Differences in determinants of intention to stay and retention between younger and older nursing assistants in long-term care facilities: A longitudinal perspective

Personal care workers' intention to stay in residential aged care: An integrative review

AIM

To identify key factors that influence personal care workers' (PCW) intention to stay in residential aged care (RAC).

BACKGROUND

PCWs are the 'backbone' of providing direct care in RAC settings. The well-being of older people hinges upon their dedication and commitment; thus, enhancing their intention to stay is a priority to reduce turnover and ensure continuity of care.

METHODS

Six databases were searched for articles focusing on factors influencing PCWs' intention to stay in RAC. Studies were independently assessed for quality using the Joanna Briggs Institute Methodology for systematic review tools. Reporting of the results followed the PRISMA guidelines.

FINDINGS

Eight articles published between 2010 and 2022 were included. The key issues were categorized as: (a) sociodemographic characteristics; (b) psychological factors; (c) workplace factors and (d) job satisfaction. Older age, being married and immigration status were positively associated with intention to stay. Work stress and burnout contributed towards demotivation, while a supportive and engaging organizational culture that recognized workers' contributions and provided appropriate remuneration and benefits, enhanced job satisfaction and retention.

CONCLUSION

This review affirms the complexity of the decision-making process influencing workers' intention to stay. A comprehensive understanding of the interplay of these factors and the personal and sociocultural challenges faced by PCWs is essential to design strategies to provide support and enhance job satisfaction and retention.

IMPLICATIONS FOR AGED CARE

This review showed that support from the organization is critical in improving PCWs' intention to stay in aged care. Given the interconnectedness of a range of key factors, decision-makers need to address modifiable factors holistically. Including PCWs in planning retention strategies could be the missing link in tailoring interventions towards workforce retention.

IMPACT

Personal, psychological and workplace factors alone and in combination influence personal care workers' intention to stay in residential aged care (RAC). The interrelationships among the factors impacting PCWs' intention to stay are complex, wherein a change in one often influences other factors. Addressing the causes of psychological stress, improving workplace culture and understanding their interrelationships provide a foundation for co-designing strategies to promote intention to stay among PCWs in RAC.

REPORTING METHOD

The authors have adhered to relevant EQUATOR guidelines PRISMA.

NO PATIENT OR PUBLIC CONTRIBUTION

This integrative review is conducted with no involvement or contribution from patients or the public.

Examining the relationship between personality traits, work experience, burnout, and intention to stay among home care aides in Taiwan

BACKGROUND

Home care aides play an important role in providing long-term care services, but there is currently an insufficient supply of workers to meet the growing demand in Taiwan due to the increasing number of older adults and people with disabilities requiring care. There are numerous factors that influence the retention of home care aides. Previous research has indicated that taking employees' individual personalities into account can enhance task delegation and organizational efficiency within an organization. Severe occupational burnout is likely to diminish vitality and disrupt sleep, which, in turn, can result in higher employee turnover rates. To date, no research has explored the correlation between personality traits, burnout, work experience, and the retention of home care aides. Given these gaps in knowledge, the present study aims to investigate how personality traits and occupational burnout are associated with the intention to stay among home care aides in Taiwan.

METHODS

The study was a cross-sectional survey that utilized purposive sampling to interview 285 home care aides in Hualien County from December 2020 to January 2021. A self-report questionnaire, administered with informed consent, was used to collect data on demographics, work experience, occupational burnout, personality, and intention to stay. The researchers utilized hierarchical regression analysis to analyze the data. All measurements exhibited high reliability and consistency, with Cronbach's α values ranging from 0.8 to 0.9.

RESULTS

The subscales for personal burnout, work-related burnout, and client-related burnout, along with all personality scales, were highly correlated with intention to stay, except for the openness trait (p < .05). Moreover, married, full-time employment, satisfied with the promotion system and current job as home care aides on the whole, lower levels of work-related burnout, and agreeable personality type were found to be significant predictors for intention to stay (p < .05) , and the adjusted R2 of the model was 29.4%.

CONCLUSIONS

This study has concluded that using personality traits as a criterion to select home care aides with a high level of agreeableness prior to recruitment, enhancing the professionalism and comprehensive of promotion system, and reducing work burnout are measures that may help home care service providers increase the intention to stay among home care aides.

