Occupational stress, distributive justice and turnover intention among public hospital nurses in China: A cross-sectional study

Effects of perceived stress on turnover intention of female healthcare staff: a serial multiple mediation model

BACKGROUND

Healthcare staff in China, especially females, work in a high-pressure, high-load, and high-risk environment, which affects the physical and mental health, the efficiency and quality of work, and increases turnover intention. The present study investigated the relationship between perceived stress and turnover intention in female healthcare staff, and the effects of future-oriented coping and work-family balance on this relationship.

METHODS

Four hundred thirty-five female medical workers were recruited to perform a perceived stress scale, future-oriented coping inventory, work-family balance scale and turnover intention scale. Meanwhile, serial multiple mediation analysis was performed using PROCESS.

RESULTS

1) Perceived stress positively predicted the level of turnover intention in female healthcare staff; 2) Preventive coping and proactive coping showed mediation effects on the relationship between perceived stress and turnover intention, and preventive coping positively related to proactive coping; 3) The work-family balance also showed mediation effects on the relationship between perceived stress and turnover intention; 4) Preventive coping, proactive coping and work-family balance showed a serial multiple mediation on the relationship between perceived stress and turnover intention in female healthcare workers.

CONCLUSIONS

Perceived stress affects the level of turnover intention in female healthcare staff through preventive coping, proactive coping, and work-family balance. In addition, the sequential model of future-oriented coping was validated among female healthcare staff.

The association between school educational atmosphere, learning engagement, and professional commitment of nursing students, and learning engagement as the mediator

BACKGROUND

The current shortage and loss of nurses has become a significant problem in healthcare systems around the world. Professional commitment is essential to prevent the loss of nursing staff and stabilize the nursing workforce.

OBJECTIVES

This study aimed to explore the unique relationship between school educational atmosphere, learning engagement, and professional commitment, and whether learning engagement would mediate the relationship between educational atmosphere and professional commitment.

DESIGN

A cross-sectional study design was used.

SETTINGS

The participants came from six schools in four cities in Hubei Province, China.

PARTICIPANTS

A total of 1009 nursing students above the first year of undergraduate studies were included by convenient sampling method.

METHODS

Data were collected using the Educational Climate Inventory, the Utrecht Work Engagement Scale-student, and the Professional Commitment Scale. Pearson correlation was used to examine the relationship between educational atmosphere, learning engagement, and professional commitment. Mediation analysis was used to test whether learning engagement mediated the relationship between educational atmosphere and professional commitment.

RESULTS

A positive educational atmosphere was associated with a high level of learning engagement, which was associated with a higher level of professional commitment. Learning engagement mediated the relationship between educational atmosphere and professional commitment.

CONCLUSIONS

The findings provide empirical evidence for promoting professional commitment in nursing students. Learning engagement is an important mediating variable connecting educational atmosphere and professional commitment. In order to stabilize the career choices of nursing students, it is necessary to take measures to improve their learning engagement during school.

Transition shock, future time perspective, professional self-concept, and professional identity among nursing interns: A cross-sectional study

Background

Transition shock is prevalent among nursing interns. Future time perspective helps nursing interns learn and work more effectively and improve their problem-solving skills. Professional self-concept and professional identity play an important central and driving role in nursing interns' career choices and career development. However, the mechanism by which future time perspective, professional self-concept and professional identity are linked to transition shock among nursing interns remains unknown.

Objectives

We assess the degree of transition shock experienced by nursing interns and investigate the connections among transition shock, future-focused viewpoint, professional identity, and professional self-concept.

Design

A descriptive, cross-sectional design was conducted.

Setting

Eight hospitals in Hunan Province, China were included in the study.

Participants

Nursing interns at the studied hospital participated in the study.

Methods

A total of 1090 nursing interns [929 female, 161 male] were recruited from eight hospitals. Data on transition shock, future time perspective, professional self-concept and professional identity among nursing interns were collected using questionnaires from 30 May to June 15, 2022.

