Turnover Rates and Factors Associated With Turnover: A Longitudinal Analysis of the Retention Period of Clinical Nurses in Korea Using National Data

Many countries, including Korea, are struggling with a nursing workforce shortage. This study aimed to identify the actual turnover rate of Korean clinical nurses and the factors affecting the turnover rate, considering the time required for nurses to gain experience at their current medical institution. This longitudinal study followed up on a cohort consisting of all 107,682 nurses from January 1, 2017 to July 30, 2020. Differences in the distribution of retention and turnover according to the medical institutions' and nurses' characteristics were analyzed using the chi-square test. The hazard ratios (HRs) for turnover in each analysis interval were analyzed using multilevel Cox proportional-hazards analysis. The mean turnover rate was 10.0% within 1 year and 33.4% within 3.5 years. Several organizational characteristics (the type and ownership of the hospital, its location, and the bed-to-nurse ratio) and individual characteristics (gender, age, and clinical experience) were found to be associated with turnover risk. Among these factors, compared to hospitals with a bed-to-nurse ratio in general wards of 6.0 or more, those with a ratio of 3.5-3.9 had an HR for 1-year turnover of 0.81 (95% confidence interval [CI]  =  0.67-0.98), and those with a ratio of 2.5-2.9 had an HR for 3.5-year turnover of 0.77 (95% CI  =  0.66-0.90). The bed-to-nurse ratio is a condition that can be modified through collaboration between government policy-makers and medical institutions. To reduce nurse turnover and retain experienced nurses, appropriate staffing should be implemented.

Implementation of a technician success and onboarding coordinator to reduce technician turnover

PURPOSE

This article provides an overview of changes implemented at an academic medical center to reduce pharmacy technician turnover.

SUMMARY

Pharmacy technician turnover has been a problem for years. Technicians come and go; they move on to other positions, and continuous turnover is an avoidable expense. With greater focus on creating a successful onboarding experience for newly hired technicians, turnover should decrease and satisfaction and engagement should increase. When a newly hired technician leaves a department within the first year, it can have a negative impact on the engagement of the remaining technicians who spent time training new hires in how to complete tasks, mentoring them, and incorporating them into the team. Creating a positive onboarding experience will decrease expenses accrued and minimize wasted resources and staff time dedicated to a technician who will not be around in 6 months to 1 year. At M Health Fairview, a Minneapolis, MN-based health system, technician retention has been improved through a standardized approach to onboarding and orientation, including creation of the new staff role of technician success and onboarding coordinator (TSOC).

CONCLUSION

A standard approach to onboarding pharmacy technicians and integrating them into the pharmacy department has proven to be essential to technician retention at M Health Fairview. To get started, it is important to find the right person for the TSOC role to coordinate successful onboarding of newly hired pharmacy technicians. That person should be an individual with passion to engage and inspire newly hired technicians, with several years of experience, and with the ability to cascade knowledge.

Associations between paramedics' salutogenic health experience and the intention to stay in the profession: A cross-sectional survey

AIM

To investigate the association between paramedics' salutogenic health and their intentions to stay in their profession.

DESIGN

A cross-sectional survey.

METHODS

Paramedics from eight purposively selected organizations participated in this study (n = 433). The data were collected in 2022 with the Salutogenic Health Indicator Scale and validated single questions that assessed work ability, recovery and self-rated stress. Intention to stay was measured using two questions about the intention to leave prehospital emergency medical service work and leave the nursing sector completely during the next 2 years. Data were analysed using logistic regression and statistical significance tests.

RESULTS

Men had higher mean salutogenic health scores than women. No significant differences in salutogenic health were observed across work experience or occupational groups. Paramedics intending to stay in their profession exhibited higher salutogenic health scores than those intending to leave. In the logistic regression models, increasing levels of salutogenic health and work ability were associated with intention to stay in the profession.

A prospective cohort study of presenteeism and increased risk of unemployment among Japanese workers during the COVID-19 pandemic

OBJECTIVES

Presenteeism adversely affects workers' quality of life, leading to further deterioration of their health and affecting their ability to continue working. Unemployment is one of the most serious consequences for workers experiencing presenteeism. A worker's ability to work depends on the degree of mismatch between their health status and job demands and work factors. The COVID-19 pandemic has affected workers' experiences of presenteeism as well as their employment status. We examined the association between presenteeism and risk of job resignations and unemployment among Japanese workers during the COVID-19 pandemic.

METHODS

A prospective study of 27 036 internet monitors was conducted, starting in December 2020, with 18 560 (68.7%) participating in the follow-up by December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment.

RESULTS

The group with the highest WFun scores had higher odds ratios (ORs) for both retirement and unemployment for health reasons than the group with the lowest WFun scores. ORs were 2.99 (95% CI, 2.48-3.62; P < .001) and 1.82 (95% CI, 1.65-2.00; P < .001), respectively.

