Can the Reboot coaching programme support critical care nurses in coping with stressful clinical events? A mixed-methods evaluation assessing resilience, burnout, depression and turnover intentions

BACKGROUND

Critical care nurses (CCNs) are routinely exposed to highly stressful situations, and at high-risk of suffering from work-related stress and developing burnout. Thus, supporting CCN wellbeing is crucial. One approach for delivering this support is by preparing CCNs for situations they may encounter, drawing on evidence-based techniques to strengthen psychological coping strategies. The current study tailored a Resilience-boosting psychological coaching programme [Reboot] to CCNs. Other healthcare staff receiving Reboot have reported improvements in confidence in coping with stressful clinical events and increased psychological resilience. The current study tailored Reboot for online, remote delivery to CCNs (as it had not previously been delivered to nurses, or in remote format), to (1) assess the feasibility of delivering Reboot remotely, and to (2) provide a preliminary assessment of whether Reboot could increase resilience, confidence in coping with adverse events and burnout.

METHODS

A single-arm mixed-methods (questionnaires, interviews) before-after feasibility study design was used. Feasibility was measured via demand, recruitment, and retention (recruitment goal: 80 CCNs, retention goal: 70% of recruited CCNs). Potential efficacy was measured via questionnaires at five timepoints; measures included confidence in coping with adverse events (Confidence scale), Resilience (Brief Resilience Scale), depression (PHQ-9) and burnout (Oldenburg-Burnout-Inventory). Intention to leave (current role, nursing more generally) was measured post-intervention. Interviews were analysed using Reflexive Thematic Analysis.

RESULTS

Results suggest that delivering Reboot remotely is feasible and acceptable. Seventy-seven nurses were recruited, 81% of whom completed the 8-week intervention. Thus, the retention rate was over 10% higher than the target. Regarding preliminary efficacy, follow-up measures showed significant increases in resilience, confidence in coping with adverse events and reductions in depression, burnout, and intention to leave. Qualitative analysis suggested that CCNs found the psychological techniques helpful and particularly valued practical exercises that could be translated into everyday practice.

CONCLUSION

This study demonstrates the feasibility of remote delivery of Reboot and potential efficacy for CCNs. Results are limited due to the single-arm feasibility design; thus, a larger trial with a control group is needed.

Evaluation of a blended training solution for critical care nurses' work environment: Lessons learned from focus groups in four European countries

AIM

The aim of this study was to evaluate a blended pilot training course on Healthy Work Environments (HWEs) for critical care nurses as follows: 1) to explore the experience of trainees and trainers who took part in the training; and 2) to identify the strengths and weaknesses of the training program in its potential transferability to nursing practice in Intensive Care Units (ICUs).

BACKGROUND

Despite the evidence supporting the association between HWEs and job satisfaction, nursing retention, and patient outcomes, nurses still have high rates of burnout, mental health problems and intent to leave. To address this challenge, a blended training was created and piloted with the aim to highlight the relevance and impact of HWEs, enhancing its transferability to daily practice. The training was based on the six standards of HWEs as proposed by the American Association of Critical Care Nurses and created within an Erasmus + project. The pilot was delivered by trainers (critical care nursing educators) to critical care nurses and included six workshops of eight hours each (48 h in total) in each country.

DESIGN

After the pilot testing, a qualitative approach, with focus group discussions was used.

METHODS

All the trainees (n=82), who had attended at least one workshop were invited to participate in the focus groups. Overall, eight focus groups were held with critical care nurses who participated as trainees (n=39) from four testing countries: Cyprus, Croatia, Spain and Poland. One international focus group was held with trainers who conducted the training (n=4). Four more trainers completed the questionnaire online. All focus group were video recorded, and transcribed verbatim. Then, the national transcripts were translated into English. An inductive thematic analysis was carried out.

FINDINGS

Three themes were identified: 1) Valuing the relevance of the training program and a positive learning experience; 2) A powerful insight leading to increased awareness and empowerment in personal and professional life; 3) Challenges identified in terms of training, follow up and management of change. Both trainees and trainers expressed a positive opinion with regard to the content of the training and the didactic methods used. They emphasized the strong influence of the training on their understanding of a HWEs, its impact in an ICU context and the need for action, mainly related to communication issues.

