Turnover intention and retention of newly licensed nurses in their first job: A longitudinal study

Registered nurses' experiences of the graduate nurse residency program: A qualitative study

BACKGROUND

The turnover of new graduate nurses is a critical issue worldwide. A key contributing factor is the highly stressful transition from student to registered nurse. Graduate nurse residency programs support new graduate nurses during this transition and facilitate professional development.

OBJECTIVE

This study aimed to gain insight into the experiences of registered nurses' in the graduate nurse residency program.

DESIGN

A descriptive qualitative study design using thematic analyses.

SETTING

This study was conducted in an academic tertiary hospital in Singapore.

PARTICIPANTS

Registered nurses who completed the graduate nurse residency program were selected using a purposive sampling approach.

METHODS

This study was conducted from September to December 2023. A total of 19 registered nurses were invited to an individual semi-structured interview. The interviews were either conducted online through Zoom or instant messaging. The Zoom interviews were audio- and video-recorded and transcribed verbatim. A six-step inductive thematic analysis was used for data analysis.

RESULTS

Two themes depicting nurses' experiences of the graduate nurse residency program were elucidated, (1) easing the shift from student to registered nurse; and (2) facilitating the transition to becoming a competent nurse. The participants alluded to the importance of the graduate nurse residency program in playing a supportive role in enabling their transition. The provision of technical and soft skills were valued by the participants. The graduate nurse residency program also aided in participants' professional development through evidence implementation and mentorship. The graduate nurse residency program was an enabler of participants' intent to stay in the nursing profession.

CONCLUSIONS

The findings of this study show that nurses viewed the graduate nurse residency program in a positive light. The provision of a multi-modal graduate nurse residency structured program focusing on building clinical competencies, mentorship, and evidence implementation projects can promote new graduate nurses' transition into professional practice. Further research is needed to examine the long term impacts of graduate nurse residency programs using cohort or randomized controlled trials.

Relationship between transition shock, resilience, career calling, and retention intention among new nurses: a moderated mediation model

BACKGROUND

Nurse shortage has become an ongoing and urgent problem worldwide. The high turnover rate of new nurses, who are the primary backup personnel for the nursing force, exacerbates the possibility of this situation. Transition shock has been demonstrated to be critical in influencing new nurses' retention intention. However, the mechanisms underlying this impact remain unclear.

OBJECTIVES

This study aims to explore transition shock's effect mechanism on retention intention among new nurses, and to clarify the career calling's mediating role and the resilience's moderating role in this relationship.

METHODS

This is a multicenter cross-sectional study. From January 28 to February 20, 2024, an online questionnaire survey was administered among 739 new nurses from 11 hospitals in Shanxi Province, China, using convenience sampling. The survey included a demographic information questionnaire, the Transition Shock of Newly Graduated Nurses Scale, the Medical Staff Resilience Scale, the Career Calling Scale, and the Nurses' Intention to Stay Scale. The data were analyzed using descriptive analysis, Pearson correlation analysis, and the PROCESS Macro Model 4 and 7 for the regression.

RESULTS

Transition shock was significantly negatively correlated with retention intention (p < 0.001). Career calling played a partial mediating role between transition shock and retention intention, accounting for 63.53% of the total effect. Further, resilience moderated transition shock's effect on career calling; thereby, a moderated mediation model was developed.

CONCLUSIONS

Transition shock reduces retention intention by decreasing new nurses' levels of career calling, while resilience moderates this mechanism. Nursing managers can adopt measures to increase retention intention among new nurses by reducing their transition shock and enhancing their career calling education and resilience training.

TRIAL AND PROTOCOL REGISTRATION

This study was registered with the Chinese Clinical Trial Registry ( http://www.chictr.org/cn/ ) under the following ID: ChiCTR2400080373.

Coming and going: A narrative review exploring the push-pull factors during nurses' careers

BACKGROUND

Shortages of nurses are one of the biggest challenges healthcare systems face around the world. Given the wide range of contexts and individuals working in nursing, a 'one-size-fits-all' retention strategy is unlikely to be effective. Knowing what matters most to nurses at different career stages would help employers and policy-makers who want to enhance nurse retention to design tailored strategies.

