HHNs).

Methods: A total of 31 HHNs from three community hospitals in Zhejiang province were invited to participate in the study. They completed a questionnaire survey based on the home healthcare nurse job satisfaction scale (HHNJS) from February to March 2022. Consistent fuzzy preference relation (CFPR) methods and important-performance analysis (IPA) were used to obtain the attribute weights and performance for HHNs job satisfaction.

Results: The results showed that the attributes of C₁₃, C₁₄, C₁₅, C₂₃, C₂₄, C₄₂, C₅₁, and C₅₂ were key factors influencing HHNs job satisfaction.

Conclusion: The hybrid multiple-criteria decision-making (MCDM) model can help home-healthcare-agency administrators better understand the key factors related to HHNs job satisfaction and establish reasonable improvement strategies.

Health problems, turnover intention, and actual turnover among shift work female nurses: Analyzing data from a prospective longitudinal study

Aims

This study investigated health problems, turnover intention, and actual turnover among shift work nurses. While turnover intention is often used as a proxy variable for turnover, the relationship between these variables requires clarification. This study tested for relevant associations using prospective longitudinal data with a time lag of 12 months. We also tested for associations between health problems (sleep disturbance, fatigue, and depression) and turnover intentions/turnover, with a focus on the mediating role of turnover intention.

Methods

This study conducted a secondary analysis of data from the Shift Work Nurses’ Health and Turnover project, which is a prospective longitudinal cohort study. We analyzed health problems, turnover intention, and actual turnover. The data were analyzed via descriptive statistics, the Pearson’s chi-squared test, independent t-test, univariable logistic regression, multiple logistic regression, and causal mediation.

Results

Participants included 491 shift work female nurses. Of these, 112 (22.8%) had turnover intention, while 38 (7.7%) left their jobs within the 12-month period of investigation. Of the 112 with turnover intention, 22 left their jobs (OR 5.68. 95% CI 2.84–11.36). The logistic regression analysis showed that sleep disturbance and fatigue were associated with turnover intentions and actual turnover, while depression was only associated with turnover intention. The causal mediation analysis showed that turnover intention mediated the relationship between health problems (sleep disturbance and fatigue) and actual turnover (sleep disturbance OR 1.31, 95%CI = 1.02–1.60; fatigue OR 2.11, 95%CI = 1.50–2.68); sleep disturbance had a natural direct effect on actual turnover (OR 2.66, 95%CI,2.07–3.21).

Conclusion

Turnover intention strongly predicted actual turnover. Sleep disturbances may result in turnover, even in cases without existing turnover intention. These findings highlight the need for early interventions aimed at preventing and alleviating sleep disturbances for shift work female nurses.

The Effects of Wages and Training on Intent to Switch or Leave Among Direct Care Workers

Background and Objectives

Although most studies have not separated turnover of direct care workers (DCWs) into those who switch to another organization (switchers) and those who leave the industry (leavers), switchers and leavers have different impacts on the facilities they quit and the labor market for DCWs. We distinguished between intent to switch and intent to leave and investigated the impact of wages and training on each turnover intention.

Research Design and Methods

Data were obtained from Japan’s Fact-Finding Survey on Long-term Care Work. We included DCWs (n = 7,311) in the analyses and used multinomial regression by sex and provider type to compare those who wanted to switch and those who wanted to leave with those who wanted to remain in their current workplace.

Results

The impacts of an increase in wages and a higher training score were larger for intent to switch than intent to leave. Compared with wages, the impact of training was greater. The impact of job characteristics on turnover intention varied between women and men and across provider types.

Discussion and Implications

This study provides a better understanding of the difference in the determinants of switching and leaving and simultaneously increases our understanding of the differences between women and men and across provider types.

Nursing home nurses' turnover intention: A systematic review

Aim

This review aimed to examine and describe the published research on nursing home (NH) nurses' turnover intentions in their workplace.

Design

This study is a systematic review following PRISMA guidelines.

Methods

An electronic search was conducted for English and Korean articles to identify research studies published between 2009–2019 using CINAHL, PubMed, Cochrane Library, PsycINFO, RISS, and DBpia.

Results

A total of six studies met the inclusion criteria and revealed NH nurses' turnover intentions. The factors influencing NH nurses' turnover intentions were identified and classified as individual and organizational factors. Among the various factors above, this study found that job satisfaction was the most influential factor in nurses' turnover intentions. Therefore, further efforts are required to increase NH nurses' job satisfaction to decrease turnover intention.

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.

Mental health of nurses involved with COVID-19 patients in Japan, intention to resign, and influencing factors

The purpose of this study was to investigate the association between mental health (posttraumatic stress disorder, depression, anxiety disorder, and burnout) and intention to resign, and influencing factors regarding nurses involved with COVID-19 patients in A Prefecture as subjects.The design is a cross-sectional questionnaire-based study.Methods are conducted between August 4 and October 26, 2020. Basic attributes (gender, age, years of experience, etc.) were examined. Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, Impact of Event Scale-Revised, Maslach Burnout Inventory, "intent to resign," were used to collect data from nurses working at hospitals treating patients with COVID-19 in Japan.As a result, between 20% and 30% of nurses involved with patients with COVID-19 are in a state of high mental distress. Regarding the associations between psychiatric symptoms and intention to resign, "I want to quit being a nurse" was affected by "cynicism" and "professional efficacy"; "I want to change hospitals/wards" was affected by "cynicism"; and "subthreshold depression," "anxiety disorder," and "burnout" affected "I want to continue working as a nurse." The increase in the number of patients with COVID-19 was a factor affecting mental health and intention to resign. When the number of patients increased, anxiety disorders and intention to resign also increased. Damage from harmful rumors increased the severity of every psychiatric symptom. To prepare for a pandemic such as COVID-19, it is necessary in normal times to construct psychological support systems and community systems to prevent damage from harmful rumors.