CONCLUSIONS

Workers with work functioning impairment are at increased risk of resignation or unemployment. Management strategies for workers with work functioning impairment are needed to reduce their disadvantages in employment.

The Role of Continuing Professional Training or Development in Maintaining Current Employment: A Systematic Review

The impact of continuing job education and professional development on early exit from the labor market is unclear. This systematic review examined how continuing job education or professional development influences the retention of current employment. We searched the PubMed and Embase databases from their start dates to January 2023. Two reviewers screened the full texts of relevant reports and assessed the methodological quality of the included studies using the adapted Effective Public Health Practice Project quality assessment. We qualitatively synthesized the results of the included studies. We screened 7338 publications and included 27 studies consisting of four cohort and 23 cross-sectional studies in the review. The participants of the selected studies were mostly from the health sector (24 studies). There were 19 studies on staying or leaving a current job, six on employee turnover intention, two on job change, one on return to work, one on early retirement, and one on employment. Continuing employee development or training opportunities were associated with increased intention to stay in a current job, decreased intention to leave a current job, decreased employee turnover intention, job change, or early retirement and with faster return to work. One of the two studies that examined the role of age showed that continuing employee development is a more important factor for retaining current employment among younger than older employees. A few studies found that job satisfaction and commitment fully mediated the relationship between employee development and employee intention to leave current employment. This study suggests that participating in professional training/development is related to a lower risk of leaving current employment.

Determinants of Job Satisfaction among Nurses from Chilean Hospitals

Objective

To measure, at the national scope, the satisfaction of Chilean nurses working in hospitals, and establish personal and institutional determinants associated with satisfaction.

Methods

Cross-sectional multicenter study, carried out in 40 public and private high-complexity hospitals in Chile. A self-administered survey was conducted with 1,632 clinical nurses from medical-surgical units. The variables of interest studied were: job satisfaction, personal determinants (sex, age, and postgraduate training), institutional organizational determinants (assignments and work environment, measured through the Practice Environment Scale of the Nursing Work Index), and institutional structural determinants. Data analysis applied hierarchical logistic regression models, with three blocks of determinants, following nested models design.

Results

The study showed that 21% of the nurses is very satisfied with their job. Training opportunities and professional growth are specific work aspects with which there is a lower percentage of nurses satisfied (10% and 11.2%, respectively). Among the personal factors, male sex and age are associated positively with satisfaction (p<0.05). Among the institutional organizational factors, a good work environment was associated with greater satisfaction (p<0.001); the number of patients per nurse was associated marginally with satisfaction (p<0.05). The structural factors of hospitals were not associated with satisfaction.

Conclusion

A low proportion of nurses working in the high-complexity hospitals studied are satisfied with their job. Planning of strategies must be prioritized, leading to improving the retention of nurses, reducing the number of patients per nurse, and promoting good work environments in hospitals.

An Exploratory Study of Psychological Distress, Professional Quality of Life, Effort-Reward Imbalance, and Turnover Intention of Hospital Nurses during the COVID-19 Pandemic

This exploratory study aimed to identify factors that may influence nurses' turnover intentions during the COVID-19 pandemic. The data were collected during January 2023 from 250 nurses and analyzed using descriptive statistics, t-test, ANOVA, Scheffe, Pearson's correlation, and multiple regression analysis. Among the sociodemographic and clinical characteristics, nursing care and working with personal protective equipment significantly impacted the turnover intention. Among the independent variables, compassion satisfaction, burnout, effort-reward ratio, and psychological distress were significant, with an explanatory power of 43.3%. Among the subjects, 86.4% (216 people) showed a moderate or high burnout level because of the COVID-19 pandemic, and burnout seemed to have a significant impact on turnover intention. Therefore, to lower the turnover intention of nurses, burnout should be prevented, and managers should create an environment where nurses can receive a balanced reward for their efforts.

Retention of newly graduated registered nurses in the hospital setting: A systematic review

BACKGROUND

There is a gap in the literature on identifying and describing effective interventions for the retention of newly graduated registered nurses in hospital settings. To the best of our knowledge, no systematic review has been conducted on this issue.

AIM

To identify effective interventions that promote the retention of newly graduated registered nurses in the hospital setting and their components.

DESIGN

A systematic review was conducted according to PRISMA 2020 Statement.

METHODS

Information derived from the PubMed, CINAHL, Scopus, PsycINFO and Cochrane Library databases was reviewed, for the period January 2012-October 2022. Screening, data extraction and quality appraisal were conducted independently by two reviewers. The Joanna Briggs Institute Critical Appraisal tools were used for descriptive, quasi-experimental and cohort studies. Disagreements between the two reviewers were resolved through discussion.