Results

On a 4-point rating scale, the participants' felt transition shock had a mean overall score of 2.39 (SD = 0.52). The dimension with the highest score was overwhelming workload (mean = 2.74, SD = 0.58), while the dimension with the lowest score was incongruity between work and personal life (mean = 2.16, SD = 0.70).Professional identity was statistically significantly correlated with transition shock (r = -0.198, p < 0.01). The preferred level of nursing (β = 0.354, p < 00.01), professional self-concept (β = 0.226, p < 00.01), professional identity (β = -0.2576, p < 00.01) and future time perspective (β = 0.119, p < 00.01) were predictors of transition shock.

Conclusions

The development of nursing interns' sense of professional identity and future time perspective should be enhanced during both the education phase and clinical placement to help nursing interns overcome the experience of transition shock.

Construction and evaluation of a predictive model for compassion fatigue among emergency department nurses: A cross-sectional study

BACKGROUND

Compassion fatigue is a syndrome resulting from long-term work-related traumatic event stress exposure of medical staff. The emergency department is considered to be a high-risk, high-intensity and high-stress work environment, with a high prevalence of trauma and violence. Nurses in the emergency department are more prone to compassion fatigue than nurses in other departments. Compassion fatigue not only affects the physical and mental health, and job satisfaction of emergency department nurses, but also causes serious consequences for patients, such as poor patient outcome, medical errors, and increased patient mortality during hospitalization.

OBJECTIVES

Our study aims to develop and evaluate a predictive model for compassion fatigue among emergency department nurses.

DESIGN

A cross-sectional study.

DATA SOURCES

The emergency department nurses (N = 1014) were recruited from 21 tertiary hospitals (from Chengdu, Chongqing, Guiyang, Guangzhou and Shanghai) in central, southwestern, southern, and eastern China from July 25, 2022 to October 30, 2022.

METHODS

Univariate and multiple logistic regression analyses were used to determine the potential predictive factors associated with compassion fatigue in emergency department nurses. A nomogram was built based on the predictive factors and internally evaluated using a bootstrap resampling method (1000 bootstrap resamples). The performance of the predictive model was evaluated by measuring the Hosmer-Lemeshow goodness of fit test and calibration curve.

RESULTS

The prevalence of compassion fatigue among emergency department nurses was 75.9 %. The multiple logistic regression analysis revealed that the independent predictive factors for compassion fatigue among emergency department nurses were working position, job satisfaction, diet habit, sleep hours per day, occupational stress, physical harassment and the level of workplace violence, all of which were identified to create the nomogram. The Hosmer-Lemeshow goodness of fit test indicated that the predictive model was well calibrated (χ2 = 11.520, P = 0.174). The bootstrap-corrected concordance index of nomogram was 0.821 (95 % CI: 0.791-0.851). The calibration curve of the nomogram showed good consistency between the predicted and actual probabilities.

CONCLUSIONS

A predictive model of compassion fatigue among emergency department nurses has been developed, based on the general demographic, work-related and lifestyle characteristics, occupational stress, and workplace violence, with satisfactory predictive ability. This model can identify emergency department nurses who are at high risk of compassion fatigue. Our study provides an empirical basis for early detection, early diagnosis and early intervention of emergency department nurses at high risk of compassion fatigue.

Influence of the ethical climate on workers' health among healthcare professionals: a systematic review

OBJECTIVE

To evaluate the influence of the ethical climate on workers' health among healthcare professionals.

METHOD

Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis.

RESULTS

Among the 2644 studies, 20 were included for analysis, in which three (15.0%) articles were classified as high quality (score ≥ 80%), while 17 (85.0%) were classified as regular (score 50-79%). There was a moderate negative correlation between the ethical climate and overall moral distress (r=-0.43; 95%CI -0.50; -0.36) and the frequency of moral distress (r=-0.36; 95%CI -0.45; -0.25), as well as the positive and strong correlation between ethical climate and job satisfaction (r=0.71; 95%CI 0.39-0.88).

