Perceived HRM and turnover intentions of elderly care workers: perspective from person-job fit and institutional ownership

BACKGROUND

Although the phenomenon of high turnover rate in the elderly care industry has existed for a long time, there are few studies that have constructed frameworks to comprehensively analyze the strength of the effects of various factors on the turnover intention of elderly care workers.. This study analyzed the impact of different types of perceived human resource management practices on elderly care workers' turnover intentions and whether this relationship is moderated by person-job fit and ownership of elderly care institutions.

METHODS

This is a cross-sectional and regional survey study. The study included questionnaire survey data from a total of 305 elderly care workers from 42 elderly care institutions in 21 provinces in China during June to September 2021. Descriptive statistics, Pearson correlation coefficient, multiple regression, and heterogeneity analyses were performed.

RESULTS

Perceived work environment ( β =-0.5164, p< 0.01), perceived occupational protection ( β =-0.3390, p< 0.01), perceived welfare benefits ( β = -0.2620, p< 0.01) and perceived competency training ( β = -0.1421, p< 0.1) were all significantly and negatively related to turnover intentions, the quality of perceived work environment has the greatest impact on elderly care workers' turnover intentions. Under the moderating effects of person-job fit and ownership of elderly care institutions, there existed heterogeneity between perceived human resource management and turnover intentions among elderly care workers. High level of person-job fit and elderly care institutions' public feature can effectively weaken the negative impact of each type of perceived human resource management on turnover intention among elderly care workers.

CONCLUSIONS

The managers of elderly care institutions should optimize the management mechanism, typically pay attention to elderly care workers' working environment, formulate and improve the professional standards and job requirements for elderly care workers, promote the public welfare value of nursing care services, and strengthen the sense of honor and responsibility of elderly care workers to reduce the turnover rate.

Assessing the mediating role of organizational justice between the responsible leadership and employee turnover intention in health-care sector

PURPOSE

The aim of this study is to investigate the extent to which organizational justice (OJ) mediates between responsible leadership (RL) and employee turnover intention (TI).

DESIGN/METHODOLOGY/APPROACH

Both online and offline questionnaire was used to collect the data from 387 Indian health-care employees, and the data were analyzed using partial least squares structural equation modeling (PLS-SEM) with the help of SmartPLS 4.

FINDINGS

The study's findings demonstrated a significant positive association between RL and OJ and a negative association between OJ and employee TI. Furthermore, results also confirmed the mediating role of OJ between RI and TI.

RESEARCH LIMITATIONS/IMPLICATIONS

The generalizability of the study's data collection is limited because it is based on the responses of Indian health-care sector employees to an online and offline survey. The authors propose that the health-care sector uses RL as an approach that takes a broad view of the parties with a stake and focuses on creating fairness in acts and justice at the workplace to address the major issue of employee turnover.

ORIGINALITY/VALUE

This study expanded on previous research by demonstrating that the influence of responsible leadership on employee TI is mediated by OJ in the context of India's health-care sector. It also contributes to the literature regarding RI, OJ and TI. The study also enriched the body of knowledge about using the PLS-SEM approach to predict employee TI.

Toxic leadership behaviour of nurse managers and turnover intentions: the mediating role of job satisfaction

INTRODUCTION

Globally, hospitals are confronted with major challenges of turnover of nurses. Knowledge of the factors that account for the turnover of nurses will aid in creating strategies that will enhance nurse managers' leadership behaviour and job satisfaction to reduce turnover. The study, therefore, investigated the mediating role of job satisfaction on toxic leadership and turnover intentions of nurses.

METHODS

A multi-centre cross-sectional study was undertaken to assess 943 nurses using the Toxic-leadership Behaviour of Nurse Managers scale, Minnesota Satisfaction Questionnaire and Turnover Intention scale. Descriptive statistics was used to assess the prevalence of toxic leadership, job satisfaction and turnover and Pearson's correlation examined the relationships between the variables. Hayes' PROCESS macro approach of mediation was used to determine the effect of toxic leadership behaviour on the turnover intention on the possible influence of job satisfaction.

RESULTS

The response rate for the study was 76.0%. Mean scores for turnover intentions and toxic leadership behaviour were 3.71 and 2.42 respectively. Nurses who work with toxic managers showed a higher propensity to leave their jobs. Job satisfaction acted as a mediator between the toxic leadership practices of managers and turnover intentions. The total effect of toxic leadership behaviour on turnover intention comprised its direct effect (β = 0.238, SE = 0.017, 95% CI [0.205, 0.271]) and its indirect effect (β = -0.020, SE = 0.017).

