COVID-19: The effects of perceived organizational justice, job engagement, and perceived job alternatives on turnover intention among frontline nurses

Work engagement among nurses in the context of the COVID-19 pandemic: A systematic review

BACKGROUND

Despite nurses receiving education on how to respond during crises, the stress and demands arising from unprecedented situations, such as the COVID-19 pandemic, may affect their work engagement.

AIM

To appraise and synthesize studies examining work engagement among nurses in the context of the COVID-19 pandemic.

METHODS

It is a systematic review in which three databases were searched. Critical appraisal tools and PRISMA guidelines were used. Content analysis was performed.

ETHICAL CONSIDERATIONS

Ethical approval was not required for this systematic review.

FINDINGS

A total of 21 studies were included. The results were classified into three categories: (1) levels and meanings of work engagement, (2) the relationship of work engagement with various factors, and (3) measures to enhance work engagement.

CONCLUSION

The review revealed that nurses' work engagement varied from moderate to high. Factors such as education level and work schedule flexibility influenced their engagement. Positive associations were found between work engagement and job satisfaction, intention to stay, and organizational support, while stress and workload showed negative relationships. The crucial role of health policymakers, hospital administrators, and nurse managers in acting ethically, creating favorable working conditions and fostering nurses' work engagement was emphasized.

Determinants of intention to leave among nurses and physicians in a hospital setting during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The global outbreak of COVID-19 has brought to light the profound impact that large-scale disease outbreaks can have on healthcare systems and the dedicated professionals who serve within them. It becomes increasingly important to explore strategies for retaining nurses and physicians within hospital settings during such challenging times. This paper aims to investigate the determinants of retention among nurses and physicians during the COVID-19 pandemic.

METHOD

A systematic review of other potential determinants impacting retention rates during the pandemic was carried out. Secondly, a meta-analysis on the prevalence of intention to leave for nurses and physicians during the COVID-19 pandemic.

FINDINGS

A comprehensive search was performed within four electronic databases on March 17 2023. Fifty-five papers were included in the systematic review, whereas thirty-three papers fulfilled the eligibility criteria for the meta-analysis. The systematic review resulted in six themes of determinants impacting intention to leave: personal characteristics, job demands, employment services, working conditions, work relationships, and organisational culture. The main determinants impacting the intention to leave are the fear of COVID-19, age, experience, burnout symptoms and support. Meta-analysis showed a prevalence of intent to leave the current job of 38% for nurses (95% CI: 26%-51%) and 29% for physicians (95% CI: 21%-39%), whereas intention to leave the profession for nurses 28% (95% CI: 21%-34%) and 24% for physicians (95% CI: 23%-25%).

CONCLUSION

The findings of this paper showed the critical need for hospital managers to address the concerning increase in nurses' and physicians' intentions to leave during the COVID-19 pandemic. This intention to leave is affected by a complex conjunction of multiple determinants, including the fear of COVID-19 and the confidence in and availability of personal protective equipment. Moreover, individual factors like age, experience, burnout symptoms, and support are maintained in this review. Understanding the influence of determinants on retention during the COVID-19 pandemic offers an opportunity to formulate prospective strategies for retaining nurses and physicians within hospital settings.

Association between organizational justice and serious psychological distress among hospital nursing staff during the COVID-19 pandemic: A cross-sectional study

AIM

Amidst the COVID-19 pandemic, the association between organizational justice and psychological distress among hospital nursing staff is underexplored. Thus, this cross-sectional study, conducted in Fukuoka Prefecture, Japan, examined the relationship between organizational justice and serious psychological distress (SPD) among hospital nursing staff during COVID-19.

METHODS

The study surveyed 783 hospital nursing staff using the Organizational Justice Questionnaire and Effort-Reward Imbalance Questionnaire. The Kessler K6 scale was used to measure SPD. Sociodemographic and occupational characteristics were controlled for as potential confounders.

RESULTS

The prevalence of SPD was 14.4%, with a mean K6 score of 6.5. Moderate procedural justice (odds ratio [OR] = 2.38, 95% confidence interval [CI] = 1.14-4.94, p = .021) and low distributive justice (effort-reward imbalance) (OR = 3.66, 95% CI = 2.01-6.67, p < .001) were associated with SPD, even after adjustment for confounders. Interactional justice showed significance only in the crude model. Effort-reward imbalance had the strongest association with SPD.