CONCLUSION

The negative and positive perception of the ethical climate among healthcare professionals, respectively, influenced the increase in moral distress and job satisfaction.

Mediating effects of social support, mental health between stress overload, fatigue and turnover intention among operating theatre nurses

BACKGROUND

The high rate of nurses turnover and nursing staff shortage have been an ongoing concern issue and a challenge for global health systems. To explore the turnover intention among operating theatre nurses, and to test the hypothetical model for estimating the effects of stress overload and fatigue between social support, mental health and turnover intention.

DESIGN

a multi-center and cross-sectional online survey.

METHODS

This study was conducted from October 2020 to March 2021 comprised 1060 operating theatre nurses from 76 Chinese hospitals. The descriptive analysis, independent sample t test and one-way analysis of variance and Spearman correlation analysis were used to explore the relationships among variables by the SPSS software, and stepwise multiple linear regression analysis was utilized to identify influencing factors of turnover intention and its dimensions among operating theatre nurses. A structural equation model was analyzed by the AMOS software.

RESULTS

Social support, mental health, stress overload and fatigue were important predictors of turnover intention among operating theatre nurses. Besides, stress overload positively affected fatigue, mental health and turnover intention; fatigue negatively affected social support, however, fatigue positively affected mental health; social support negatively affected mental health and turnover intention; mental health positively affected turnover intention. Moreover, social support, mental health mediated between stress overload, fatigue and turnover intention among operating theatre nurses.

CONCLUSION

Social support, mental health mediated between stress overload, fatigue and turnover intention among operating theatre nurses.

Fatigue as a Cause of Professional Dissatisfaction Among Chinese Nurses in Intensive Care Unit During COVID-19 Pandemic

Aim

To clarify the mediating role of burnout and the moderating role of turnover intention in the association between fatigue and job satisfaction among Chinese nurses in intensive care units (ICU) during the COVID-19 pandemic.

Methods

A cross-sectional survey of fifteen provinces in China was conducted, using an online questionnaire, from December 2020 to January 2021, during the COVID-19 pandemic. A total of 374 ICU nurses (effective response rate: 71.37%) provided sufficient responses. Sociodemographic factors, job demographic factors, fatigue, burnout, job satisfaction, and turnover intention were assessed using questionnaires. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive modeling (GAM) were performed to examine all the considered research hypotheses.

Results

Fatigue was found to be negatively and significantly associated with job satisfaction. Moreover, burnout played a partial mediating role and turnover intention played a moderating role in the relationship between fatigue and job satisfaction.

Conclusion

Over time, a state of physical and mental exhaustion and work weariness among Chinese ICU nurses potentially results in job burnout and consequently promotes the level of job dissatisfaction. The results also found that turnover intention played a moderating role in the relationship between burnout and job satisfaction. Specific policies could be considered to eliminate nurses' fatigue and negative attitudes during times of public health emergencies.

The impact of organizational justice on psychological distress among Chinese public hospitals nurses: A cross-sectional study

Few studies have explored the association between organizational justice and mental health, particularly in collectivist countries. Hence, the aim of the present study was to evaluate the impact of organizational justice on psychological distress and to discuss the findings in collectivist culture. A cross-sectional survey was conducted among nurses from public hospitals in western of China, July 2022, which followed the STROBE guidelines. This study used Chinese versions of the Organizational Justice Scale and Kesseler Psychological Distress Scale to assess the perceptions of organizational justice and mental health levels, respectively. A total of 663 nurses completed the questionnaires. The psychological distress of university-educated and low-income nurses was poor. There was a moderately positive relationship between organizational justice and psychological distress (R = 0.508, P < .01), indicating that the greater level of organizational injustice, the poorer mental health. Hierarchical regression analysis showed that organizational justice was an strong predictor of psychological distress, accounting for approximately 20.5% of the psychological distress. The findings of this study highlight the importance of interpersonal injustice and distributive injustice on psychological distress specific in Chinese culture, suggesting that nursing management or leaders should notice that the most being taken seriously by nurses is their recognition and respect for subordinate, meanwhile, alerting nurses, in some sense, a negative relationship with leaders as a kind of workplace bullying could harm their mental health. The promulgation of organizational justice policy to protect employees from the government and the real role of employee labor union organizations are urgently needed.