CONCLUSION

The proposed blended training program may be used by trainers, who can enable nurses develop the competencies required to influence their work environment, in a context of shared responsibility.

Critical care nursing workforce in crisis: A discussion paper examining contributing factors, the impact of the COVID-19 pandemic and potential solutions

AIMS AND OBJECTIVES

The critical care nursing workforce is in crisis, with one-third of critical care nurses worldwide intending to leave their roles. This paper aimed to examine the problem from a wellbeing perspective, offering implications for research, and potential solutions for organisations.

DESIGN

Discursive/Position paper.

METHOD

The discussion is based on the nursing and wellbeing literature. It is guided by the authors' collaborative expertise as both clinicians and researchers. Data were drawn from nursing and wellbeing peer-reviewed literature, such as reviews and empirical studies, national surveys and government and thinktank publications/reports.

RESULTS

Critical care nurses have been disproportionately affected by the COVID-19 pandemic with studies consistently showing critical care nurses to have the worst psychological outcomes on wellbeing measures, including depression, burnout and post-traumatic stress disorder (PTSD). These findings are not only concerning for the mental wellbeing of critical care nurses, they also raise significant issues for healthcare systems/organisations: poor wellbeing, increased burnout and PTSD are directly linked with critical care nurses intending to leave the profession. Thus, the wellbeing of critical care nurses must urgently be supported. Resilience has been identified as a protective mechanism against the development of PTSD and burnout, thus offering evidence-based interventions that address resilience and turnover have much to offer in tackling the workforce crisis. However, turnover data must be collected by studies evaluating resilience interventions, to further support their evidence base. Organisations cannot solely rely on the efficacy of these interventions to address their workforce crisis but must concomitantly engage in organisational change.

CONCLUSIONS

We conclude that critical care nurses are in urgent need of preventative, evidence-based wellbeing interventions, and make suggestions for research and practice.

Identifying factors associated with UK veterinary nurse resignations through examination of veterinary practice data

BACKGROUND

This study aimed to identify demographic, practice and job-specific factors that are associated with veterinary nurses resigning from UK companion animal veterinary practices.

METHODS

Employment data from nurses working across a group of practices at the end of 2020 were included. Nurses were categorised into those who remained at, or resigned from, their practice in 2021. Proposed risk factors for future resignations were analysed using multivariable binary logistic regression modelling.

RESULTS

In total, 278 of 1642 (16.9%) nurses across 418 practices resigned in 2021. The most frequently recorded reasons for nurses resigning included 'career progression' (n = 102; 36.7%), 'personal reasons' (n = 36; 12.9%) and 'better pay or benefits' (n = 33; 11.9%). Factors associated with lower odds of future nurse resignations included longer tenure (p < 0.001), higher practice property and facilities rating (p = 0.049) and being a head or student nurse (p = 0.008).

LIMITATIONS

Data were collected retrospectively and were not recorded for research purposes.

CONCLUSIONS

This study highlights key factors that are predictive of veterinary nurse resignations. With known difficulties in staff retention within veterinary practices, analysis of these data is an important addition to the evidence base surrounding the complex issue of nurse retention and could help steer future retention strategies.

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.

Global prevalence of turnover intention among intensive care nurses: A meta-analysis

BACKGROUND

Nurse turnover is considered a major cause of nurse shortage, representing problems for health care systems in terms of both quality and cost of care for patients, and intention to leave is the strongest practical predictor variable of actual turnover.

AIM

This systematic review and meta-analysis aims at exploring the global prevalence of turnover intention in intensive care nurses.

DESIGN

This was a systematic literature review.

METHODS

A systematic review of empirical quantitative studies on turnover intention in nurses of intensive care units (ICUs), published in English till March 2021, was conducted. The databases PubMed, Embase, ISI Web of Knowledge, and CINAHL were searched. Eligible studies were observational or descriptive studies that reported the prevalence of turnover intention among nurses in all types of ICUs. The quality of studies was assessed using a modified Newcastle-Ottawa Scale. A random effect meta-analysis was conducted to estimate the pooled prevalence of turnover intention among ICU nurses.