Acute care nurses' perceptions of leadership, teamwork, turnover intention and patient safety - a mixed methods study

BACKGROUND

This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined.

METHODS

In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario.

RESULTS

Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study's key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey).

CONCLUSIONS

The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.

Reasons Behind Generation Z Nursing Students' Intentions to Leave their Profession: A Cross-Sectional Study

This study aims to identify predictors of turnover intention within 2 years of employment among 3rd and 4th grade Generation Z nursing students. Turnover intention is a multi-stage process ranging from mere desire, to serious thoughts, decision-making, and actual planning. Previous studies have focused on identifying the factors affecting turnover intention among practicing nurses. However, undergraduate nursing students also contemplate their decision to stay or leave the nursing profession after graduation. This cross-sectional descriptive study recruited 210 nursing students from 3 colleges in South Korea. A self-administered survey was conducted using the Career Preparation Behavior Scale, the Calling and Vocational Questionnaire, the Social Responsibility Scale, and the Revised Self-Leadership Questionnaire. Four questions were used to explore participants’ turnover intention, their motivation for studying nursing, their major satisfaction, and their clinical experience satisfaction. Descriptive and multiple logistic regression statistics were obtained using SPSS. Of the participants, 17.6% had turnover intention within 2 years of employment. Multiple logistic regression analysis indicates that clinical experience satisfaction is the only significant predictor. In the univariate analysis, nursing students who had turnover intentions were less likely to practice career preparation behaviors and had lower levels of vocational consciousness and social responsibility. To keep a proficient nursing workforce in the profession, professional commitments from universities and hospital institutions are needed to provide quality clinical learning experiences for nursing students. Further prospective study is needed to observe how Generation Z undergraduate students’ turnover intentions change and what factors influence this process.

RISE: Exploring Volunteer Retention and Sustainability of a Second Victim Support Program

EXECUTIVE SUMMARY

The Resilience In Stressful Events (RISE) program that supports healthcare professionals traumatized by stressful clinical events has had a stable, volunteer-based membership since its inception in 2011 at Johns Hopkins Hospital. For this study, we explored RISE members' perceptions of the program that contribute to their retention and the program's sustainability. We distributed a survey with quantitative and qualitative elements to assess perceptions in seven domains of interest. The response rate was 100%. Pearson chi-squared tests established statistical associations among quantitative variables. Qualitative data were explored using content analysis. Of 27 respondents, 19 had been members for 3 or more years. The training completion percentage was 100%, and the annual turnover percentage was 12%. Members found their duties to be meaningful (100%), personally satisfying (96%), and positively impactful (93%). A total of 89% reported confidence in their competency to perform RISE duties, 84% in their autonomy, and 56% in their personal resilience; 28% reported some burnout from RISE duties. Cronbach's α for these domain scores ranged from 0.65 to 0.97. Content analysis also revealed positive perceptions of RISE volunteering and personal empowerment. Members indicated a personal affinity with RISE and gains in energy and enjoyment from their membership. Contributing factors to volunteer retention may include members' perceptions that RISE builds valued skills and supports their affinity for others.

Investigating the relationship between organizational justice, job satisfaction, and intention to leave the nursing profession: A cross-sectional study

AIMS

This study aims to test a hypothetical model linking various dimensions of organizational justice to the job satisfaction and nurses' intention to leave the profession based on the theoretical assumptions of the Alexander model of voluntary turnover.

DESIGN

A cross-sectional survey.

METHODS

This study was conducted on 317 inpatient ward nurses of six teaching hospitals in Tehran, Iran during 1 September 2017-14 November 2018. Clinical nurses were recruited by a multistage random sampling. Data were collected using structured questionnaires of organizational justice, job satisfaction, and nurses' intention to leave. Data were analysed by structural equation modelling using Amos 22 statistical program.

RESULTS

The structural equation model demonstrated adequate fit and the hypothesized correlations were partially supported. The findings suggested that the distributive justice (p < .001; β = 0.24) and interactional justice (p < .001; β = 0.44) could indirectly affect the nurses' intention to leave the nursing profession via the direct impact on job satisfaction, while job satisfaction had a significant, negative effect on the nurses' intention to leave (p < .001; β = -0.71).

CONCLUSIONS

According to the results, the model fit was acceptable, suggesting the validity of the final model. Furthermore, distributive and interactional justice could reduce the intention to leave the nursing profession by influencing the job satisfaction of the clinical nurses.

IMPACT

This was one of the first studies to determine the aspects of justice that must be further emphasized by healthcare managers to increase the job satisfaction of nurses and their retention in healthcare systems. The findings indicated that fair interactions have a greater impact on job satisfaction and retention of nurses than procedural and distributive justice. The results of this study provide valuable references for nursing managers to increase the job satisfaction of nurses and their retention in healthcare settings.

Family-supportive organizational environment and turnover intention

Purpose

The purpose of this paper is to test a model in which family-supportive organizational environment is associated with lower levels of turnover intention through higher levels of work-family enrichment and job satisfaction.