Primary Healthcare Pharmacists' Perceived Organizational Support and Turnover Intention: Do Gender Differences Exist?

Purpose

This study aims to explore the relationship between the four-dimensional structured perceived organizational support (emotional support, instrumental support, supervisor support, and coworker support) and the turnover intention of pharmacists in primary healthcare institutions. The gender differences between perceived organizational support and turnover intention will also be examined.

Methods

A cross-sectional study was conducted in primary healthcare institutions of 31 cities in China from 2 July to 1 September 2021. And the binary logistic regression model was employed for data analysis.

Results

937 valid questionnaires are allocated from pharmacists in primary healthcare institutions. The regression results indicated that emotional support (b=0.073, p<0.001) has a significant influence on pharmacists' turnover intention, and the effect of supervisor support (b=0.173, p=0.046) on pharmacists' turnover intention differs by gender.

Conclusion

These findings offer suggestions for the management and stabilization of pharmacists in primary healthcare institutions. It is suggested that specific measures should be taken to increase pharmacists' perceived organizational support and reduce their turnover intention. At the same time, gender differences need to be taken into consideration by the managers when providing perceived organizational support to reduce their turnover intention through adaptive management.

Stressors, coping strategies and intention to leave the nursing profession: A cross-sectional nationwide study in China

AIMS

This study aims to investigate the association between stressors, coping strategies and intention to leave the nursing profession among nurses.

BACKGROUND

Job stressors and coping strategies are believed to affect turnover intention among nurses, but no large-scale study has been conducted on these associations in China yet.

METHOD

A cross-sectional secondary analysis was conducted among 51,406 nurses from 1858 hospitals. Univariable and multivariable logistic regression analyses were carried out, and odds ratios were reported.

RESULTS

Overall, 49.58% nurses had an intention to leave the profession. It is found that stress from health condition, family, occupational injuries, nurse-patient tension, high job demands, strict leaders and colleague relationships were significantly associated with higher intention to leave. Coping strategies such as talking to family and friends, talking to leaders, doing outdoor activities, engaging in hobbies and attending on-the-job training were significantly associated with lower intention, but social gathering, psychological counselling and suffering in silence had an opposite effect.

CONCLUSIONS

Our study provides new insights into the association between stressors, coping strategies and turnover intention among nurses in China.

IMPLICATIONS FOR NURSING MANAGEMENT

Evidence from this study indicates that policies promoting a safe and supportive work environment should be developed to help nurses cope with stress.

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

Nurses' turnover intention has become a concern for medical institutions because nurses are more needed than ever under the prevalence of COVID-19. This research sought to investigate the effects of the four dimensions of organizational justice on COVID-19 frontline nurses' turnover intention through the mediating role of job engagement. We also tested the extent to which perceived job alternatives could moderate the relationship between job engagement and turnover intention. This descriptive cross-sectional study used an online survey to collect data from 650 frontline nurses working in appointed hospitals in Jiangsu province, China. Hierarchical regression was used to analyze the hypothesized relationships. Findings revealed that all organizational justice components significantly influenced job engagement and turnover intention. Job engagement also significantly affected nurses' turnover intention and mediated the relationships between organizational justice components and turnover intention. Besides, perceived job alternatives moderated the relationships between job engagement and turnover intention. The implications of this study include demonstrating that healthcare authorities should respect human rights through effective organizational justice as this approach could encourage nurses to appreciate their job and be more devoted to staying and achieving their institutional duties, especially under challenging circumstances.