CONCLUSIONS

Job satisfaction acted as a mediating factor for toxic leadership behaviour and nurses' turnover intentions. As part of nurse retention initiatives, avoiding toxic leadership behaviours will be the ultimate agenda. Nurse administrators should recognize the value of excellent leadership and develop a structured training programme through the use of evidence-based professional development plans for nurse managers.

Exploring hospitality workers' career choices in the wake of COVID-19: Insights from a phenomenological inquiry

The COVID-19 pandemic severely hit the hospitality industry and caused employees concerns over health, finance, and well-being. These challenges may trigger their decisions to leave the profession, leading to major talent crises in the industry. Guided by the transactional model of stress and coping and the career construction theory, this study explored how their experiences with the pandemic affected their career choices moving on. A phenomenological approach was adopted, and 31 current and past hospitality employees were interviewed. The findings supported the conceptual model and addressed the connection between stress management and career decisions among the participants. It is also noted that, besides generational differences, most participants' career decisions at this critical moment were influenced by their personality traits, industry involvement, and employer-employee relationships. Thus, to create a sustainable, resilient, and engaged workforce, hospitality practitioners must commit to crafting positive relationships with their employees both in regular and crisis times.

Examining employees' affective and behavioral responses to internal crisis communication in times of COVID-19

Communication is an essential component of crisis management strategies in hospitality and tourism. This study aimed to build on the integrated internal crisis communication framework. This study employed qualitative and quantitative data collection methods. Following a preliminary qualitative study, a conceptual model was developed and tested with a total of 806 responses. The results showed that the approach and content of internal crisis communication messages directly affected employees' evaluations of their organizations' crisis management efforts and their psychological safety, both of which further affected their perceived social resilience and turnover intentions. Furthermore, the results of multigroup analyses revealed the different impacts of internal crisis communication on participants who were in full-time positions vs. part-time positions and salaried employees vs. hourly employees. Finally, theoretical and practical implications were provided based on the research findings.

The effect of hotel employee resilience during COVID-19: The moderation role of perceived risk and challenge stressors

The effect of hotel employee resilience during major crises lacks sufficient empirical investigation. This research aimed to develop a conceptual model of hotel employee resilience effects on turnover intentions and service quality with belief restoration as mediation and challenge stressors and perceived risk as moderation variables. A questionnaire survey was conducted with 28 star-rated hotels (including two 3-star, fifteen 4-star, and eleven 5-star hotels) in southeastern, northeastern, central, and western China against the background of the COVID-19 pandemic, and with operational (e.g., front office, food and beverage, housekeeping) and administrative (e.g., human resource, sales, finance) departments. A total of 1318 valid questionnaires were collected. The results showed that: (1) employee resilience predicted employee service quality positively and turnover intentions negatively; (2) belief restoration partially mediated the impact of employee resilience on service quality and turnover intentions; and (3) perceived risk and challenge stressors had diverse moderation effects (e.g., U-shaped, linear) in the impacts of resilience, and they were important external and internal situational factors that influenced the impact of employee resilience. This research revealed the effects and situational conditions of hotel employee resilience during a major crisis, which provides a theoretical basis for establishing hotel crisis response strategies.

Does workplace toxicity influence turnover intentions among Indian healthcare employees? Investigating the moderating role of gratitude

PURPOSE

The study examined the relationship between workplace toxicity and turnover intentions among Indian healthcare employees. It also explored the role of gratitude as a moderator in the workplace toxicity-turnover intentions relationship.

DESIGN/METHODOLOGY/APPROACH

The study is based on a cross-sectional research design. The sample comprises 315 employees from the Indian healthcare sector. Approximately, 400 employees are approached both through email and office visits. Responses were received from 336 participants, and 21 incomplete questionnaires were discarded. The relationships between four variables of workplace toxicity and turnover intentions are examined using correlation and hierarchical regression. The moderation effect of gratitude is studied using the PROCESS macro in SPSS 21.

FINDINGS

The results revealed that workplace toxicity could explain 45.8% variations in employees' turnover intentions. It also reported significant negative regression coefficients between all four dimensions of workplace toxicity and turnover intentions. It suggested that toxic health organizations may promote turnover intentions among healthcare employees. Also, findings recommended a significant moderating effect of gratitude amid the relationships of four dimensions of workplace toxicity and turnover intentions.