RESULTS

We identified 18 cross-sectional studies investigating a total of 23 140 intensive care nurses from 23 countries. The intention to leave rate was ranged from 3.0% to 75.0%. The pooled prevalence of turnover intention was 27.7% (95% confidence interval: 21.6%-34.3%).

CONCLUSIONS

This meta-analysis showed that more than 27% of the intensive care nurses had the intention to leave worldwide. In the current context of nursing shortage, efforts should be made to improve conditions for this important group of care providers.

RELEVANCE TO CLINICAL PRACTICE

The prevalence of turnover intention is relatively high among intensive care nurses. Nurse managers should take this intention seriously, as the intention to leave may lead to an actual decision to leave the profession.

Designing shift work: Proposal for a participatory approach deployed in a hospital setting and focusing on actual work

Designing the working day is not just a matter of changing the shift system. It also requires reflection on the working conditions and a negotiation of solutions with the stakeholders concerned. This article seeks to show that a participatory approach, built using organisational simulation, provides a framework with which to understand the reality of each profession and co-construct suitable solutions. Our action-research took place in a hospital's pneumology ward. The methodology can be broken down into four phases: diagnosis, sharing of the diagnosis, organisational simulation (the focus of this article) and experimenting with solutions. The results show that the approach gave the stakeholders the opportunity to discover and discuss the rules and constraints of actual work, to compare their different views, and to develop a new and shared view of the work situation. The approach allowed them to co-construct relevant solutions and to appropriate the changes necessary for their success.

Nurses' intention to leave their job in sub-Saharan Africa: A systematic review and meta-analysis

Introduction

Nurses' intention to leave their job is a worldwide concern. Internal and external brain drain factors are the main reason for nurses' intention to leave their job. So far, in Sub Sahara Africa, several observational studies have been done on nurses' intention to leave their job. However, a comprehensive review that would have a lot of evidence for designing an intervention is lacking. Hence, this study aimed to the pooled status of nurses' intention to leave their job.

Methods

In the current meta-analysis, the target variables were searched from different electronic databases. These electronic databases are Pub Med, Google Scholar, Science Direct, African Index Medicus, African Journal Online, EMB ASE, and the Cochran Library. To determine the pooled proportion of intention to leave their job in Sub- Saharan Africa, all the necessary data was extracted by using a standardized data extraction format. We analyzed the data by using Stata 15 statistical software. Heterogeneity between the primary studies assessed by Cochran Q and I-square tests. A random-effect model computes to estimate the pooled nurses' intention to leave their job.

Result

We included fifteen full-text studies in the current meta-analysis. The findings of this meta-analysis revealed that the pooled proportion of nurses' intention to leave their job in sub-Saharan Africa was 50.74% (95% CI; 41.33, 60.14; I2 = 95.80%). The subgroup analysis showed that the highest pooled proportion of intention to leave their job (58.03% (95% CI: 47.93, 68.12)) in East Africa. The lowest pooled estimation to leave their job among nurses showed that South Africa (33.04% (95%CI: 20.45, 45.63)).

Conclusion

In the current study, there was a high proportion of nurses indentation to leave their job. Nurses' intention to leave their job also varied from region to region in the study area. Therefore, health managers and stakeholders focus on design sufficient development and career opportunities, positive working atmosphere, and secure their autonomy.

Turnover among foreign nurses in Saudi Arabia

Background: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon.

Design and methods: The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals.

Results: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores.

Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted.

A workforce survey of critical care nurses in the National Health Service

AIM

To measure key aspects of the critical care nursing workforce across the National Health Service (NHS) and compare these with recommended standards where they exist.

BACKGROUND

The provision of high-quality and safe critical care services is dependent on adequate numbers of highly skilled nurses. Understanding the issues and challenges within critical care services across the NHS is key to future planning and policy in this area.