Design/methodology/approach

Based on a sample of 300 employees, the bootstrap procedure for estimating indirect correlations in multiple mediator models was used to test the research hypotheses.

Findings

The results suggest that employees experiencing high levels of family-supportive organizational environment are likely to report lower intention to leave their profession by virtue of their higher levels of job satisfaction and work-life enrichment.

Research limitations/implications

The study is limited to public organization and sample size. Further research is needed to make comparison between large/state-owned and small/private organizations.

Practical implications

In the Iran context, work-family enrichment and job satisfaction are effective in reducing the employees' turnover intention. Organizations should show concerns for the employees' work-life enrichment and job satisfaction to reduce their turnover intention.

Social implications

Turnover is one of the problems of organizations in many countries throughout the world including Iran, which has negative consequences through increasing the cost of organizations. The results of this study suggest ways in which staff retention could be improved.

Originality/value

The present study contributes to supportive organizational environment literature by addressing the relationship between family-supportive organizational environment and employee-related outcomes. Given some commonalities between Iran and other developing countries, the findings might be of potential interest in comparative studies dealing with the employees' turnover issue.

Evaluating the effects of social networking sites addiction, task distraction, and self-management on nurses' performance

AIMS

The purpose of this study was to explore the relationship of social networking sites (SNSs) addiction on nurses' performance and how this relationship was mediated by task distraction and moderated by self-management.

DESIGN

This cross-sectional study is designed to empirically test the relationship of SNSs addiction, task distraction, and self-management with the nurses' performance.

METHODS

Data were collected by conducting an online survey on nurses across the world using a web-based questionnaire developed through 'Google Docs' and distributed through Facebook from 13 August 2018 - 17 November 2018. The Facebook groups were searched using the selected key terms. In total, 45 groups were found to have relevance to this research; therefore, request was made to the admins of these groups to participate in this research and to post a link in their groups. Only 19 group admins responded positively by uploading a link of the research instrument on their respective group pages and 461 members of these groups participated in the research.

RESULTS

Results of the data collected from 53 different countries indicated that SNSs addiction results in lowering the nurses' performance. This relationship is further strengthened by task distraction introduced as a mediating variable. The results show that self-management mediates the relationship between SNSs addiction and employees' performance. Moreover, the results of the study confirm that self-management reduces the negative impact of SNSs addiction on nurses' performance.

CONCLUSION

Social networking sites (SNSs) addiction and task distraction reduce the nurses' performance, whereas self-management enhances nurses' performance.

IMPACT

This study addresses the problem of using SNSs at the workplace and its potential effect on nurses' performance. Results demonstrate that SNSs addiction reduces the performance which is further decreased by task distraction; however, self-management of nurses can enhance the nurses' performance. The research has numerous theoretical and practical implications for hospital administration, doctors, and nurses.

Turnover intention of hospital staff in Ontario, Canada: exploring the role of frontline supervisors, teamwork, and mindful organizing

BACKGROUND

This study contributes to a small but growing body of literature on how context influences employee turnover intention. We examine the impact of staff perceptions of supervisory leadership support for safety, teamwork, and mindful organizing on turnover intention. Interaction effects of safety-specific constructs on turnover intention are also examined.

METHODS

Cross-sectional survey data were collected from nurses, allied health professionals, and unit clerks working in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario.

RESULTS

Hierarchical regression analyses showed that staff perceptions of teamwork were significantly associated with turnover intention (p < 0.001). Direct associations of supervisory leadership support for safety and mindful organizing with turnover intention were non-significant; however, when staff perceived lower levels of mindful organizing at the frontlines, the positive effect of supervisory leadership on turnover intention was significant (p < 0.01).

CONCLUSIONS

Our results suggest that, in addition to teamwork perceptions positively affecting turnover intentions, safety-conscious supportive supervisors can help alleviate the negative impact of poor mindful organizing on frontline staff turnover intention. Healthcare organizations should recruit and retain individuals in supervisory roles who prioritize safety and possess adequate relational competencies. They should further dedicate resources to build and strengthen the relational capacities of their supervisory leadership. Moreover, it is important to provide on-site workshops on topics (e.g., conflict management) that can improve the quality of teamwork and consequently reduce employees' intention to leave their unit/organization.

Health indicators as moderators of occupational commitment and nurses' intention to leave

AIM

This study examined the hypothesis that health indicators moderate the relationship between occupational commitment and intention to leave among nurses, using a large sample in Japan.

METHODS

A self-administered questionnaire was distributed to all registered nurses (N = 11,171) working in group hospitals in western Japan in 2014. The questionnaire evaluated intention to leave, occupational commitment, psychological distress, cumulative fatigue, and demographic variables. After a preliminary analysis of the bivariate and multivariate associations between variables and intention to leave, we tested the interactions between occupational commitment and health indicators on intention to leave.

RESULTS

Of the 5,768 returned questionnaires, data from 5,505 (49.3%) participants were analyzed. Participants' mean age was 36.27 years (SD = 10.37). Most (95.14%) were women. According to a generalized estimating equation, the interaction of continuance occupational commitment and cumulative fatigue was significantly related to intention to leave (b = -0.0055). Additionally, the interaction of affective occupational commitment and psychological distress was significantly related to intention to leave (b = 0.0079).

CONCLUSIONS

This study clarified that the relationship between occupational commitment and intention to leave was robust for nurses in good health. Interventions aimed at reducing fatigue and improving psychological distress should be implemented to prevent the protective effects of occupational commitment on nurses' intention to leave from being compromised.