PRACTICAL IMPLICATIONS

Hospital administrators must ensure that health professionals have the necessary support to remain effective in the field by providing a conducive working environment emerging from sound human resource practices that promote respect, collegial relationships, teamwork and collaboration. The present research demonstrates gratitude as one such factor that could act as a catalyst within the workplace. Practitioners could achieve a healthy work environment by developing complementary relief measures that build organizational capacities and improve its culture while sponsoring programs for individual employees that instill positivity through awareness of gratitude in everyday life.

ORIGINALITY/VALUE

This study offered a comprehensive understanding of workplace toxicity by investigating its four dimensions. Also, it is one of the pioneer studies that evaluate the role of gratitude in restricting workplace toxicity-induced turnover intentions.

How are witnessed workplace bullying and bystander roles related to perceived care quality, work engagement, and turnover intentions in the healthcare sector? A longitudinal study

BACKGROUND

Workplace bullying is widespread in the healthcare sector and the negative effects are well known. However, less attention has been paid to bystanders who witness bullying in the workplace. Bystanders can affect the bullying process by engaging in active, passive, or destructive behaviors. There is a need to study work-related and organizational consequences of witnessing bullying and bystander behaviors.

OBJECTIVE

The aim was to explore how witnessed workplace bullying and bystander behaviors are associated with work-related and organizational consequences, such as perceived quality of care, work engagement, and turnover intentions, among healthcare workers over time.

DESIGN

Longitudinal design. An online questionnaire was administered twice over the course of six months.

SETTING(S)

Employees in the healthcare sector in Sweden, such as physicians, nurses, and assistant nurses, responded to the questionnaire.

PARTICIPANTS

1144 participants provided longitudinal data.

METHODS

Structural equation modeling was used to explore the associations between witnessed bullying, bystander behavior, work-related and organizational factors over time.

RESULTS

Witnessed workplace bullying (B = -0.18, 95 % CI [-0.23 to -0.12]) and the bystander outsider role (B = -0.24, 95 % CI [-0.29 to -0.19]) were statistically significantly related to a decrease in perceived quality of care. Work engagement was statistically significantly predicted by all three bystander roles over time; positively by the defender role (B = 0.11, 95 % CI [0.05-0.17]), and negatively by the outsider role (B = -0.23, 95 % CI [-0.29 to -0.16]), and the assistant role (B = -0.32, 95 % CI [-0.41 to -0.24]). The outsider role (B = 0.12, 95 % CI [0.02-0.22]), the assistant role (B = 0.17, 95 % CI [0.03-0.30]), and witnessed workplace bullying (B = 0.18, 95 % CI [0.08-0.29]), all positively predicted increased turnover intentions at a subsequent time point.

CONCLUSIONS

In addition to the direct negative impact workplace bullying has on those targeted by it, witnessing bullying and taking different bystander roles can have work-related and organizational consequences by influencing perceived care quality, employees' work engagement, and their intention to leave the organization.

Mediating effect of job performance between emotional intelligence and turnover intentions among hospital nurses during the COVID-19 pandemic: a path analysis

Background

Nursing shortages are a persistent and concerning problem for the nursing workforce worldwide. However, the COVID-19 pandemic has brought additional stressors and workloads and has worsened nursing shortages.

Aim

To investigate interrelationships among emotional intelligence, job performance, and turnover intentions of nurses during the coronavirus disease 2019 (COVID-19) pandemic, and explore the mediating effect of job performance between emotional intelligence and turnover intentions.

Methods

A cross-sectional survey was conducted. In total, 673 nurses working in a medical centre hospital in northern Taiwan were recruited from November 2020 to April 2021. An anonymous questionnaire was used in this survey. Data were collected using a seven-item turnover intention scale, a 16-item emotional intelligence scale, a 24-item job performance scale, and demographic questions. A path analysis was performed. This study was based on STROBE guidelines.

Findings

Statistically significant correlations between turnover intentions and emotional intelligence (r = −0.10, p = 0.012), between turnover intentions and job performance (r = −0.13, p = 0.002), and between emotional intelligence and job performance (r = 0.54, p < 0.001) were detected. Model fit indices were adequate. Job performance had a significant indirect effect between emotional intelligence and turnover intentions (β = −0.16, p = 0.011).

Discussion

It was found that job performance was a mediator between emotional intelligence and turnover intentions during the pandemic. The study results support the need to continue to create healthy work environments.