CONCLUSIONS

The findings showed that moderate procedural justice and low distributive justice were associated with SPD, highlighting the need for organizational interventions to address these factors. Imbalances in effort/reward had the greatest impact, highlighting the critical role of distributive justice in mental health. Thus, in the context of a pandemic, extreme procedural justice is not necessarily associated with mental health, and efforts to ensure distributive justice are critical to improving the mental health of hospital nursing staff. Moreover, organizational stressors should be addressed during disruptive conditions such as infectious disease outbreaks.

Relationship between shift assignments, organizational justice, and turnover intention: A cross-sectional survey of Japanese shift-work nurses in hospitals

AIM

Shift management and planning processes for shift-working nurses are important for their continued work. This study aimed to determine the association between shift assignments, organizational justice, and their interaction with turnover intention among shift-work nurses.

METHODS

This cross-sectional study used an online questionnaire administered to Japanese nurses between January and February 2020. Enquiries pertaining to their daily start and end times for each shift type, the shift assignments, organizational justice, and their turnover intention were made. To examine the association with turnover intention, logistic regression analysis was performed with shift assignments, organizational justice, and their interaction terms as independent variables.

RESULTS

A total of 386 nurses participated in the final analysis. Of these, 161 nurses (41.7%) had turnover intention. Unequal work assignments and procedural justice were significantly associated with turnover intention. However, the interaction between these factors was not significant.

CONCLUSION

The results suggest that procedural justice in the workplace and turnover intention are related, but in shift planning, even procedural justice cannot buffer unequal work from leading to turnover intention. This study provides valuable insights for nursing managers who manage the schedules of shift-working nurses.

Ambivalent identification mediates the relationship between organizational justice and stress

The present study aims to examine the relationship between organizational justice and employee stress through the lenses of social identity theory and the ambivalent identification process. The research hypotheses assume that employees working in organizational environments with low levels of justice could experience more stress, and this relationship is also mediated by ambivalent identification. In other words, the mediating mechanism of this relation posited that low levels of organizational justice were associated with high levels of ambivalent identification, which in turn increased levels of work-related stress. Across a field study in several organizations from healthcare sectors, results confirmed that employees treated with less fairness experienced high ambivalence toward their organization, which increased their perception of stress, i.e., work-related burnout, client-related burnout, physical symptoms, and interpersonal strain at work. Furthermore, results supported only a full mediation model, in which the direct relationship between organizational justice and stress was not significant. The present results make an important contribution to the research literature on justice: the inclusion of the mediator variable, namely, ambivalent identification, drops the expected direct effect of organizational justice on stress, suggesting a call for action in adopting the social identity perspective in addition to organizational justice models, and specifically introducing the study of a detrimental form of identification, such as ambivalent identification. Limitations and practical implications of the study were discussed.

The impact of nurses' sense of security on turnover intention during the normalization of COVID-19 epidemic: The mediating role of work engagement

BACKGROUND

COVID-19 pandemic has entered a normal stage in China. During this phase, nurses have an increased workload and mental health issues that threaten the sense of security. Poor sense of security may have a considerable impact on turnover intention through low work engagement. It was challenging to maintain the nurse workforce. Fewer studies have been conducted on the effect of nurses' sense of security on their turnover intention in that phase. This study aimed to investigate the interrelationship between nurses' sense of security, work engagement, and turnover intention during the normalization phase of the epidemic in China and to explore the impact of sense of security on turnover intention.

METHODS

A cross-sectional survey was conducted from September 2020 to May 2021 in Guangdong Province, China. Data were collected online using Sense of Security Scale for Medical Staff (SSS-MS), Utrecht Work Engagement Scale (UWES), and Turnover Intention Scale. Pearson's correlation analysis was used to assess the correlation between sense of security, work engagement, and turnover intention. The hypothesis model used multiple linear regression models and the bootstrapping procedure to analyze the relationship between these variables.

RESULTS

Data were collected from 2,480 nurses who met the inclusion criteria. Over half(64.5%) of nurses had a high and very high turnover intention. After controlling the demographic and working variables, sense of security (β = 0.291, P < 0.001) had a direct positive effect on work engagement. Sense of security (β = -0.447, P < 0.001) and work engagement (β = -0.484, P < 0.001) had a direct negative effect on turnover intention. Sense of security and all of its components were associated with turnover intention through the partially mediating effects of work engagement.

CONCLUSIONS

Nurses' turnover intention was at a high level during the normalization phase of the epidemic. Sense of security and its components act as positive resources to reduce turnover intention by improving work engagement. Policy makers and managers may pay attention to the needs of nurses' sense of security, which may be a new perspective to help managers reduce their turnover intention and stabilize the nurse team.