DESIGN

A stakeholder-driven consensus development approach was adopted to design a workforce survey by members of the Critical Care National Network Nurse Leads (CC3N) Forum.

METHODS

The survey was conducted across all the critical care units in England, Northern Ireland, Wales, and Scotland. Data were collated to enable presentation of descriptive statistics.

RESULTS

Data returns were received from 240 of the 272 units in England and Northern Ireland. Scotland and Wales data were excluded from analysis and reporting. Differences in the sample and data returns limited comparison with the previous survey in some aspects. Stability was seen in vacancy and sickness rates. Improvements were seen in safe nurse: patient ratios, supernumerary "nurse in charge," critical care outreach service cover, use of national competency framework, and agency use. Dependency on overseas nurses in some units remains high. Specialist critical care training levels in many units do not meet current required standards.

CONCLUSION

Clear improvements have been made. There is significant stability. Some challenges remain. Continued review of resource allocation is important in the coming years, as is policy and strategy to ensure recruitment, appropriate training, and support for staff well-being.

RELEVANCE TO CLINICAL PRACTICE

The reader will gain insight into the critical care nursing workforce in the NHS in England and Northern Ireland. The results are useful for nurses, nurse managers, and policymakers.

Nursing practice environment, resilience, and intention to leave among critical care nurses

BACKGROUND

Retaining experienced critical care nurses (CCNs) remains a challenge for health care organizations. Nursing practice environment and resilience are both seen as modifiable factors in ameliorating the impact on CCNs' intention to leave and have not yet been explored in Malaysia.

AIMS AND OBJECTIVES

To assess the association between perceived nursing practice environment, resilience, and intention to leave among CCNs and to determine the effect of resilience on intention to leave after controlling for other independent variables.

DESIGN

This was a cross-sectional survey.

METHODS

The universal sampling method was used to recruit nurses from adult and paediatric (including neonatal) critical care units of a large public university hospital in Malaysia. Descriptive analysis and χ² and hierarchical logistic regression tests were used to analyse the data.

RESULTS

A total of 229 CCNs completed the self-administrated questionnaire. Of the nurses, 76.4% perceived their practice environment as being favourable, 54.1% were moderately resilient, and only 20% were intending to leave. The logistic regression model explained 13.1% of variance in intention to leave and suggested that being single, an unfavourable practice environment, and increasing resilience were significant predictors of nurses' intention to leave.

CONCLUSION

This study found that an unfavourable practice environment is a strong predictor of intention to leave; however, further exploration is needed to explain the higher likelihood of expressing intention to leave among CCNs when their resilience level increases.

RELEVANCE TO CLINICAL PRACTICE

Looking into staff allocation and equality of workload assignments may improve the perception of the work environment and help minimize intention to leave among nurses.

Nurses' intention to leave their job and associated factors in Bahir Dar, Amhara Region, Ethiopia, 2017

Background

Intention to leave is an employee’s plan of tendency to leave the current working institute to find an alternative job in the near future. Even though nurses are the backbone of patient caring, there was no study done on intention to leave their job in North West Ethiopia. Therefore, the aim of this study was to assess nurses’ intention to leave their job and associated factors in Bahir Dar, North West Ethiopia, 2017.

Methods

An institutional-based cross-sectional study was conducted from 1st March to 30th March 2017. After proportional sample size allocation, 210 participants were selected by simple random sampling method. Data were collected by using a self-administered structured questionnaire. Statistical Package for Social Science version 23.0 was used to enter, clean, code and analyze the collected data. The association between independent and dependent variables was assessed by using bivariable and multivariable logistic regression model. Factors that had statistically significant association with the dependent variable (P < 0.05) were identified as significant in the multivariable logistic regression analysis.

Result

From a total of 210 nurses, 191 of them were participating in this study making a response rate of 90.95%. From all nurses, 64.4%of them were employed in the hospital. In this study, nurses’ overall intention to leave their job was 64.9% (95% CI: [57.6, 71.2]). Nurses’ intention to leave their job was determined by disagree in recognition (AOR = 4.83; 95%CI: [1.73, 13.50]), and work itself (AOR = 31.30; 95%CI: [7.16, 136.78]).