Conclusion

These results can assist hospitals in developing specific evidence-based interventions such as showing appreciation and providing acknowledgments to reduce turnover of their nurses during the COVID-19 pandemic.

Burnout across boundaries: Can parental burnout directly or indirectly influence work outcomes?

Burnout, while historically considered a work-related condition, can be associated with parenting where it can have direct impacts upon parental outcomes and one's personal resources such as mental health. However, little is known about the domain-incongruent effects of burnout and thus whether parental burnout can manifest within the workplace. The current study uses longitudinal data collected from 499 parents over three intervals across an 8-month period to explore two possible mechanisms. Firstly, a direct relationship is explored by considering whether parental burnout provides incremental validity above job burnout in the prediction of three work outcomes: job satisfaction, turnover intentions, and counterproductive work behaviors. Secondly, it is explored whether depression mediates the relationship between parental burnout and work outcomes. Findings suggest parental burnout may have limited impacts upon work outcomes, providing the impetus for a new direction of research to better understand whether or how burnout in one domain of life can influence the outcomes in other life domains.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-02687-3.

Workplace bullying and turnover intentions of nurses: the multi-theoretic perspective of underlying mechanisms in higher-order moderated-serial-mediation model

PURPOSE

This study examines the relationship between workplace bullying (WPB) and the turnover intentions (TIs) of nurses, both directly and indirectly, i.e. through serial mediation of psychological contract violation (PCV) and poor employee wellbeing (EWB). And that with the moderating effect of servant leadership (SL) on its final path to TIs of nurses.

DESIGN/METHODOLOGY/APPROACH

A total of 285 nurses voluntarily participated in the survey through convenient sampling from 13 different district hospitals. The authors performed partial least squares structural equation modeling (PLS-SEM) to test the study's measurement and structural models.

FINDINGS

Overall, results indicated 62% prevalence rate of WPB and TIs of nurses had 67% variance explained by the exogenous factors. Workplace bullying was found to have direct as well as indirect relationship with TIs of nurses. For the latter, PCV and poor EWB were found to have partially mediated, both singly and serially. The moderating effect of SL on the serial mediation pathway was negative and significant.

ORIGINALITY/VALUE

Drawing on a tripartite theoretical perspective, this study illuminates the mechanism underlying WPB-TIs relationship with an advanced multivariate statistical technique in the nursing work setting in a developing country.

Impact of the COVID-19 pandemic on management-level hotel employees' work behaviors: Moderating effects of working-from-home

This study examines the effects of working-from-home during the COVID-19 pandemic on management-level hotel employees' work engagement, burnout, and turnover intentions. The study demonstrates that working-from-home tends to be a double-edged blade that leads to both positive and negative employee behavioral outcomes. Findings reveal that while working-from-home is associated with a higher level of vigor, it magnifies the effects of absorption on burnout. In addition, due to work-home interference, working-from-home suppresses the positive effect of dedication and amplifies the negative effect of burnout on turnover intentions. The theoretical contributions and managerial recommendations are provided.

The role of supervisor support and basic psychological needs in predicting work engagement, burnout and turnover intentions in a medical contract research service setting

BACKGROUND

The pharmaceutical industry is forced to contain costs by outsourcing drug testing to commercial contract research organizations (CROs). This ensures the performance of clinical trials by experienced employees who must competently and skillfully exercise due care and diligence. Skilled talent for demanding CRO's is scarce, expensive and hard to retain. Evidence from empirical examinations in the CRO industry will be valuable for decision-makers. The lack of employee engagement and the neglect of employee well-being has financially harmful implications for industries with high job demands.

OBJECTIVE(S)

This study investigated the relationship between supervisor support, the satisfaction of self-determination needs and engagement at work, emotional exhaustion and intention to leave in a CRO.

METHODS

A quantitative, cross-sectional approach was employed. Participants comprised a convenience sample of 260 CRO-employed males and females 18 years and older with different education and tenure levels. Structural equation modelling (SEM) was used to test the validity of a specified model. Raykov's reliability was utilized to evaluate internal consistency, and data were summarized descriptively. Coefficients of correlation and Cohen's d effect size were computed to assess relationships. The SEM model tested direct and indirect effects.

RESULTS

The validated and reliable model found an improvement in supervisor support and satisfaction of self-determination needs would predict work engagement, reduced emotional exhaustion and intentions to leave amongst the CRO sample. Results also show that work engagement would affect emotional exhaustion and turnover intentions via satisfaction of self-determined needs.