Work-Related Intervention Needs and Potential Occupational Outcomes among Medical Assistants: A Cross-Sectional Study

Medical assistants' (MAs) working conditions have been characterized as precarious, and workplace-related intervention needs have been identified. However, strategies to change the MAs adverse working conditions are mostly seen on an individual level, including leaving the employer or even the profession. Since such intentions are antecedents of actual turnover, we aimed to quantify the potential link of reported unmet intervention needs with unfavorable occupational outcomes. Data were collected by means of a nationwide survey among medical assistants (n = 994) in Germany (September 2016-April 2017). The three subscales working conditions, reward from the supervisor, and task-related independence were derived from a 12-item instrument regarding work-related interventions needs (the independent variables). We used subscale-specific z-scores and a total needs z-score. The four outcome variables (i.e., intention to leave the employer, intention to leave the MA profession, choosing MA profession again, and recommending MA profession to young people) were dichotomized, and logistic regression analyses were performed and limited to MAs in employment (n = 887). We found that increasing needs according to the categorized total needs score were associated with increasing odds of all occupational outcomes. Needs pertaining to working conditions and reward from the supervisor were the strongest determinants of MAs' consideration of leaving their employer or profession (Odds ratios: 1.55-2.61). In summary, our study identified unmet work-related intervention needs that are associated with unfavorable occupational outcomes. In light of staffing shortage in health care, the identified needs should be addressed to ensure that sufficient recruitment of junior staff in the profession of medical assistants remains feasible and that experienced staff is retained.

Intention to leave and associated factors among psychiatric nurses in China: A nationwide cross-sectional study

BACKGROUND

The retention of psychiatric nurses is an important concern for healthcare administrators in China. However, Chinese psychiatric nurses' intention to leave their jobs and the factors associated with it have been scarcely studied.

OBJECTIVE

To investigate Chinese psychiatric nurses' intention to leave their jobs, and to explore the associations between the intention to leave and individual characteristics, job-related factors and job satisfaction.

DESIGN

A cross-sectional, anonymous survey of a nationwide sample was conducted.

SETTINGS

Thirty-two tertiary psychiatric hospitals in 29 provincial capital cities in China.

PARTICIPANTS

All 9907 nurses in 32 hospitals were targeted for this survey conducted in December 2017; 8493 responded (response rate = 85.7%), and 7933 (without logic errors in the data) were included in the analysis.

METHODS

A questionnaire was used to investigate the respondent's intention to leave their job and to collect data on related factors, including individual characteristics (gender, age, marital status, educational background and self-rated health), job-related factors (professional title, working years, income, work hours, history of patient-initiated violence, perceived respect from patients, social recognition as well as physician-nurse coordination and trust) and job satisfaction. The short version of the Minnesota Satisfaction Questionnaire was used to assess job satisfaction. Chi-square tests and multilevel logistic regression analysis were used to examine associations between an intention to leave and other factors.

RESULTS

Among 7933 respondents, 20.2% reported an intention to leave their current jobs. The multiple regression analysis showed that better self-rated health (i.e. OR = 0.373, 95%CI = 0.308-0.452 for good health, reference: poor health), working more than 20 years (OR = 0.479, 95%CI = 0.389-0.590, reference: 20 years or less), higher monthly income (i.e. OR = 0.521, 95%CI = 0.399-0.680 for 6001-8000 RMBs, reference: 4500 RMB or less), perceived patient respect (OR = 0.727, 95%CI = 0.623-0.849), physician-nurse coordination (OR = 0.549, 95%CI = 0.480-0.629) and being satisfied with one's job (OR = 0.373, 95%CI = 0.308-0.452) were negatively associated with an intention to leave; while those who were male (OR = 1.879, 95%CI = 1.605-2.199), working more than 40 hours per week (OR = 1.584, 95%CI = 1.374-1.825) and experienced patient-initiated violence in the past 12 months (OR = 1.566, 95%CI = 1.376-1.781) had a higher odds of reporting an intention to leave.

CONCLUSIONS

Self-rated health, monthly income, work hours, patient-initiated violence, perceived patient respect, physician-nurse coordination and job satisfaction are significant factors associated with a nurse's intention to quit their job. In order to retain nurses in Chinese tertiary psychiatric hospitals, the government and hospital administrators should consider ways to address these factors.

A Prospective Examination of Clinician and Supervisor Turnover Within the Context of Implementation of Evidence-Based Practices in a Publicly-Funded Mental Health System

Staff turnover rates in publicly-funded mental health settings are high. We investigated staff and organizational predictors of turnover in a sample of individuals working in an urban public mental health system that has engaged in a system-level effort to implement evidence-based practices. Additionally, we interviewed staff to understand reasons for turnover. Greater staff burnout predicted increased turnover, more openness toward new practices predicted retention, and more professional recognition predicted increased turnover. Staff reported leaving their organizations because of personal, organizational, and financial reasons; just over half of staff that left their organization stayed in the public mental health sector. Implications include an imperative to focus on turnover, with a particular emphasis on ameliorating staff burnout.

Job-related stress in psychiatric assistant nurses

Aim

We aimed to clarify how stress among psychiatric assistant nurses (PANs) differed from Registered Nurses (PRNs).

Design

Cross-sectional survey study was conducted with PRNs and PANs working in six psychiatric hospitals in Japan.

Methods

The Psychiatric Nurse Job Stressor Scale (PNJSS) and the job stressor and stress reaction subscales of the Brief Job Stress Questionnaire measured stress in 68 PANs and 140 PRNs. The results were statistically analysed.

