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

A Survey Study of Motivators for Pediatric Hospitalists to Work in the Community

BACKGROUND AND OBJECTIVE

The loss of pediatric beds in the community has contributed to decreased access to pediatric inpatient and emergency services. Community pediatric hospitalist programs could reduce the overhead of inpatient care, promoting the financial feasibility of caring for hospitalized children closer to home. This study aims to determine which career motivators are the most important for pediatric hospitalists to begin working in, remain in, and leave the community setting.

METHODS

A survey was sent to a convenience sample of 269 community hospitalists from 31 different sites. Sites were invited if the program director was known to the authors. Responses were evaluated and χ-square or Fisher's exact test were used to compare the differences.

RESULTS

One hundred twenty six community pediatric hospitalists completed the survey (response rate 49.1%). The 3 most important motivators for pediatric hospitalists to begin working in the community were work-life integration (80%), geographic location (75%), and flexible hours (71%). Pediatric hospitalists who planned to leave the community setting were more likely to cite mentoring and teaching opportunities (76% vs 32%, P = .0002), opportunities for research and quality improvement (29% vs 10%, P = .021), and paid time for nonclinical interests (52% vs 26%, P = .02) as very important.

CONCLUSIONS

This study demonstrates key motivators for pediatric hospitalists to work in the community and elucidates motivators for transitioning to larger pediatric centers. This knowledge may be used to guide community pediatric hospital medicine recruitment and program development that could lead to improved retention.

A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings

By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.

Exploring the Factors behind Nurses' Decision to Leave Clinical Practice: Revealing Causes for Leaving and Approaches for Enhanced Retention

Nursing turnover has emerged as an urgent concern with a substantial influence on the financial efficiency and quality of care in healthcare frameworks worldwide. This study determined important factors associated with nurses' intentions to leave and what would bring them back. This was a cross-sectional, multisite study of nurses in three public hospitals. Convenience sampling was used to recruit 205 nurses from the selected hospitals. A questionnaire was used to measure demographic and professional background information, current job satisfaction, and the intention to leave work and return. Bivariate and multivariate analyses were run using SPSS. This study revealed that both job satisfaction (M = 47.26, SD = 11.59, range: 19-76) and intent to leave a current job (M = 14.18, SD = 4.36, range: 4-20) were reported at moderate levels. There were significant differences reported between the scores of nationality and job satisfaction (p < 0.05) and between the means of income level and intention to leave (p < 0.05). There was also a significant, negative association between satisfaction and intention to leave (r = -0.551, p < 0.05). In regression, income level (β = 0.159, p = 0.021), incentives (β = 0.186, p = 0.002), hospital type (β = 0.189, p = 0.005), and intention to leave (β = -0.454, p < 0.001) significantly influenced satisfaction. Gender (β = -0.122, p = 0.037) and nationality (β = -0.210, p = 0.007) were found to influence the intention to leave among participants significantly. In conclusion, this study indicated that job satisfaction and intention to leave are important factors affecting nurses' enthusiasm. Incentives also had a positive impact on increasing nurses' satisfaction levels. Future research studies should investigate what factors might lead to improved monthly salaries and provide more incentives among nurses.

The impact of meaning in life and professional happiness on the turnover intention of health care workers: a cross-sectional study from China

INTRODUCTION

The turnover and shortage of health care workers (HCWs) have been a worldwide problem for healthcare organizations. The primary aim of this study was to identify the factors influencing the intention of Chinese HCWs to leave their job, especially meaning in life and professional happiness.

METHODS

This observational cross-sectional study, conducted among 1125 full-time HCWs, assessed demographic variables, meaning in life, professional happiness, and turnover intention by a survey. The survey was distributed to HCWs in three tertiary hospitals. The data were analyzed by T-tests, ANOVA, Kruskal-Wallis tests and hierarchical linear regression model.

RESULTS

There were statistically significant differences in turnover intention of HCWs by gender, age, role, educational level, years in practice, and number of monthly night shifts. HCWs' meaning in life and professional happiness were negatively associated with the turnover intention. Furthermore, after controlling for other factors, meaning in life explained 3.7% of the turnover intention and professional happiness explained 13.4%.