Factors Influencing RNs' Intention to Stay in Nursing Homes: Multilevel Modeling Approach

The current study investigated factors that influence the intention to stay (ITS) of RNs working in South Korean nursing homes (NHs). Thirty-six questionnaire responses from organizational NHs and 101 from individual RNs were analyzed using multilevel regression analysis. At the individual level, RNs' ITS increased with years of work at their current NH, and that of RNs who received emergency calls to work at night was lower than that of RNs with fixed night shifts. At the organizational level, ITS was higher when the ratios of RNs to residents and RNs to nursing staff were higher. To improve ITS, NHs should consider adopting mandatory deployment of RNs, increasing their RN to resident ratios, and implementing a fixed night shift RN system, wherein night shift working hours count as twice the daytime hours, and night shift is voluntary. [Journal of Gerontological Nursing, 49(7), 40-48.].

Non-human and human service efficiency of long-term care facilities in China

Introduction

Care services provided by long-term care facilities (LTCFs) are currently plagued by care resource shortages and insufficient utilization. The analysis on the temporal and spatial distribution of human resources and non-human resources in LTCFs, could provide a basis to optimize resource allocation and efficient use of limited resources.

Methods

This study used data envelopment analysis to comprehensively evaluate the efficiency of human and non-human resources in different time spans and regions. The spatial Markov chain and spatial correlation were also applied to explore the heterogeneity of and correlation between the service efficiency of LTCFs in different regions and then analyzes the influencing factors of efficiency using Tobit regression model.

Results

The quantitative changes in the service efficiency of LTCFs in various provinces showed a "W" shape in two periods, ranging from 0.8 to 1.6. The overall efficiency of LTCFs in different regions had a lower probability to achieve short-term cross-stage development. Non-human resource efficiency presented a "cluster" distribution mode, demonstrating a great probability to achieve cross-stage development, which might be due to the regional disparities of economic development and land resource. Tobit regression analysis results also showed that the comprehensive efficiency of LTCFs decreases by 0.210 for every square increase in construction space variation. However, human resource efficiency had a significant spatial polarization, making it difficult to develop area linkages. The reason for this might be the nursing staff have relatively stable regional characteristics, weakening the inter-provincial spatial connection. We also found that female workers, aged between 35 and 45 can positively affect the efficiency of LTCFs. Those staff stay focused and improve their skills, which might improve the efficiency of LTCFs. So improving technology and service quality changes by increasing female workers, aged between 35 and 45, and avoiding excessive construction space changes can enhance the growth of service quality and personnel stability of LTCFs.

Conclusion

There is an urgent trade-off among staff quality improvement, resource reduction, construction excessive and substantial regional variation in efficiency. Therefore, strengthening policy support to encourage inter-regional initiatives, particularly highlighting the development of human resources interaction and common development is urgent.

Serial multiple mediation of psychological empowerment and job burnout in the relationship between workplace bullying and turnover intention among Chinese novice nurses

AIM

This study aimed to examine the direct and indirect effects of workplace bullying on turnover intention using the serial multiple mediators of psychological empowerment and job burnout.

DESIGN

A cross-sectional study was conducted.

METHODS

A convenience sample of 506 novice nurses from five Triple A hospitals in China's S province from November 2020 to February 2021 and were evaluated using online questionnaires on workplace bullying, psychological empowerment, job burnout, and turnover intention.

RESULTS

The prevalence of turnover intention was 51.9%. In the serial multiple mediator model, workplace bullying had a direct effect (c = 0.452, p < 0.001) and indirect effect (c' = 0.229, p < 0.001) on turnover intention through the serial multiple mediators of psychological empowerment (B = -0.093, p = 0.020) and job burnout (B = 0.127, p < 0.001); hence, the proposed model explained the total variance of 32.2% in turnover intention.

PATIENT OR PUBLIC CONTRIBUTION

Nursing managers should use effective measures for strengthening the psychological empowerment to minimize novice nurse burnout and turnover intention resulting from workplace bullying.

Examining the Needs-Based Time Use of Chinese Nursing Assistants: A Time-Motion Study

BACKGROUND

In light of the worldwide shortage of nurses and to maximize the effectiveness of the nursing care available, it is important to investigate the components of the care regularly provided by nursing assistants (NAs) to older adults. Well-organized allocation of NA care activities is directly linked to the quality of care provided to nursing home (NH) residents and their quality of life. However, relevant knowledge about the actual time allocation of NAs in this context is lacking, as previous related studies have focused only on the duration necessary for NAs to complete nursing activities.