Results

Psychiatric assistant nurses had significantly higher scores than PRNs on the job stressor subscales in psychiatric nursing ability, interpersonal relations and in the stress reaction subscales of irritability and somatic symptoms. "Psychiatric nursing ability," "Communication" and "Use of techniques" were associated with almost all stress reactions in PANs than in PRNs.

The Effects of Occupational Stress, Work-Centrality, Self-Efficacy, and Job Satisfaction on Intent to Quit Among Long-Term Care Workers in Korea

A large and growing population of elderly Koreans with chronic conditions necessitates an increase in long-term care. This study is aimed at investigating the effects of occupational stress, work-centrality, self-efficacy, and job satisfaction on intent to leave among long-term care workers in Korea. We tested the hypothesized structural equation model predicting the intention to quit among long-term care workers in Korea. Survey data were collected from 532 long-term care workers in Seoul, Korea. Results showed that occupational stress was positively associated with intention to leave the job. The study also identified several possible mediators (self-efficacy, work-centrality, job satisfaction) in the relationship between stress and intent to quit. Evidence-based stress management interventions are suggested to help the workers better cope with stressors. Mentoring programs should also be considered for new workers.

Factors influencing job satisfaction of academic librarians in university libraries in Edo and Delta states, Nigeria

Purpose

This study aimed to investigate the factors that influence job satisfaction of academic librarians in university libraries in Edo and Delta states in Nigeria.

Design/methodology/approach

The study adopted a descriptive survey design using 88 academic librarians in the university libraries in the two states. Total enumeration sampling technique was used for this study. All 88 librarians in the federal, state and private university libraries in Édo and Delta states of Nigeria were considered appropriate for this study. The instrument used for data collection was self-structured questionnaire, and all 88 respondents in this study responded to the questionnaire.

Findings

Five factors capable of influencing job satisfaction of employees – work environment, remuneration, fairness, promotion and training – were expatiated upon to ascertain their influence on librarians’ job satisfaction. The result revealed that all the variables significantly influence librarians’ job satisfaction which serves as stimulus for employee’s productivity and delivery of quality services to clientele.

Originality/value

This research is the first to ascertain the factors that influences job satisfaction of academic librarians in university libraries in Edo and Delta states of Nigeria.

The Influence of Organizational Context on Quitting Intention

This study uses multilevel methods to investigate the effects of organizational context on job satisfaction and quitting intention among staff working in long-term mental health care settings. Two types of organizational features are examined: group job satisfaction and structural features of the work unit (unit size, workload, and level of client functioning on the unit). A review of the organizational literature reveals that most empirical research has investigated job satisfaction at the individual level of analysis rather than the group level. The authors argue that the affective context of a group has real and measurable consequences for individual attitudes and behavior, independent of individual attitudes toward the job. Using multilevel modeling, study findings support the premise that group job satisfaction exercises effects on intention to quit independent of individuals’ dispositions toward their jobs. These effects are both direct and interactive. The findings underscore the importance of affective context in shaping individual attitudes and behavioral intentions.

Job Satisfaction Among Nurses in China

This study examined job satisfaction among nurses in China. A nationwide survey was conducted with 403 nurses employed at hospitals in 16 provinces in China using the Job Descriptive Index Scale. The findings indicated that, overall, nurses were dissatisfied with work, pay, and promotions. Pay was rated as the least satisfying aspect of work followed by promotions. Nurses with more years of experience, higher professional titles, and more opportunities to attend continuing education programs were more likely to have a high level of job satisfaction than nurses with fewer years of experience, lower professional titles, and fewer opportunities to attend continuing education programs. Nurse managers should pay close attention to nurses’pay, career advancement opportunities, and promotions. They should recognize nurses’ achievements and provide opportunities for continuing education programs and independent work with emphasis on critical thinking and decision making, autonomy, accountability, and delegation.

Trends in job satisfaction among German nurses from 1990 to 2012

OBJECTIVE

Improving the job satisfaction of nurses is essential to enhance their productivity and retention and to improve patient care. Our aim was to analyse trends in German nurses' job satisfaction to enhance understanding of the nursing labour market and inform future policies.

METHODS

We used 1990-2012 German Socioeconomic Panel data for trends in nurses' job satisfaction. Comparisons were drawn with doctors, other health care workers, and employees in other sectors of employment. Analysis explored associations between job satisfaction trends and other aspects of employment, such as whether full time or part time and pay. To account for fluctuations across the period of analysis, linear trends were generated using ordinary least squares.

RESULTS

Over 23 years, job satisfaction of German nurses underwent a steady and gradual decline, dropping by an average 7.5%, whereas that of doctors and other health care workers increased by 14.4% and 1%, respectively. The decline for part-time nurses (13%) was more pronounced than that for full-time nurses (3%). At the same time, nurses' pay rose by only 3.8% compared to a 23.8% increase for doctors.

CONCLUSIONS

The steady decline in nurses' job satisfaction over the last two decades may be attributable to the multiple reforms and associated policy changes that generally disadvantaged nurses. Contributing factors to job satisfaction decline include lower pay and the demanding and strenuous work environment. Irrespective of the reason, health services researchers, leaders, and policy makers should investigate the reasons for this decline given the forecast growth in work load and complexity of care. Supportive policies for nurses would help enhance the quality and sustainability of German health care.