CONCLUSION

In our study, positive psychological factors were related to turnover intentions. Professional happiness was the strongest predictor. Thus, health human resource managers should foster positive psychology among HCWs to reduce their turnover.

Impact of psychosocial risk on intention to leave work during COVID-19 in Indonesia: The mediatory roles of burnout syndrome and job satisfaction

The COVID-19 pandemic intensified the complexity of work in the health sector, leading to an increase in the intention to leave work (ITL) in Indonesia. Previous research has revealed a theoretical gap in investigating the roles of burnout syndrome (BS) and job satisfaction (JS) as mediators of the effect of psychosocial risk (PR) on ITL. This research study aimed to fill this gap by examining the effect of PR on ITL during the COVID-19 pandemic, with BS and JS as mediators. Data was collected from 306 health workers in public and private hospitals of Central Jakarta, Indonesia. This data was analyzed as part of a cross-sectional research study involving the partial least square-structural equation modeling (PLS-SEM) method and using SmartPLS software. The questionnaire was based on the Copenhagen Psychosocial Questionnaire (COPSOQ) III short version, the Burnout Assessment Tools (BAT), and a modified Turnover Intention. The findings revealed that, within the direct effect pathways, JS was the highest predictor of health workers' ITL, and workplace PR significantly impacted employees' JS and BS. Another notable finding was related to the research gap vis-a-vis the indirect effect pathways: it showed that JS and BS had partial mediatory power over the relationship between PR and ITL. BS and JS were found to have a high and significant impact on employees' ITL. Therefore, this research study has contributed to the model's novelty in measuring ITL mediated by JS and BS.

Individual perspectives and mental maps of working conditions and intention to stay of physicians in academic medicine

Introduction

Job satisfaction has a strong impact on the intention to stay which is an important aspect to counter skills shortage in academic medicine. The purpose of the three studies reported here is to find out what specific factors are relevant for the intention to stay and turnover intention of physicians in academic medicine -and what measures might have a positive impact on employee retention.

Methods

In an interview study combining qualitative and quantitative methods, we investigated how the individual mental representation of working conditions influences job satisfaction and its impact on the intention to stay. In total, 178 physicians from German university hospitals, residents, and physicians, in 15 departments of anesthesiology were interviewed and surveyed. In a first study, chief physicians participated in interviews about job satisfaction in academic hospitals. Answers were segmented into statements, ordered by topics, and rated according to their valence. In a second study, assistant physicians during and after their training period talked about strengths, weaknesses, and potential improvements of working conditions. Answers were segmented, ordered, rated, and used to develop a "satisfaction scale." In a third study, physicians participated in a computer-led repertory grid procedure composing 'mental maps' of job satisfaction factors, filled in the job satisfaction scale and rated if they would recommend work and training in their clinic as well as their intention to stay.

Results

Comparing the interview results with recommendation rates and intention to stay show that high workload and poor career perspectives are linked to a negative attitude. A positive attitude towards work environment and high intention to stay is based on sufficient personnel and technical capacities, reliable duty scheduling and fair salaries. The third study using repertory grids showed that the perception of current teamwork and future developments concerning work environment were the main aspects to improve job satisfaction and the intention to stay.

Discussion

The results of the interview studies were used to develop an array of adaptive improvement measure. The results support prior findings that job dissatisfaction is mostly based on generally known "hygiene factors" and whereas job satisfaction is due to individual aspects.

Factors Influencing Nurse Intent to Leave Acute Care Hospitals: A Systematic Literature Review

Professional nurses are leaving their current positions in acute care hospitals and, in some cases, the profession in greater numbers than ever. Nurse leaders must understand factors surrounding nurses' intent to leave to develop strategies to mitigate this phenomenon and retain nurses. This review of the literature seeks to synthesize studies on nurses' intent to leave. Themes include job satisfaction, resources and staffing impacting workloads, leadership, and burnout.