OBJECTIVE

To review and synthesise findings from recently published literature on the push-pull factors influencing nurses' decisions at the micro level, to enter and stay (or leave) at key career stages (i.e. pre-career, training, early-, mid- and late-career, and return to practice).

METHODS

We undertook a set of structured searches of the literature and a narrative synthesis to explore factors that motivate individuals to enter the nursing profession and the push-pull factors influencing nurse retention at different career stages. Electronic databases CINAHL, Medline, Scopus and Embase were searched in December 2022 (and updated in November 2023) for English language publications. Additional health workforce sources, such as King's Fund and Nuffield Trust, were also searched.

RESULTS

227 articles met the criteria for inclusion in the narrative review. Some push-pull factors were common to nurses across all career stages, including workplace support, flexible schedule patterns, opportunities for career advancement, fair treatment and salaries. In contrast, some challenges and push-pull factors were unique to each career stage. Students experienced difficulty in adjusting and balancing education and life; early-career nurses experienced transition shocks; mid-career nurses were frustrated by the lack of career advancement; late-career nurses desired more recognition; nurses returning to practice were discouraged by their lack of confidence and the cost of return-to-practice courses.

CONCLUSION

Our findings reinforce the view that factors influencing nurses' choices about whether to enter, continue or leave nursing jobs are multi-factorial and multi-dimensional. Policy and employment practices should be informed by research that has a more nuanced insight into what matters most to whom and at what career stage.

TWEETABLE ABSTRACT

Nuanced insight into motivations is needed to attract and retain a mix of nurse throughout their careers @ZEjebu @julia_philippou @JaneEball.

Turnover intention and influential factors among primary healthcare workers in Guangdong province, China: a cross-sectional study

OBJECTIVES

Primary health workers are crucial to the healthcare system, yet China experiences a notable shortage driven by high turnover rates. This study aimed to investigate the prevalence and determinants of turnover intention among primary health workers.

DESIGN

Cross-sectional study.

SETTING

Primary healthcare facilities across 21 cities in Guangdong province, China.

PARTICIPANTS

Online questionnaires (SurveyStar, Changsha Ranxing Science and Technology) were administered to 16 573 primary health workers in September and October 2022.

PRIMARY AND SECONDARY OUTCOME MEASURES

Variables measured included demographics, work-related factors, job satisfaction, emotional exhaustion and turnover intention. Comparisons of turnover intention were made across different categorical groups, and hierarchical regression analysis was used to pinpoint influencing factors.

RESULTS

The average turnover intention score among participants was 10.49±2.93. Notable positive correlations included those with male gender, single marital status, leadership positions and roles as public health physicians. Emotional exhaustion correlated positively (β=0.108), while job satisfaction showed a significant negative correlation (β=-0.154). Other negative influential factors were observed with tenure lengths of 6-10 years, 11-15 years and ≥16 years, as well as with senior professional titles, lower salary levels and perceptions of fair compensation.

CONCLUSIONS

Turnover intention is notably prevalent among primary healthcare workers, with emotional exhaustion and job satisfaction identified as primary determinants. Salary, payment justice in compensation and tenure also significantly influence turnover intention. Based on the above analysis, a series of intervention measures can be expectedly unveiled to reduce the turnover intention of primary health workers and maintained the steady development of basic medical resources.

Bridging Educational Grant in Nursing (BEGIN) students' intentions for retention in long-term, home and community care: A survey protocol

INTRODUCTION

Retention of nurses in long-term care (LTC) and home and community care (HCC) settings is a growing concern. Previous evidence underscores factors which contribute to nurses' intentions for retention in these sectors. However, perspectives of nursing students preparing to enter the workforce, and their intentions for short-term and long-term retention, remain unknown. This study aims to explore relationships between short-term and long-term intentions for retention with psychological empowerment, work engagement, career commitment, burnout, prosocial motivation, self-care and personal resilience among students enrolled in nursing educational bridging programs supported by the Bridging Educational Grant in Nursing (BEGIN) program in Ontario, Canada.