Job satisfaction and turnover intention among Iraqi doctors--a descriptive cross-sectional multicentre study

BACKGROUND

During the last two decades, the Iraqi human resources for health was exposed to an unprecedented turnover of trained and experienced medical professionals. This study aimed to explore prominent factors affecting turnover intentions among Iraqi doctors.

METHODS

A descriptive cross-sectional multicentre study was carried out among 576 doctors across 20 hospitals in Iraq using multistage sampling technique. Participants completed a self-administered questionnaire, which included socio-demographic information, work characteristics, the 10-item Warr-Cook-Wall job satisfaction scale, and one question on turnover intention. Descriptive and bivariate and multiple logistic regression analyses were conducted to identify significant factors affecting turnover intentions.

RESULTS

More than one half of Iraqi doctors (55.2%) were actively seeking alternative employment. Factors associated with turnover intentions among doctors were low job satisfaction score (odds ratio (OR) = 0.97; 95% confidence interval (CI): 0.95, 0.99), aged 40 years old or less (OR = 2.9; 95% CI: 1.74, 4.75), being male (OR = 4.2; 95% CI: 2.54, 7.03), being single (OR = 5.0; 95% CI: 2.61, 9.75), being threatened (OR = 3.5; 95% CI: 1.80, 6.69), internally displaced (OR = 3.1; 95% CI: 1.43, 6.57), having a perception of unsafe medical practice (OR = 4.1; 95% CI: 1.86, 9.21), working more than 40 h per week, (OR = 2.3; 95% CI: 1.27, 4.03), disagreement with the way manager handles staff (OR = 2.2; 95% CI: 1.19, 4.03), being non-specialist, (OR = 3.9, 95% CI: 2.08, 7.13), and being employed in the government sector only (OR = 2.0; 95% CI: 1.09, 3.82).

CONCLUSION

The high-turnover intention among Iraqi doctors is significantly associated with working and security conditions. An urgent and effective strategy is required to prevent doctors' exodus.

Should I stay or should I go? The impact of working time and wages on retention in the health workforce

BACKGROUND

Turnover in the health workforce is a concern as it is costly and detrimental to organizational performance and quality of care. Most studies have focused on the influence of individual and organizational factors on an employee's intention to quit. Inspired by the observation that providing care is based on the duration of practices, tasks and processes (issues of time) rather than exchange values (wages), this paper focuses on the influence of working-time characteristics and wages on an employee's intention to stay.

METHODS

Using data from the WageIndicator web survey (N = 5,323), three logistic regression models were used to estimate health care employee's intention to stay for Belgium, Germany and the Netherlands. The first model includes working-time characteristics controlling for a set of sociodemographic variables, job categories, promotion and organization-related characteristics. The second model tests the impact of wage-related characteristics. The third model includes both working-time- and wage-related aspects.

RESULTS

Model 1 reveals that working-time-related factors significantly affect intention to stay across all countries. In particular, working part-time hours, overtime and a long commuting time decrease the intention to stay with the same employer. The analysis also shows that job dissatisfaction is a strong predictor for the intention to leave, next to being a woman, being moderately or well educated, and being promoted in the current organization. In Model 2, wage-related characteristics demonstrate that employees with a low wage or low wage satisfaction are less likely to express an intention to stay. The effect of wage satisfaction is not surprising; it confirms that besides a high wage, wage satisfaction is essential. When considering all factors in Model 3, all effects remain significant, indicating that attention to working and commuting times can complement attention to wages and wage satisfaction to increase employees' intention to stay. These findings hold for all three countries, for a variety of health occupations.

CONCLUSIONS

When following a policy of wage increases, attention to the issues of working time-including overtime hours, working part-time, and commuting time-and wage satisfaction are suitable strategies in managing health workforce retention.

The relationship between South Korean clinical nurses' attitudes toward organizations and voluntary turnover intention: A path analysis

The purpose of this study was to examine the relationship between attitudes toward their organizations and voluntary turnover intention among South Korean clinical nurses. Data from a total of 312 clinical nurses in six hospitals in South Korea were collected for the study. Both hierarchical multiple regression analysis and path analysis were used to analyse the data. The overall fit of the hypothetical model was good. Voluntary turnover intention was found to have significant direct pathways to job embeddedness and organizational commitment. Organizational commitment and satisfaction with organizational rewards had indirect pathways to voluntary turnover intention through job embeddedness. All variances explained 62.3% of the voluntary turnover intention scores. The findings suggest that greater job embeddedness, organizational commitment and satisfaction with organizational rewards lead to lower voluntary turnover intention among clinical nurses in South Korea.

Physician satisfaction and burnout at different career stages

OBJECTIVE

To explore the work lives, professional satisfaction, and burnout of US physicians by career stage and differences across sexes, specialties, and practice setting.

PARTICIPANTS AND METHODS

We conducted a cross-sectional study that involved a large sample of US physicians from all specialty disciplines in June 2011. The survey included the Maslach Burnout Inventory and items that explored professional life and career satisfaction. Physicians who had been in practice 10 years or less, 11 to 20 years, and 21 years or more were considered to be in early, middle, and late career, respectively.

RESULTS

Early career physicians had the lowest satisfaction with overall career choice (being a physician), the highest frequency of work-home conflicts, and the highest rates of depersonalization (all P<.001). Physicians in middle career worked more hours, took more overnight calls, had the lowest satisfaction with their specialty choice and their work-life balance, and had the highest rates of emotional exhaustion and burnout (all P<.001). Middle career physicians were most likely to plan to leave the practice of medicine for reasons other than retirement in the next 24 months (4.8%, 12.5%, and 5.2% for early, middle, and late career, respectively). The challenges of middle career were observed in both men and women and across specialties and practice types.