The Status of Occupational Stress and Its Influence on the Health of Medical Staff in Lanzhou, China

This study aimed to understand the status quo of occupational stress and its impact on the health of medical staff and provide a theoretical basis for relieving occupational stress and improving the health status of medical staff. The occupational stress and health status of medical staff in 14 hospitals in Lanzhou were studied using a general questionnaire, Effort-Reward Imbalance questionnaire, and Self-Rated Health Measurement Scale. A total of 2169 participants were included in the analysis, and 59.4% of the medical staff experienced occupational stress. The results of the occupational stress survey showed that the prevalence of occupational stress among medical staff aged 40-50, with a master's degree or above, senior professional title, working for 10-20 years, and working more than 48 h per week was higher than in the other groups. The health survey results showed that, compared with other groups, the scores of physical, mental, and social health were lower in medical staff with working years of 10-20 years and working hours of more than 48 h per week. The results show that working years and working hours per week affect not only the level of occupational stress but also physiological, psychological, and social health.

The Effect of Perceived Organizational Support and Employee Care on Turnover Intention and Work Engagement: A Mediated Moderation Model Using Age in the Post Pandemic Period

The purpose of this study was to adopt the well-established and mature job demands–resources model (JD-R), and to extend its model to work engagement and turnover intention of frontline healthcare personnel. Using the cross-sectional survey and partial least squares path modeling tools, the results showed that perceived organizational support had a negative impact on the turnover intention of frontline healthcare staff. This finding is important because it shows how the medical system managers can buffer the negative impact of a lack of job resources on the work engagement of employees in terms of personal strategies, such as the psychological pressure in coping with a high workload. Compared with employee care, perceived organizational support for the respondents had a positive impact on work engagement, whereas work engagement had a negative impact on turnover intention. This study successfully integrated the literature on job resources, work engagement, and turnover intention to determine the real needs of frontline medical personnel.

Distributive Justice and Turnover Intention Among Medical Staff in Shenzhen, China: The Mediating Effects of Organizational Commitment and Work Engagement

Background

Turnover of medical staff is a vital issue in the global healthcare system. Previous evidence has confirmed the critical effect of distributive justice on turnover intention, but few studies have focused on the mediating mechanism behind this relationship or the medical staff. This study aimed to examine the mediating roles of organizational commitment and work engagement in the relationship between distributive justice and turnover intention of medical staff, and explore potential occupational differences.

Methods

Stratified random sampling was adopted to select qualified medical staff from each clinical department of a large general hospital in Shenzhen, China, at a physician-to-nurse ratio of 1:1.5. The medical staff were surveyed using the Distributive Justice Scale, the Organizational Commitment Scale, the Work Engagement Scale, and the Turnover Intention Scale from May to July 2020. Of the 500 medical staff sampled, 480 responded (response rate: 96.00%), and 457 were finally included for analysis (effective response rate: 95.21%). A mediation analysis was performed using Model 6 of the SPSS macro PROCESS program.

Results

There were significant positive correlations among distributive justice, organizational commitment, and work engagement and significant negative correlations among distributive justice, organizational commitment, work engagement, and turnover intention. Distributive justice directly and negatively affected the turnover intention of physicians and nurses, but there were occupational differences in the underlying mechanism between distributive justice and turnover intention. Distributive justice indirectly affected turnover intention among physicians mainly through the mediating effect of organizational commitment, and indirectly among nurses through three different pathways: the mediating effect of organizational commitment, the mediating effect of work engagement, and the chain mediating effect of organizational commitment and work engagement.

Conclusion

The relationship between distributive justice and turnover intention was found to be mediated by organizational commitment and work engagement among medical staff in Shenzhen, with variations between physicians and nurses. Thus, appropriately targeted interventions are needed for physicians and nurses to reduce turnover intention.