CONCLUSIONS

The study highlights the importance of the relationship between supervisor support, satisfaction of self-determination needs, employee engagement and well-being in a demanding organization. Although supervisor support is associated with improved work engagement and employee well-being, the improvement of satisfaction of self-determination needs should not be neglected in organizations with high job demands where talent retention is critical.

Will we have the same employees in hospitality after all? The impact of COVID-19 on employees' work attitudes and turnover intentions

A crisis caused by COVID-19 pandemic affected the whole world leaving long-lasting effects on almost every aspect of human lives. The aim of this study was to test how different effects of COVID-19, expressed through job insecurity, employees' health complaints occurred during isolation, risk-taking behavior at workplace and changes in the organization, may impact work-related attitudes (job motivation and job satisfaction) and turnover intentions of the employees in hospitality industry. Based on the data collected from 624 hospitality workers from Serbia, the results indicated that job insecurity and changes in the organization were predictors of all outcomes, in a negative direction, while risk-taking behavior acted as a predictor of job satisfaction only, also in a negative direction. The significance of demographic characteristics, as control variables, showed that age and marital status had significant impact on job motivation and turnover intentions. The theoretical and practical implications were discussed.

Is career adaptability a double-edged sword? The impact of work social support and career adaptability on turnover intentions during the COVID-19 pandemic

During the COVID-19 pandemic, many hospitality organizations are trying to help their employees overcome various challenges. Career adaptability has proven to be useful in helping employees handle challenges, while proactive personality is a critical factor affecting the formation of career adaptability. However, career adaptability can be a double-edged sword, and it is unclear how it may impact employees' turnover intentions. Drawing on social exchange theory, the current study reconciles mixed findings in the literature by proposing a moderated mediation model suggesting that work social support moderates the indirect relationship between proactive personality and turnover intentions through career adaptability. Results based on data collected from 339 hotel employees in the United States indicate that proactive personality is positively associated with employees' career adaptability. More importantly, work social support significantly moderates the relationship between career adaptability and turnover intentions. Theoretical and managerial implications are discussed.

Final clinical practicum, transition experience and turnover intentions among newly graduated nurses: A cross sectional study

BACKGROUND

The shortage of nurses is a global issue, and turnover rates are especially high for newly graduated nurses. The transition from student to nurse is often described as challenging, and the final clinical practicum before graduation is suggested to be important in preparing graduating students for the transition. However, little is known about the actual relationships between the final clinical practicum, transition and turnover intentions.

OBJECTIVES

To examine whether the final clinical practicum experience is associated with the transition experience and turnover intentions of newly graduated nurses, and whether the transition experience mediates the potential relationship between the practicum and turnover intentions.

DESIGN

Cross-sectional survey study.

SETTINGS

The study was carried out in Finland (October-December 2018).

PARTICIPANTS

Registered nurses graduated within the past two years (n = 712).

METHODS

A new survey instrument with five subscales was developed for measuring the final clinical practicum experience. Transition experience was measured on four scales that demonstrated the emotional, physical, socio-developmental and intellectual domains of the transition: Psychological distress, sleep quality, role conflict/ambiguity, perception of transition and educational preparation. Turnover intentions from job and profession were asked about with two questions. Structural equation modelling was used to explore the associations between the variables. The models were adjusted for multiple potential confounders.

RESULTS

Final clinical practicum experience was associated with all domains of the transition experience and turnover intentions. The association between the practicum and turnover intentions was partly mediated by the emotional (psychological distress) and socio-developmental (role conflict and ambiguity) domains of the transition.

CONCLUSIONS

Our findings provide new evidence about the associations between the specific final clinical practicum dimensions and turnover intentions and the specific mechanisms linking this association. These results highlight the importance of final clinical practicums and suggest targets for improving nurses' transition processes during their first years in practice.

The role of organizational attractiveness in an internal market-oriented culture (IMOC): a study of hospital frontline employees

Background

Hospitals need to understand how to reduce their frontline employees’ turnover rate as well as how to positively engage them and improve their service. Central to these issues, we find, is the employees’ perception of their organization’s attractiveness. This objective of this paper is to clarify how the role of organizational attractiveness relates to frontline employees’ perception of their internal market-oriented culture as well as their turnover rate, engagement, and service quality. To our knowledge, no previous research has explored the role of organizational attractiveness from a frontline employee perspective in health-service organizations.