CONCLUSION

Burnout, satisfaction, and other professional challenges for physicians vary by career stage. Middle career appears to be a particularly challenging time for physicians. Efforts to promote career satisfaction, reduce burnout, and facilitate retention need to be expanded beyond early career interventions and may need to be tailored by career stage.

Primary school teachers in China: associations of organizational justice and effort-reward imbalance with burnout and intentions to leave the profession in a cross-sectional sample

OBJECTIVE

We examined associations of organizational justice (OJ) and effort-reward imbalance (ERI) with burnout and intentions to leave the teaching profession (ILTP) among primary school teachers in China.

METHODS

Six primary schools located in Wuhan, China, were randomly selected from three different socioeconomic areas in 2010. In total, these schools employed 533 teachers, and 436 of these (82 %) participated in a cross-sectional survey. OJ and ERI were assessed by 13-item and 10-item questionnaires, respectively. Burnout was measured using the emotional exhaustion subscale of the Chinese Maslach Burnout Inventory. ILTP were operationalized based on the frequency of thoughts about turnover during the past year. Logistic regression-based odds ratios (ORs) with 95 % confidence intervals (CIs) were estimated separately for OJ and ERI. In a second step, these work stress scales were entered into the same regression model.

RESULTS

Separate regression models suggested moderate to strong associations of OJ and ERI with burnout and ILTP. After simultaneous adjustment, the overall OJ score remained associated with burnout and ILTP, but ERI appeared to be the stronger and more consistent determinant of both outcomes. For instance, an increase of 1 standard deviation of the ERI score was associated with an OR of 2.60 (95 % CI 1.97-3.43) for burnout and with an OR of 2.26 (95 % CI 1.66-3.08) for ILTP.

CONCLUSIONS

Organizational justice and in particular ERI appeared to be determinants of burnout and ILTP among primary school teachers in China.

Voice or Consistency? What You Perceive as Procedurally Fair Depends on Your Level of Power Distance

Power distance (PD) is a cultural value known for its moderating effect on subordinates’ reaction to procedural justice. The reaction to procedural justice in general as well as the reaction to the voice criterion exclusively emerged to be stronger among low PD (LPD) than high PD (HPD) individuals. Until now, no research exists, however, on the effect of PD on Leventhal’s procedural justice criteria, when measured separately. By means of two studies, the effect of PD on voice was therefore compared with the effect of PD on Leventhal’s consistency criterion. Consistency was chosen due to HPD individuals’ preference for structure and stability. Study 1 ( n = 258), a cross-cultural scenario-based study examining the effect in terms of received and violated fairness, revealed a moderating effect of PD on the reaction to voice, but not on the reaction to consistency. Voice was found to be exclusively important for LPD individuals, whereas consistency emerged to be important regardless of PD. Study 2, a mono-cultural within-subjects study ( n = 161), replicated these results. Accordingly, not voice but consistency seems to be the procedural justice criterion of particular relevance for managers to consider in times of globalization and increasing cultural diversity.

Stress, depression, and intention to leave among nurses in different medical units: implications for healthcare management/nursing practice

AIMS

The aim of the present study was to compare the levels of stress, depression, and intention to leave among clinical nurses employed in different medical units in relation to their demographic characteristics under the National Health Insurance (NHI) System in Taiwan.

METHODS

Cross-sectional Spearman's correlation, one-way ANOVA with Scheffe post hoc analysis tests, and multiple regression analyses were conducted. Several self-report questionnaires, such as the Center for Epidemiological Studies Depression Scale, the Perceived Stress Scale and Intention to Leave Scale, were administered. A total of 314 research participants were surveyed, all of whom came from regional hospitals in Northern Taiwan.

RESULTS

Marital status and working tenure were significant predictors to the levels of stress, depression, and intention to leave among nurses before taking the medical units into consideration. However, with adding medical units as predictors, the effect of marital status and working tenure were insignificant except for the stress model, indicating medical units were showing dominant effect over other variables. In particular, internal medical ward (IMW) nurses experienced a higher prevalence of depression than emergency room (ER) nurses and professional nursing practitioners. External medical ward (EMW) nurses also experienced greater depression than emergency room (ER) nurses. Both IMW and EMW nurses perceived significantly greater stress than ER and dialysis center. Moreover, IMW nurses also perceived greater stress than operating room (OR) nurses and showed stronger intention to leave than their counterparts in the outpatient service departments.

CONCLUSIONS

The results indicated that significant differences existed among various medical units with regards to nurses' stress, depression, and intention to leave. Nurses working in internal and external medical wards, especially the inexperienced and married ones, experienced greater depression and stress, thereby developing stronger intention to leave their job.

Registered nurse retention strategies in nursing homes: a two-factor perspective

BACKGROUND

As the American population ages and the proportion of individuals over the age of 65 expands, the demand for high-quality nursing home care will increase. However, nursing workforce instability threatens care quality and sustainability in this sector. Despite increasing attention to nursing home staff turnover, far less is known about registered nurse (RN) retention.

PURPOSE

In this study, the relationships between retention strategies, employee benefits, features of the practice environment, and RN retention were explored. Further, the utility of Herzberg's two-factor theory of motivation as a framework for nursing home retention studies was evaluated.