Investing in our human capital: Sharing the experience of implementing a retention strategy at a large academic hospital from a leadership lens

The impact of the COVID-19 pandemic on healthcare providers is well documented and has resulted in significant pressures from a health human resources perspective with many point-of-care providers taking extended leave or moreover, leaving the healthcare sector altogether. As part of a larger Health Human Resources (HHR) strategy at Sunnybrook Health Sciences Centre (Sunnybrook) in Toronto, Canada, a time-limited interprofessional working group titled Supporting Team Sunnybrook (STS) was created. The working group was created to focus on staff retention to respond to ongoing concerns by leaders with regard to staff leaving the organization at an increased rate as documented by our organization's decision support team. Anecdotally, many staff cited their decision to leave the organization as a consequence of the pandemic. As no staff retention committee had been formally created at our organization, STS was established to engage all staff members while addressing and resolving current feedback, concerns, suggestions and issues. The objective of our working group was to review published literature, establish themes from this review, and align these themes to priority themes brought forward by staff through a number of data capture activities. Data capture activities included reviewing existing survey data, new survey data and meetings with staff members. Analysis of the data resulted in the identification of five key consensus areas (priority themes): Staff recognition, wellbeing, grow at Sunnybrook, leaderful leaders, and communication. Our team created five corresponding working groups with the aim to create short- and long-term goals, as well as time sensitive and sustainable operational activities that would contribute to improved staff retention at our organization. Outcomes from our work provided two key learnings to leaders on their ongoing work to retain staff which were the importance of: (1) engagement across all roles, professions including non-clinical team members and support staff and (2) broad communication on the outcomes of our working group to demonstrate that that their feedback was taken seriously and acted upon.

The role of psychological capital in the relationship between nurses' job satisfaction and turnover intention

PURPOSE

To find out whether psychological capital has a mediating role in the relationship between job satisfaction and turnover intention on nurses.

DESIGN AND METHODS

This study is a cross-sectional descriptive study. 466 nurses participated in this study. Data were collected via paper-and-pencil format using Minnesota Satisfaction Questionnaire, Psychological Capital Questionnaire and Turnover Intention Scale.

CONCLUSIONS

Our findings revealed effects of poor psychological capital among nurses. The effect of psychological capital was statistically significant and it partially mediated job satisfaction and turnover intention.

PRACTICE IMPLICATIONS

Initiative sand training programs should be planned to improve nurses' attitudes towards psychological capital levels.

Verbal Violence and Turnover Intention Among New Nurses in Korea: A Time-Lagged Survey

AIM

To test a model examining the impact of verbal violence against new nurses on their turnover intention and the mediating effects of emotional reaction and burnout based on affective events theory.

BACKGROUND

In Korea, turnover rate of nurses, especially new nurses, is at a serious level. Verifying the paths is important by which nurses decide to turnover intention after experiencing verbal violence, which is the most common form of workplace violence. In particular, Research on new nurses who are vulnerable to exposure to verbal violence and have a high turnover rate is insufficient.

METHODS

Data was collected using a time-lagged online surveys from 212 Korean new nurses. Structural equation modelling was used to test the hypothesized model.

RESULTS

The level of the turnover intention of new nurses was almost 4 out of 5. Verbal violence not only has a direct effect on turnover intention, but also has an indirect effect through burnout. Emotional reactions and burnout sequentially mediated the relationship between verbal violence and turnover intention; these variables explained approximately 57% of turnover intention.

CONCLUSIONS

To decrease negative emotional reactions and burnout caused by verbal violence may benefit to reduction of turnover intention of new nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The critical need for new nurses' violence interventions that focus on emotional reactions and burnout, and subsequently improving desirable patient-coworker-nurse relationships and quality of life for new nurses.