Conclusion

Nurses’ intention to leave their job in the current study was high. The contributing factors for this problem were disagree in recognition at work and work itself. Hence, we recommended that hospital and health center managers should maintain recognition at work and work itself to retain nurses.

Factors Influencing Nurses’ Intention to Leave and Intention to Stay: An Integrative Review

Nursing retention is a critical issue for organization. High nurses’ turnover impact negatively on an organization requirement to meet patient needs and quality care. This integrative review aims to critically review and synthesize published studies to obtain better understanding of the determinants of nurse’s intention to leave or stay in the organization. Thirty-seven studies which met the inclusion criteria from different locations using a variety of instruments and research designs were identified using PRISMA guideline. Many factors including job satisfaction, organizational commitment, quality of work life, work environment, leadership style, bullying at work, family reason, and job security were identified to be associated negatively with nurse’s intention to leave and positively with intention to stay in organization. More qualitative studies are needed to understand in depth, the reasons and factors that underlie and influence turnover, intention to leave or remain in organization.

Paternalistic Leadership, Organizational Cynicism, and Intention to Quit One's Job in Nursing

The aim of this study was to determine the relationship between paternalistic leadership, organizational cynicism, and the intention to quit one's job among nurses. The implementation part of the study was carried out with nurses working in a public hospital in the city of Mersin, Turkey. Data were collected in January 2018 from 215 participants and then analyzed. The analyses indicate that the dimensions of organizational cynicism and paternalistic leadership explained 41.8% of the variance for the intention to quit. In addition, there were negative and significant relationships between paternalistic leadership and dimensions of organizational cynicism. As the participants' perceptions of cognitive cynicism and behavioral cynicism increased, their intention to quit increased. In addition, as their perceptions of paternalistic leadership increased, their cognitive, affective, and behavioral cynicism decreased. This study will help managers of healthcare institutions better understand how paternalistic leadership is related to organizational cynicism and the intention to quit one's job.

Telemedicine Intensive Care Unit Nursing Interventions to Prevent Failure to Rescue

BACKGROUND

Although telemedicine intensive care unit (tele-ICU) nurses are integral to the tele-ICU model of care, few studies have explored the influence of tele-ICU nursing interventions on preventing failure to rescue in critically ill patients.

OBJECTIVE

To determine how tele-ICU nurses characterize their interventions to prevent failure to rescue.

METHODS

This qualitative interpretive study recruited a purposive sample from 11 tele-ICU centers across the United States for structured open-ended interviews. An inductive and deductive approach suitable for health services qualitative research was adapted to further explain and extend a relevant conceptual framework for tele-ICU nursing practice.

RESULTS

Of 33 nurses practicing in tele-ICUs who responded to a recruitment email, 19 participated in this study. Findings included 4 major interrelated themes: (1) fundamental attributes of the tele-ICU nurse, (2) proactive clinical practice, (3) effective collaborative relationships, and (4) strategic use of advanced technology.

CONCLUSION

A conceptual framework extending the American Association of Critical-Care Nurses model of success for tele-ICU nursing practice is proposed to prevent failure to rescue. Tele-ICU nurses use systems thinking and integration of complex factors in their practice to prevent failure to rescue. Tele-ICU nurses' perception of their role in preventing failure to rescue and emotional intelligence competence are key to building and maintaining effective relationships with the ICU. Tele-ICU nurses' intentional use of advanced technology, rather than the technology itself, supports and enhances proactive tele-ICU practice to prevent failure to rescue.

Magnitude of Turnover Intention and Associated Factors among Health Professionals Working in Public Health Institutions of North Shoa Zone, Amhara Region, Ethiopia

BACKGROUND

Health workers are one of the most important building blocks of the health system. High turnover rate contribute to the shortfalls and unbalanced distribution of health personnel in the health workforce. Turnover intention is the strongest predictor of actual turnover.

OBJECTIVE

To assess the magnitude of turnover intention and associated factors among health professionals working in public health institutions of North Shoa Zone, Amhara region, Ethiopia.