METHODOLOGY

This study was a secondary analysis of the nationally representative 2004 National Nursing Home Survey. The final sample of 1,174 participating nursing homes were either certified by Medicare or Medicaid or licensed by state agencies. We used a weighted multinomial logistic regression using an incremental approach to model the relationships.

FINDINGS

Although most nursing homes offered some combination of retention programs, the majority of strategies did not have a significant association with the level of RN retention reported by facilities. Director of nursing tenure and other extrinsic factors had the strongest association with RN retention in adjusted analyses.

PRACTICE IMPLICATIONS

To improve RN retention, organizations may benefit greatly from stabilizing nursing home leadership, especially the director of nursing position. Second, managers of facilities with poor retention may consider adding career ladders for advancement, awarding attendance, and improving employee benefits. As a behavioral outcome of motivation and satisfaction, retention was not explained as expected using Herzberg's two-factor theory.

Thirty years of nursing turnover research: looking back to move forward

Despite the substantial amount of useful prior work on turnover among nurses, our understanding of the causal mechanisms explaining why nurses voluntarily leave their jobs is limited. The purpose of this article is to promote the development of stronger conceptual models of the causes of voluntary turnover among nurses. The author compares the nursing-specific literature to research on voluntary turnover from the general management field over the past 30 years and examines the evolution of key theories used in the nursing literature. Results of this review comparing nursing research with that in the broader field suggest that, over time, nursing research has not kept pace with conceptualizations from general management explaining why people either remain at or quit their jobs. The author argues that conceptual models of turnover among nurses can benefit significantly from drawing more effectively on particular models and concepts available in general management studies of turnover.

Relationships Among Employees’ Working Conditions, Mental Health, and Intention to Leave in Nursing Homes

Employee turnover is a large and expensive problem in the long-term care environment. Stated intention to leave is a reliable indicator of likely turnover, but actual predictors, especially for nursing assistants, have been incompletely investigated. This quantitative study identifies the relationships among employees’ working conditions, mental health, and intention to leave. Self-administered questionnaires were collected with 1,589 employees in 18 for-profit nursing homes. A working condition index for the number of beneficial job features was constructed. Poisson regression modeling found that employees who reported four positive features were 77% less likely to state strong intention to leave (PR = 0.23, p < .001). The strength of relationship between working conditions and intention to leave was slightly mediated by employee mental health. Effective workplace intervention programs must address work organization features to reduce employee intention to leave. Healthy workplaces should build better interpersonal relationships, show respect for employee work, and involve employees in decision-making processes.

The Correlates of Nursing Staff Turnover in Home and Hospice Agencies

Using data from the 2007 National Home and Hospice Care Survey, this study provides an update of nursing staff turnover at U.S. home health and hospice agencies and explores correlates of nursing staff turnover. Results show that the three-month turnover rates of registered nurses (RNs), licensed practice nurses (LPNs), home health aides (HHAs), and certified nursing assistants (CNAs) in 2007 were 10.2%, 14.3%, 12.5%, and 12.9%, respectively. A higher nurse staffing level reduced the odds of RN and HHA turnover; the availability of communication aids reduced the odds of LPN turnover. Moreover, among benefit programs, the provision of partial insurance for family reduced the odds of HHA turnover; dental or vision health insurance reduced the odds of RN turnover; mileage reimbursement or agency car reduced the odds of LPN turnover. The provision of a 401k plan and a paid-time-off program increased the odds of RN turnover. The study results suggest that high staffing levels and benefit programs (e.g., health insurance) may reduce the odds of experiencing nursing staff turnover. Initiatives to minimize nursing staff turnover should consider these factors.

Turnover intention among hospital-based registered nurses in the Eastern Caribbean

PURPOSE

Vacancy rates for nurses in the English-speaking Caribbean are estimated at 30% with turnover typically associated with migration. The purpose of this study was to describe the characteristics of hospital-based registered nurses (RNs) in the sub-region, their practice environment and turnover intention in two and five years, respectively, and to determine the relationships among practice environment characteristics and turnover intention.

DESIGN

A descriptive correlational design was used with self-reported questionnaires from a convenience sample of 301 RNs working in hospitals in four English speaking Eastern Caribbean countries. Single-item visual analog scales (VAS) were used to measure turnover intention in 2 years and 5 years. The Practice Environment Scale of the Nursing Work Index (PES-NWI) measured the characteristics in the practice environment.

FINDINGS

The mean age of the nurses was 32.5 (SD = 6.75) years. Most nurses (58.8%) were single and 91.4% had relatives living abroad. Nurses scored three PES-NWI subscales < 2.5, indicating a less positive practice environment: resource adequacy, nurse participation in hospital affairs, and nurse managers' ability, leadership, and support. The subscale for collegial nurse-physician relations received the best rating (mean = 2.61, SD = .62). For 2-year intention to leave, the mean rating on the 100-mm VAS was 63.2, while that for the 5-year intention to leave was 65.6. No significant correlations were found among four of the five PES-NWI subscales and turnover intention in 2 and 5 years.

CONCLUSIONS

The practice environment, while generally unfavorable, is not associated with the nurses' intention to leave their jobs. These findings support the current policy position that calls for managing turnover among nurses. Nursing and health system administrators should assess, plan, and implement workforce policies to slow the outflow of nurses.

CLINICAL RELEVANCE

Initiatives to improve the work environment and the delivery of high-quality care are important to RNs in the Eastern Caribbean. Managing the negative impact of continuous outflow of nurses through turnover requires long-term coordinated policy and human resource development and management initiatives to sustain the supply of RNs in the subregion.