METHODS AND ANALYSIS

This cross-sectional design study will use an open online survey to investigate perspectives of current nursing students enrolled in educational bridging programs on factors relating to psychological empowerment, work engagement, career commitment, resilience, burnout, prosocial motivation, self-care and intentions for retention. Additionally, the survey will collect demographic information, including age, gender, ethnicity, citizenship, income, family status, nursing role, and years of employment and/or education. Open-ended questions will elicit participants' perspectives on financial considerations for career planning and other factors impacting intentions for retention. Descriptive data will be presented for contextualisation of participants' demographic characteristics to enhance generalisability of the cohort. Descriptive statistics will be used to summarise participants' scores on various assessment measures, as well as their short-term and long-term intentions for retention in LTC and HCC after completion of BEGIN. A Pearson's product moment r correlation will determine relationships between intentions for retention and other measures, and linear regression will determine whether any potential correlations can be explained by regression.

ETHICS AND DISSEMINATION

This research protocol received ethical approval from a research-intensive university research ethics board (#123211). Findings will be disseminated to nursing knowledge users in LTC and HCC through publications, conferences, social media and newsletters.

Factors associated with practice readiness among newly qualified nurses in their first two years of practice

BACKGROUND

Newly graduated nurses undergo stress and role adjustment as they transition into practice during the first year and continue to struggle beyond the first year. Determining their practice readiness can aid in the development of interventions to facilitate workplace readiness for nurses in their first two years entering the nursing profession.

OBJECTIVES

To examine (i) extent of practice readiness of new nurses in their role; and (ii) associations between nurses' practice readiness and demographic and occupational variables, and reasons for choosing nursing profession.

DESIGN

A cross-sectional study.

SETTINGS AND PARTICIPANTS

A total of 445 registered nurses who graduated within the last two years and working in an academic medical centre in Singapore.

METHODS

Participants completed an online questionnaire with questions from Casey-Fink Readiness for Practice Survey and questions related to key competencies for future practice.

RESULTS

More than half (57.5 %) identified at least three skills and procedures which they were uncomfortable performing independently as they transition into the clinical practice, including: (i) responding to emergency (ii) tracheostomy care; and (iii) chest tube care. The top three reasons for choosing nursing as a career were: (i) nursing is a stable industry (54.2 %); (ii) I want to help people (52.1 %); and (iii) able to work anywhere in the world (44.3 %). Nurses were most concerned with areas of trials and tribulations (42.5 %) and clinical competency (36.6 %). When compared to nurses in their first-year post-graduation, those working in their second year reported more confidence in the ability to problem solve (p = 0.003), care for a person who is dying (p = 0.004), and less difficulties in prioritizing care needs (p = 0.04). They also perceived themselves as a good problem solver (p = 0.03).

CONCLUSIONS

It is critical to continue supporting nurses' practice readiness beyond their first year of practice in their confidence and development of skills of higher complexity.

Missed Nursing Care as a Mediator in the Relationship between Career Calling and Turnover Intention

AIM

To explore the role of missed nursing care in mediating the relationship between career calling and intention to leave among nurses.

INTRODUCTION

Increasing nurse turnover is still a major concern in the global healthcare system. The most reliable indicator of turnover is turnover intention. It is crucial to understand its affecting elements to suggest measures to lower nurses' turnover intention.

BACKGROUND

Turnover intention has been linked to career calling and missed nursing care. Little empirical research has investigated the possibility that missed nursing care mediates between career calling and turnover intention.

METHODS

A cross-sectional survey of 347 nurses was conducted. The survey instruments included the General Information Questionnaire, Calling Scale, Missed Nursing Care Scale and Turnover Intention Questionnaire. Structural equation models were used to build the model. This study made use of the STROBE checklist.

RESULTS

For 43.8% of nurses, turnover intention was high or very high. Missed nursing care and turnover intention were negatively correlated with career calling. Missed nursing care and turnover intention were positively related. Missed nursing care mediated the relationship between career calling and turnover intention.

DISCUSSION

Career calling and missed nursing care can both influence turnover intention. Career calling can reduce the likelihood of turnover by preventing missed nursing care.

CONCLUSION

Missed nursing care mediated the relationship between career calling and intention to leave.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Nursing managers should improve nurses' career calling through professional education and minimize missed nursing care by using electronic nursing reminder devices to reduce turnover intention.