PURPOSE

This study was designed to investigate the time allocation of NAs in completing job tasks necessary to meet the needs of residents in nursing care units at an NH in China.

METHODS

A time-motion method and nonparticipatory observations were used to collect data. Two postgraduate students observed 15 NAs' time expenditure and nursing content simultaneously during day shifts for 3 weeks as the NAs provided care to residents in four different nursing care levels. Data on nursing time and activity frequency were collected using a worklist based on the Zuluaga-Raysmith model.

RESULTS

The 119.6 hours of observation included 8,907 discrete observed activities. In terms of the care provided to meet the needs of residents, the most time-consuming activities were physical health care (26.8%) and communication care (18.3%), followed by mental, emotional, social, and spiritual health care (14.1%) and protection and security care (12.6%). The higher the level of care, the higher the proportion of somatic nursing time and nursing activity frequency. However, the time and frequency of psychological and spiritual care showed an opposite trend.

CONCLUSIONS

Because of their lack of formal nursing training and skills, NAs pay more attention to meeting the physiological needs of residents while ignoring their mental needs. Moreover, their effectiveness in providing spiritual care tends to be quite low. Furthermore, the NA nursing activity classification system based on the Zuluaga-Raysmith model developed in this study is applicable for designing nursing work tasks, organizing NH units, and improving the quality of life of residents, as this model accurately reflects the essence of NA work.

Factors influencing smoking cessation counselors' intention to stay: An application of a conceptual model of intention to stay verified with path analysis

Background

The Taiwanese military trains smoking cessation counselors to counsel officers and soldiers on quitting smoking as part time. The intention to stay among smoking cessation counselors affects the promotion of smoking cessation. This study investigated smoking cessation counselors' intention to stay by applying a conceptual model of intent to stay (CMIS) to analyze influencing factors.

Methods

In this cross-sectional study, we applied the CMIS to design a questionnaire. We invited 577 smoking cessation counselors trained in the military from 2016 to 2017. The response rate was 46.7%, and the questionnaire responses of 260 military smoking cessation counselors were analyzed. We used path analysis to verify the relationships among the various aspects of the CMIS.

Results

We determined that smoking cessation counselors' intention to stay is directly affected by job satisfaction (β = 0.150, p = 0.014), job stress (β = -0.225, p < 0.001), and institutional identification (β = 0.431, p < 0.001). Career opportunities indirectly affect intention to stay through institutional identification, working environment indirectly affects intention to stay through job stress, and co-worker support and self-fulfillment indirectly affect intention to stay through job satisfaction and institutional identification. Our model could explain 36.7% of the variance in intent to stay among smoking cessation counselors.

Conclusion

Our results suggest that relevant policies should be formulated to enhance smoking cessation counselors' recognition, affirmation, and sense of belonging as related to smoking cessation counseling work, thereby raising their institutional identification and promoting their intention to stay.

What relationships can be found between nurses' working life and turnover? A mixed-methods approach

AIM

This study aimed to describe why registered nurses decide to leave their work and to investigate relationships between registered nurses' working life and turnover (leaving the unit vs. leaving the profession).

BACKGROUND

Much research has explored nurses' intention to leave, whereas less research has looked at turnover and especially leaving the profession.

METHODS

Data were collected using questionnaires and interviews.

RESULTS

The three most common reasons for both groups (leaving the profession, n = 40; leaving unit but not profession, n = 256) were high workload, low salary and applied for and got a new job. Multivariate logistic regression analysis revealed statistically significant relationships between turnover and empowering structures, such as access to resources and informal power as well as the factor learning in thriving.

CONCLUSIONS

Structural empowerment, such as good access to resources and informal power, is important to keeping nurses in the profession, whereas learning seems to increase the risk of leaving the profession when variables such as vitality, resources, informal power and age are held constant.

IMPLICATIONS FOR NURSING MANAGEMENT

To counteract nurses leaving the profession, managers must provide nurses with good access to resources and informal power, such as networks within and outside the organisation, and focus on nurses' vitality.