METHODS

A health facility based cross-sectional study was conducted from March to April 2016, on 612 health professionals working in public health institutions of North Shoa Zone, Amhara region, Ethiopia, using a multistage stratified sampling technique. Data were collected using a pretested self-administered structured questionnaire. The data were entered using Epidata version 3.1 and analyzed using SPSS version 22 software. Descriptive statistics were conducted to summarize the sample characteristics. Backward stepwise logistic regression model was fitted and AOR with 95% CI was calculated to identify the associated factors. P-value <0.05 was taken as a cut-off point for statistical significance. Ethical issues were addressed.

RESULTS

Among the 568 health professionals who responded to the questionnaire, 348 (61.3%) of them reported to have the intention to leave their current workplaces. The results showed that being a male [AOR = 1.496 (95% CI: 1.016, 2.204)], medical doctor [AOR = 0.318 (95% CI: 0.122, 0.824)], unsatisfied with the work nature [AOR = 1.822 (95% CI: 1.206, 2.753)], unsatisfied with the incentives [AOR = 1.668 (95% CI: 1.105, 2.517)], and unsatisfied with the supervision [AOR = 1.916 (95% CI: 1.274, 2.881)] and having low normative commitment [AOR = 2.176 (95% CI: 1.482, 3.196)] were significantly associated with turnover intention of the health professionals.

CONCLUSIONS

The magnitude of turnover intention was high among health professionals working in public health institutions of North Shoa Zone. Health service managers and policymakers should develop evidence based retention strategies considering the determinants of health professionals' intention to leave.

Psychosocial Hazards in the Workplace as an Aspect of Horizontal Segregation in the Nursing Profession

The purpose of this article was to assess the influence of psychosocial hazards as a factor affecting the presence of men in the nursing profession. The article refers to the topic of particularly low representation of men among nursing staff in Poland, in comparison to what similar statistics show for other countries. The aim of the study was to assess whether the psychosocial hazards in the nursing profession constitute a significant factor in the small number of men present in this occupation. In this article psychosocial hazards are considered as all the aspects of management and work organization that may negatively affect the employee's mental and physical health. The research was conducted from September 2017 to April 2018 in the Podlaskie Voivodeship (Poland). A total of 640 respondents working as nurses in inpatient health care facilities, of which 87% were women and 13% were men, were included in the study. A standardized Work Design Questionnaire for an objective assessment of work stressfulness was used as a research tool. The research has been run by a group of experts, who explained the aim and the meaning of the particular questions to the surveyed group. Afterwards, based on the answers and observations of the responders, the experts filled in the questionnaire. The results of the study show that in almost all the evaluated aspects, the nursing profession was assessed more negatively by surveyed men than women. The most negative aspects reported by women included hazards (a score of 60), complexity (58.3), and haste (50.0), while those reported by men included haste (70.0), complexity (66.7), and hazards (65.0). As a conclusion it has been noticed, that results received from the research confirm that psychosocial hazards may have significant impact on the number of men present in the nursing profession in Poland. This study also suggests that the greater psychosocial hazards experienced by male nurses in the workplace may be an effect of the particularly low representation of men among practicing nursing staff.

Factors influencing nurses' intentions to leave adult critical care settings

BACKGROUND

The shortage of critical care and specialist nurses has been an ongoing issue for many decades. Although all areas of nursing are affected, critical care areas are especially vulnerable to recruitment and retention problems. High nursing turnover in critical care areas is evident; however, research into the factors that influence nurses' intentions to leave adult critical care areas is limited.

AIM

To explore factors that may influence nurses' intentions to leave adult critical care areas.

OBJECTIVES

To appraise existing evidence and highlight gaps in knowledge regarding factors that may influence nurses' intentions to leave adult critical care areas.

METHODS

A systematic mixed-method literature review was conducted. The search strategy was developed using the List, Keep and Delete approach, a framework used to identify search terms for systematic health care reviews. The following key words were used: intentions to leave, nurses, adult and critical care. The databases searched were BNI, CINAHL, PubMed, PsycINFO, Embase and Health B Elite from 2005 to 2016. Primary data from non-critical care areas and neonatal and paediatric critical care areas were excluded. Comprehensive supplementary searching was performed. Papers were critically appraised using the NICE (2012) checklists. Data were analysed using the Braun and Clarke (2006) thematic framework.