Methods

The conceptual framework we developed was tested in a quantitative study. We sent a questionnaire to nurses in several public hospitals in Norway. We then analyzed the data with confirmatory factor analysis and structural equation modeling in Stata. Further, we performed multi-group comparisons to test heterogeneity in personal characteristics. The indirect effects were tested by mediator analyses.

Results

We made three main findings. First, organizational attractiveness has a significant positive effect on frontline employees’ engagement (β = 0.833) as well as on the service quality they provide to hospital patients (β = 0.472). Additionally, it significantly lowers their turnover rate (β = − 0.729). Second, the ‘internal market-oriented culture’ (IMOC) has a significantly positive effect on organizational attractiveness (β = 0.587) and explains a total of 35% of the variance in organizational attractiveness. Third, organizational attractiveness fully mediates the relationship between “internal market-oriented culture” (IMOC) and frontline employees’ engagement and the service quality they provide to patients, and it partially mediates the relationship with the turnover rate.

Conclusions

This study proves that organizational attractiveness is vital for hospital managers to focus on, as it affects employees’ perception of whether the organizations is a great place to work. It reveals the need for those same managers to develop an internal market-oriented culture (IMOC) directed toward hospital frontline employees, as it has both a direct effect on organizational attractiveness and an indirect effect on employees’ engagement, turnover intention, and service quality.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4144-8) contains supplementary material, which is available to authorized users.

'We are planning to leave, all of us'-a realist study of mechanisms explaining healthcare employee turnover in rural Ethiopia

BACKGROUND

We study healthcare employees' turnover intentions in the Afar National Regional State of Ethiopia. This rural region is experiencing the globally felt crisis in human resources, which is inhibiting its ability to meet health-related sustainable development goals.

METHODS

Realist case study which combines literature study and qualitative analysis of interview and focus group discussion data, following a realist case study protocol.

RESULTS

A large majority of employees has turnover intentions. Building on Herzberg's two-factor theory, person-environment fit theory, as well as recent sub-Saharan evidence, analysis of the collected data yields four turnover mechanisms: (1) lack of social and personal opportunities in the region, (2) dissonance between management logic and professional logic, (3) standards of service operations are hard to accept, and (4) lack of financial improvement opportunities.

CONCLUSIONS

While the first and fourth mechanisms may be out of reach for local (human resource) management interventions, the second and third mechanisms proposed to explain health workforce turnover appear to be amenable to local (human resource) management interventions to strengthen healthcare. These mechanisms are likely to play a role in other remote sub-Saharan regions as well.

Predictors of occupational stress and well-being in First-Line Nurse Managers: A cross-sectional survey study

BACKGROUND

First-line nurse managers have a pivotal role in the organization of health care but have to deal with significant job-related issues and problems in a changing and challenging health care environment. As their new roles are complex and often unclear, it might be expected that these professionals are at risk for occupational stress.

OBJECTIVES

The objective of this study is to analyze and describe relationships between job characteristics, and also interdisciplinary conflicts with physicians as potential predictors of occupational well-being (job satisfaction, psychosomatic distress, turnover intention, work engagement and burnout).

DESIGN

this study had a cross-sectional design and used a web-based survey.

METHODS

This study was conducted in 2015 in 11 Belgian (Flemish) hospitals. All First-line nurse managers were eligible (N=481) and 318 respondents (66.1%) agreed to take part in the survey. A hierarchical regression analyses was applied to analyze relationships between predictors and outcomes.

RESULTS

job demand and job control measures were predictive of all outcomes. Collaboration with doctors only predicted job satisfaction and turnover intention. Social support from management was predictive of turnover intention. Social support from colleague- first-line nurse managers was not predictive. Social support from the staff members (team) was however a strong predictor of all stress outcomes.

CONCLUSIONS

Job demands, job control and social support of the team and management were all important predictors of occupational well-being in first-line nurse managers. All of these variables can be influenced by hospital management to improve the work conditions of this professional group in order to retain their workforce.

Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study

Background

High levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses’ psychosocial work environment is necessary to respond to complex patients’ needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses’ and nurse managers’ perceptions and experiences of staff nurses’ workload; (3) To explain and interpret the two models by using the qualitative study findings.

Method

This mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models.

Results

The two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness, quality and patient safety. Respondents’ statements corresponded closely to the models’ associations.

Conclusion

A deep understanding of various associations and impacts on studied outcome variables such as risk factors and protective factors was gained through the retested models and the interviews with the study participants. Besides the softer work characteristics — such as decision latitude, social capital and team cohesion — more insight and knowledge of the hard work characteristic workload is essential.