The dual threat of COVID-19 to health and job security - Exploring the role of mindfulness in sustaining frontline employee-related outcomes

Navigating the increasingly uncertain business world requires organizations and employees to be highly adaptive to threats and changes. During COVID-19, the dual threats to health and job security have been especially salient for frontline employees. Drawing on the job demands-resources (JD-R) model, we investigated individual and organizational mindfulness as valuable resources, which influence employee outcomes of preventative behaviors, emotional exhaustion, and job performance both directly, and indirectly through threat appraisals. We find that individual and organizational mindfulness influence threat appraisals in a "counterbalanced manner": individual mindfulness decreases threat appraisals, while organizational mindfulness heightens the perceived threat of contracting COVID-19. The threat to health further serves as a double-edged sword, predicting both emotional exhaustion and preventative behaviors, while job insecurity impairs all employee outcomes. Based on these findings, we provide key implications for research and practice, and future research directions.

Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

BACKGROUND

Workplace violence (WPV) in healthcare has received much attention worldwide. However, scarce data are available on its impact on turnover intention among psychiatrists, and the possible mechanisms between WPV and turnover intention have not been explored in China.

METHODS

A cross-sectional survey was conducted among psychiatrists in 41 tertiary psychiatric hospitals from 29 provinces and autonomous regions in China. A stress-strain-outcome (SSO) model was adopted to examine the effects of WPV on mental health and turnover intention. The association and mediation by burnout and stress were examined by multivariate logistic regression (MLR) and generalized structure equation modeling (GSEM).

RESULTS

We invited 6,986 psychiatrists to participate, and 4,520 completed the survey (64.7% response rate). The prevalence of verbal and physical violence against psychiatrist in China was 78.0 and 30.7%, respectively. MLR analysis showed that psychiatrists who experienced verbal violence (OR = 1.15, 95% CI = 1.10-1.21) and physical violence (OR = 1.15, 95% CI = 1.07-1.24) were more likely to report turnover intention. GSEM analysis showed that burnout (β = 4.00, p < 0.001) and stress (β = 1.15, p < 0.001) mediated the association between verbal violence and turnover intention; similarly, burnout (β = 4.92, p < 0.001) and stress (β = 1.80, p < 0.001) also mediated the association between physical violence and turnover intention.

CONCLUSIONS

Experience of WPV is a significant contributor to turnover intention among psychiatrists. Mental health status, such as burnout and stress level significantly mediated the association. Policy makers and hospital administrators need to be aware of this association. Action is needed to promote mental health among the psychiatrists to improve morale and workforce sustainability.

Person-Centred Dementia Care in an Acute Hospital: Experiences from Nurses Working in a Specialized Dementia Unit

BACKGROUND

Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. However, the research focus has been in long-term care settings with less attention in acute hospitals. We aimed to study the perspectives and experiences of nurses implementing PCC in an acute hospital dementia unit (Care for Acute Mentally Infirm Elders [CAMIE]).

METHOD

This was an exploratory qualitative study involving individual, face-to-face, semi-structured in-depth interviews. A purposive sample of 10 nurses participated in the interview. We employed an inductive thematic analysis approach to analyse the qualitative data.

RESULTS

The findings highlighted the positive experiences, for example, meaningful connection with patients and the challenges, for example, managing challenging behaviour in providing PCC. The initial challenges were due to a lack of prior knowledge and experience. Through formal and informal learning, the nurses built confidence and competence, and also provided support to one other. They emphasized the importance of teamwork and camaraderie in the CAMIE team but raised concerns about the negative perceptions of non-CAMIE nurses on the value of their work.

CONCLUSION

Despite the challenges, adequate knowledge and robust organizational level support are the key support for nurses to embrace PCC as their care ethos in the acute care setting.

Factors Influencing Turnover Intention Among Operating Room Nurses in South Korea

BACKGROUND

Operating room nurses experience verbal abuse, high levels of job stress, and burnout that may increase turnover intention.

PURPOSE

This study was designed to investigate and identify factors influencing turnover intention among operating room nurses in South Korea.

METHODS

This study used a cross-sectional descriptive design. The sample included 193 nurses, all of whom had over 3 months of work experience at operating rooms in hospitals in Seoul, South Korea. Measures used included the Verbal Abuse Experience Scale, Job Stress Scale, Burnout Scale, and Turnover Intention Scale.