RESULTS

A total of 15 studies, including 13 cross-sectional studies and 2 qualitative studies, were reviewed. Three main themes emerged following data analysis. These themes were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences.

CONCLUSIONS

The literature review highlighted the need for further research and greater understanding of how these themes may impact critical care nurses. Nurse managers and leaders should consider these findings when developing strategies to improve nurse retention.

RELEVANCE TO PRACTICE

The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care.

Professional exhaustion, quality and intentions among family health nurses

ABSTRACT Objective: to analyze how family health nurses assess quality of care; check if they have any intention of leaving their current job and nursing; estimate prevalence of professional exhaustion; and correlate these variables. Method: cross-sectional and correlational study with 198 nurses. The Maslach Burnout Inventory was applied, as it has questions for characterizing nurses, assessing perception on quality of care and of material and human resources, and verifying intention of leaving current work and nursing. Results: most nurses assess quality of care as good, 28.0% present emotional exhaustion, there is intention of leaving current work and nursing. Conclusions: family health nurses experience professional exhaustion, which in turn presents correlation with decreased quality of care and increased intentions of leaving current work and nursing.

Intention to leave profession, psychosocial environment and self-rated health among registered nurses from large hospitals in Brazil: a cross-sectional study

Background

Nurses’ intention to leave their profession is a worldwide concern. Studies have shown that it can take the form of a chain reaction: many nurses first leave the unit, then the hospital, and finally the profession. Organisation and other labour factors, personal and conjunctural, have been associated with the intention to quit nursing. This study aimed to examine the factors associated with the intention to leave the profession among registered nurses (RNs) at large public hospitals in Brazil.

Methods

This was a cross-sectional study, conducted from 2010 to 2011: all RNs at Rio de Janeiro’s 18 largest public hospitals (>150 beds) were invited to participate. The study sample comprised 3,229 RNs (82.7% of those eligible), who answered a self-completed, multidimensional paper questionnaire. The outcome was defined as thoughts of leaving the profession sometimes a month or more. We based the analyses on hierarchical logistic regression models, considering three blocks of determinants: socio-demographic data (block I), occupational factors (block II), and health conditions (block III).

Results

Of the study population, 22.1% indicated the intention to leave the profession. In the final model after adjustment, the variables associated with the intention to leave were as follows: male sex (odds ratio [OR] = 1.65), not holding a leadership position (OR = 1.28), highly demanding work (OR = 2.49), passive work (OR = 2.10), effort-reward imbalance (OR = 2.00), poor self-rated health (OR = 1.92), over-commitment to the job (OR = 1.87), and poor supervisor support (OR = 1.33). The likelihood of expressing the intention to leave increased with age (OR = 0.98 for the oldest).

Conclusions

Self-rated health and factors connected with the work environment, particularly those that generate psychosocial strain, were most strongly associated with the intention to leave the profession. From the profiles of nurses who wished to leave the profession, we found that for many people who go into nursing—especially men and younger entrants—their prospects of remaining in the profession are poor. The potential role of psychosocial job characteristics and self-rated health indicates the need for long-term action involving all stakeholders, i.e. managers, employers, and workers.

The Effect of Nurse-Physician Collaboration on Job Satisfaction, Team Commitment, and Turnover Intention in Nurses

Voluntary turnover in nursing can lead to nursing shortages that affect both individuals and the entire hospital unit. We investigated the relationship between group- and individual-level variables by examining the association of nurses' job satisfaction and team commitment at the individual level, and nurse-physician collaboration at the group level, with individuals' intention to leave the unit at the individual level. A self-report questionnaire was administered to 1,024 nurses on 72 units in 3 Italian hospitals. At the individual level, affective commitment partially mediated the relationship between job satisfaction and nursing turnover intention. Moreover, a cross-level interaction was found. Nurses with high levels of job satisfaction showed high levels of identification with their team, and this relationship was stronger when the group perception of nurse-physician collaboration was high. Results suggested that managerial strategies to promote nurse-physician collaboration may be important to increase nurses' affective commitment to the team. At the individual level, job satisfaction and team affective commitment are important factors for retaining staff, and at the group level, good work collaboration with physicians is instrumental in developing nurses' affective identification with the team. © 2016 Wiley Periodicals, Inc.