Professional identity, job satisfaction, and turnover intention among Chinese novice nurses: A cross-sectional study

The world is faced with challenges due to a growing aging population and the increasing burden of chronic disease. The acute shortage of nurses and high turnover rates, particularly among novice nurses, are of great concern in many countries. Several studies have shown that turnover intention among nurses is influenced by professional identity and job satisfaction. However, to the best of our knowledge, no studies have examined this issue in the context of novice nurses. Thus, the present study aimed to explore the relationship between professional identity, job satisfaction, and turnover intention among novice nurses in China. From March 18 to April 23, 2022, a cross-sectional survey was carried out involving 532 novice nurses recruited from four public hospitals in Sichuan Province, China. Among the sample, 526 questionnaires were retrieved, with an effective response rate of 98.87%. The mean scores for turnover intention, professional identity, and job satisfaction were 13.02 ± 3.94, 36.17 ± 7.98, and 111.02 ± 21.46, respectively. High turnover intention was observed among novice nurses, of whom 54.37% (286/526) had high or very high turnover intention. Professional identity and job satisfaction among novice nurses were moderate. In terms of demographic characteristics, "Whether living with relatives" and "Monthly income" had a statistically significant impact on the turnover intention of novice nurses (P < .05). Both professional identity (r = -0.459) and job satisfaction (r = -0.517) were significantly and moderately negatively correlated with turnover intention (P < .01). The results of the multivariate linear regression analysis revealed that variables including "Whether living with relatives," "Professional identity," "Control and responsibility for work," and "Benefits" jointly accounted for 29.9% of the variance related to turnover intention among novice nurses. "Whether living with relatives," "Professional identity," "Control and responsibility for work," and "Benefits" were highly predictive of turnover intention levels among novice nurses. Hence, potential predictors of turnover intention should be considered, and intervention research should be conducted to reduce the level of turnover intention among novice nurses.

What are the key factors influencing newly graduated nurses' preference for choosing their workplace? A best-worst scaling approach

INTRODUCTION

The literature cites many factors that influence a nurse's decision when choosing their workplace. However, it is unclear which attributes matter the most to newly graduated nurses. The study aimed to identify the relative importance of workplace preference attributes among newly graduated nurses.

DESIGN

A cross-sectional study.

METHODS

We conducted an online survey and data were collected in June 2022. A total of 1111 newly graduated nurses in South Korea participated. The study employed best-worst scaling to quantify the relative importance of nine workplace preferences and also included questions about participants' willingness to pay for each workplace preferences. The relationships between the relative importance of the workplace attribute and the willingness to pay were determined using a quadrant analysis.

RESULTS

The order according to the relative importance of workplace preferences is as follows: salary, working conditions, organizational climate, welfare program, hospital location, hospital level, hospital reputation, professional development, and the chance of promotion. The most important factor, salary, was 16.67 times more important than the least important factor, the chance of promotion, in terms of choosing workplace. In addition, working conditions and organizational climate were recognized as high economic value indicators.

CONCLUSION

Newly graduated nurses nominated better salaries, working conditions, and organizational climate as having a more important role in choosing their workplace.

CLINICAL RELEVANCE

The findings of this study have important implications for institutions and administrators in recruiting and retaining newly graduated nurses.

Factors associated with millennial nurses' intention to pursue formal leadership roles: a cross-sectional study

PURPOSE

This study aims to examine the level of intention to pursue formal nursing leadership roles among millennial nurses and to identify the different factors that may play a role in their intentions to pursue such roles.

DESIGN/METHODOLOGY/APPROACH

This study used a multi-center, cross-sectional research design. Registered nurses born between 1980 and 2000 (n = 1,377) who worked in 23 acute care hospitals in Oman were included in this study. Data were analyzed using descriptive statistics and multiple linear regression. Data were collected between July 2019 and January 2020.

FINDINGS

Nearly 70% of millennial nurses researched their intention for career advancement to assume nursing leadership responsibility. Factors associated with nurses' intention to pursue formal nursing leadership roles were the type of nursing degree held (having a bachelor of science in nursing degree), type of hospital facility affiliation (teaching hospital), previous leadership experience, structural empowerment (access to support, opportunity and resources), work satisfaction and job burnout.