RESULTS

Burnout was found to have the greatest influence on turnover intention (β = .34, p < .001), followed by verbal abuse (β = -.23, p = .004), job stress (β = .22, p = .001), age (β = -20, p = .032), and job satisfaction (β = -.14, p = .020).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings support burnout and verbal abuse, respectively, as the most significant and second most significant predictors of turnover intention among operating room nurses in South Korea. These factors should be proactively and effectively addressed to reduce turnover intention in this important group of healthcare professionals.

The Impact of the Coronavirus Disease (COVID-19) Pandemic on Nurses' Turnover Intention: An Integrative Review

The COVID-19 pandemic has increased the demand and workload on nurses. In addition, the number of critical cases, the uncertainty about the disease, and the incidence rate of death from the disease impose a psychological stress on nurses. Considering the alarming issues of stress, burnout, and turnover among nurses even before the pandemic, the pandemic might have amplified such issues. Thus, the impact of the COVID-19 pandemic on nurses' turnover and turnover intention warrants investigation. The aim of this review is to appraise and integrate the current pre- and post-coronavirus disease (COVID-19) literature on nurse turnover, published between 2016 and 2021. Forty-three studies on nurses' turnover intention were appraised and synthesized. The reviewed literature suggested that nurses' turnover intention increased significantly after the COVID-19 pandemic. Post-COVID-19-pandemic studies focused more on predicting nurses' turnover intention through the pandemic's negative impact on the nurses' psychological wellbeing. The findings of this review should be considered by nurse managers and leaders in the development of policies and programs to reduce the negative impact of COVID-19 on nurse retention.

Factors Associated with Intention of Serbian Public Health Workers to Leave the Job: A Cross-Sectional, Population-Based Study

Recruitment and retention of public health workers (PHWs) is crucial for the optimal functioning of the public health system at a time of budget cuts and the threat of a pandemic. Individual and job-related variables were examined by univariate and multivariate logistic regression to identify predictors of the intention to leave a job during the COVID-19 outbreak among Serbian PHWs in 25 institutes of public health (n = 1663 respondents, of which 73.1% were female). A total of 20.3% of PHWs intended to leave their current job within the next five years. Males and persons aged younger than 55 years who had additional practice were more likely to report an intention to leave their job than females, those older than 54 years and those without additional work. While uncertainty and fear of infection during the COVID-19 pandemic were almost perceived as job attractiveness, other job-related characteristics were identified as significant barriers to maintaining the sufficient capacity of qualified PHWs in the future. Authorities need to address these factors, including the following: the feeling of tension, stress or pressure, and unavailability of information during the COVID-19 pandemic, as well as dissatisfaction with respect, valuation, and the job in general.

Factors affecting nurses' intention to leave their current jobs in Saudi Arabia

OBJECTIVE

It is known that job satisfaction and quality of life influence nurses' intention to resign from their jobs. However, health-care systems should examine all the possible factors that contribute to nurse turnover to retain them for the long term. To this purpose, this study further explores the aspects that affect the intention of nurses who work in Saudi Arabia to leave their current jobs.

METHODS

A sample of 318 staff nurses working in two public hospitals in Saudi Arabia was surveyed in this cross-sectional study. A questionnaire was used to assess job satisfaction, stress, quality of life, and intention of recruited nurses to leave their current jobs. Data were collected between April and May 2018.

RESULTS

Quality of life dimensions, such as physical and psychological health, predict nurses' intention to resign from their current workplaces. We found that being single or of Filipino or Indian origin, working in the medical and surgical department, or having a low monthly gross salary is correlated with a high intention to leave.

CONCLUSION

The results present a unique theoretical underpinning that expands on the previous knowledge and literature on the factors that affect nurses' intent to leave their organizations. The findings of this study can be used as a guide to establish human resource policies toward satisfying nurses' needs and improving job satisfaction and quality of life to promote retention.