Turnover intention among intensive care unit nurses in Alexandria, Egypt

BACKGROUND

Given the difficulty in recruiting new nurses, it is imperative to retain those already in the profession. This cross-sectional study explored the relationship of demographic and work-related factors, burnout, conflict management and relationship between nurses and physicians on turnover intentions among ICU nurses in eight major hospitals in Alexandria, Egypt.

SUBJECTS AND METHODS

Data on burnout, conflict management, nurse-physician communication, and turnover intention were collected by surveying 100 nurses in eight hospitals in Alexandria governorate. All nurses at the ICU of selected hospitals were approached (n=100) and a 47-item Likert scale questionnaire was administered to explore the factors affecting the turnover intention of ICU nurses in Alexandria.

RESULTS

ICU nurses exhibited a mean score for turnover intention of 3.23 (mean score percentage 65.0%). There was a moderately positive statistically significant correlation between turnover intention and emotional exhaustion (r=0.29, P<0.05), nurse-physician communication (r=0.25, P<0.05), and age (r=0.21, P<0.05). The predicting factors for turnover intention were emotional exhaustion and age.

CONCLUSION AND RECOMMENDATION

Nurses turnover intention at the ICU of the selected hospitals is high and is significantly associated with nurses' emotional exhaustion, poor nurse-physician communication, and nurses age.

Nurses' practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country, multilevel study

BACKGROUND

Nursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied.

OBJECTIVE

The aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction.

DESIGN

Multilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied.

RESULTS

Regarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied.

CONCLUSIONS

We conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries.

Relationship between job satisfaction, professional identity and intention to leave the profession among nurses in Turkey

AIMS

The purpose of this study is to investigate the relationship between job satisfaction, professional identity and intention to leave the profession among nurses in Turkey.

BACKGROUND

Although there are many studies on job satisfaction among nurses in Turkey, there is a gap in the literature in relation to professional identity, particularly for intentions to leave the profession.

METHOD

This cross-sectional, descriptive and correlational study was conducted with 2122 nurses from Turkey.

RESULTS

A positive and significant correlation was determined between the nurses' job satisfaction and professional identities. It was found that 15.5% of the nurses intended to leave their profession. Intention to leave the profession was greater among the nurses with inadequate professional identity development and low job satisfaction.

CONCLUSION

Professional identity is a factor affecting job satisfaction. Both professional identity and job satisfaction are important factors affecting nurses' intention leaving the profession.

IMPLICATIONS FOR NURSING MANAGEMENT

Given that professional identity and job satisfaction affect intention to leave the profession and professional identity affects job satisfaction, nurse managers who are mainly responsible for the quality of nursing care should develop strategies that support nurses' professional identity and increase their job satisfaction if they are to prevent nurses from leaving the profession.

[Nurses of large public hospitals in Rio de Janeiro: socio demographic and work related characteristics]

The study aimed at analyzing socio-demographic and working characteristics of nurses from public hospitals. It was carried out a cross-sectional study, involving 3.229 nurses from the eighteen largest public hospitals of the city of Rio de Janeiro. It was observed a feminine predominance (87.3%), with mean age of 39.9 ± 10 years. Around 7% referred having master or doctorate degree, 58.5% got their degree from public institutions and 24.5% used to work at the health sector before becoming nurses. Half the group has thought of abandoning their career, and almost a quarter is unsatisfied with their profession. Around 10% searched for a job outside nursing area in the previous month and 30% searched for a job in the same working area. Night work, engagement in more than one job and long professional work hours were more frequently found among men. The study has pointed challengeable aspects of nurses' profession. Results can subsidize support strategies to improve the working conditions in public hospitals due to their comprehensiveness.