ORIGINALITY/VALUE

Millennial nurses, who represent the largest segment of the nursing workforce, have begun assuming nursing management and leadership roles; however, little is known about the factors affecting their intentions to pursue these roles. The findings of this study revealed different factors (both modifiable and nonmodifiable) influencing millennial nurses' intentions to pursue formal leadership roles.

A survival analysis approach to determine factors associated with non-retention of newly hired health workers in Iran

BACKGROUND AND AIM

One of the main tasks of the healthcare human resource management is to maintain and retain professional staff. The high level turnover of professional staff may reduce the quality of healthcare service delivery. Therefore, this study investigated the factors associated with the turnover of the newly recruited healthcare professionals using survival analysis method in Iran.

MATERIALS AND METHODS

This historical cohort analysis comprised 6811 employees who began working at Mashhad University of Medical Sciences between 2005 and 2020. Employees recruited at any of the university's units between the years 2005 to 2019 were included. We used appropriate descriptive indices and Log-rank test and the Cox proportional-hazards model to assess the staff turnover. A significance level of 0.05 was used for all tests.

RESULTS

The findings of the survival analysis showed that the probability of turnover in one year, two years, and five years of employment were 0.12, 0.16, and 0.27. Based on the findings of the Log-rank test, the probability of turnover in entire of the study period was not statistically different between male and female (p = 0.573), and likewise between employees with healthcare occupations and non-healthcare occupations (p = 0.351). Employees whose current workplace and birthplace were not similar had a significantly higher probability of turnover (p < 0.001). Accordingly, the Cox regression result showed, the risk of turnover for the singles was 1.22 times higher than the married. For the Ph.D degree was 3.23 times higher compared to those with a diploma or an associate degree, and for a bachelor's or master's degree was 2.06 times more likely to change their workplace than those with a diploma or an associate degree.

CONCLUSION

Policies promoting the recruitment of native-born professionals, given priority to the married candidates than single ones, and/or recurring candidates to pledge to stay in the locality of recruitment site can increase the staff retention and reduce the costs of staff turnover including re-hiring, initial and on-the-job training, accommodation, and other extra living consumptions away from home and family.

Inclusive leadership can improve nurses' psychological ownership and reduce their turnover intention under the normalization of COVID-19 prevention

Introduction

The COVID-19 pandemic continues to impact people's lives and professions worldwide. Chinese nurses face immense work pressure under the normalization of COVID-19 prevention and control, resulting in greater turnover intention. It is, therefore, crucial to study the mechanisms that influence the turnover intention of nurses in this situation.

Objective

Many studies have examined the impact of leadership style on nurses' turnover intention; however, few researchers have investigated this influence during the COVID-19 pandemic. Based on the leader-member exchange theory, this study empirically studied the effect of inclusive leadership on turnover intention of nurses under the normalization of COVID-19 prevention and control in China, while assessing the mediating role of psychological ownership.

Design

Cross-sectional study with multi-center data.

Participants

Two thousand, two hundred ninety-nine registered nurses from 17 hospitals in China were recruited from January to March, 2022, under the normalization of COVID-19 prevention and control in China.

Methods

A demographic questionnaire and scales of inclusive leadership, psychological ownership, and turnover intention integrated into an online survey were sent to registered nurses of different hospitals. Maximum likelihood structural equation modeling (ML-SEM) was used to analyze data.

Results

Independent variable inclusive leadership has a significant effect on the overall turnover intention of nurses, p < 0.001. The direct effect path coefficient from inclusive leadership to psychological ownership is significant, p < 0.001. The direct effect path coefficient from psychological ownership to turnover intention is significant, p < 0.001. The indirect effect path coefficient from inclusive leadership to turnover intention is significant, p < 0.001.

Conclusion

Psychological anxiety, burnout, turnover intention, and even suicidal thoughts were the main symptoms of Chinese nurses under the normalization of COVID-19 prevention and control in China. The absence of a mechanism to counteract these negative conditions may ultimately lead to personal psychological distress for nurses and collapse of the healthcare system. Inclusive leadership can improve nurses' psychological ownership level and reduce their turnover intention by treating them fairly, providing them with opportunities for self-development, paying attention to communication with them, and increasing their sense of belonging, self-efficacy, and self-identity.