RESULTS

Following the critical appraisal, nine studies were included. The evidence reveals the heterogeneity of programmes developed in the hospital context to promote the retention of newly graduated registered nurses, clarifies the three competencies to be addressed (core, cross-cutting and specific), their components (programme development framework, duration, content and support components), and shows significant improvements after their implementation.

CONCLUSIONS

This systematic review identifies that either nurse residency or individualised mentoring programmes, lasting 1 year, and multi-component, addressing core and specific competencies and including preceptor or mentor components seem to be the most comprehensive and effective in promoting the retention of new nurses in the hospital setting.

RELEVANCE TO CLINICAL PRACTICE

The knowledge provided by this review will contribute to developing and implementing more effective and context-specific strategies directed at retaining newly graduated registered nurses and subsequently enhancing patient safety and healthcare costs.

NO PATIENT OR PUBLIC CONTRIBUTION

Given the study design and focus.

Retaining Healthcare Workers: A Systematic Review of Strategies for Sustaining Power in the Workplace

The shortage of healthcare workers is a growing concern. The COVID-19 pandemic and retirement wave have accelerated turnover rates. This systematic review aimed to identify and analyse the existing interventions for job retention of healthcare workers, in terms of nurses and physicians, in a hospital setting. A comprehensive search was conducted within three electronic databases, guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) and synthesis without meta-analysis (SWiM) guidelines, this resulted in 55 records that met the inclusion criteria. The intervention outcomes are categorized into substantial themes: onboarding, transition program to a different unit, stress coping, social support, extra staffing, coping with the demands of patient care, work relationships, development opportunities and department resources, job environment, work organization, recruitment approach, and technological innovations. Considering the literature, onboarding programs and mentoring for nurses and physicians are recommended. Additionally, other interventions described in this review could positively affect the retention of nurses and physicians. When selecting an intervention for implementation, managers and human resources should consider the intervention that matches the determinant of intention to leave of their healthcare workers and the hospital's mission, vision, and values. Sharing the success stories of implemented interventions may benefit healthcare organizations.

Effects of Nursing Work Environment, Need Satisfaction, and Depression on Turnover Intention in Korea

This study examined the effects of the nursing work environment, need satisfaction, and depression on turnover intention in South Korean nurses through a mediating model. This study was a descriptive cross-sectional research study and was conducted through an online questionnaire. A total of 248 nurses were recruited for this study. Data were collected in August 2022. Participants were invited to complete self-reported questionnaires that measure nursing work environment, need satisfaction, depression, turnover intention, and demographic information. The data obtained were analyzed using the dual mediation model applying the PROCESS macro (Model 6). This study analyzed the direct effects of the nursing work environment on need satisfaction, depression, and turnover intention. The nursing work environment also had indirect effects on their turnover intention via need satisfaction and depression. The mediating effect of need satisfaction, which affects the turnover intention by increasing the satisfaction of the nursing work environment, was found to be the greatest. It has been shown that the more positive a nurse's experience of the nursing work environment, the higher the nurse's need satisfaction. According to the study results, the increase in nurses' need satisfaction greatly contributes to the decrease in depression and turnover intention. Therefore, active efforts should be made to improve the nursing work environment to fulfill basic needs.

Retaining employment in the hospital setting: A descriptive phenomenological study of Indonesian nurses' experiences

Background

Losing competent nurses due to turnover can have adverse effects on healthcare administration, service delivery, and organizational dynamics. Frequent staff turnover can hinder optimal nursing practices, but some nurses remain committed. Therefore, understanding factors that foster sustained engagement and retention is crucial to create a retention strategy.

Objective

This study aimed to explore the current experience of Indonesian nurses who retain their jobs in the hospital setting.

Methods

A phenomenological design was employed in this study, with ten nurses selected using purposive sampling. Semi-structured interviews were used to gather data from a private hospital in Batam, Indonesia, between January and March 2022. A conventional content analysis was used to analyze the data.

Results

The participants had an average total work experience of 10.4 years and an average age of 35.6 years, ranging from 28 to 44 years. The majority of the participants were females, held bachelor's degrees, and were married. Three main themes were developed in this study: solid teamwork, adequate compensation, and professional career development.

Conclusion

Retaining experienced nurses in hospitals is influenced by antecedents such as teamwork, pay, and career growth. These findings offer nursing and hospital managers insights into developing policies and strategies to improve hospital nursing retention programs in Indonesia and beyond.

High-Risk Symptom Cluster Groups for Work-Life Quality and Turnover Intention among Nurses

This cross-sectional study aims to identify high-risk symptom cluster groups for assessing the quality of nursing work life (QNWL) and turnover intention among Korean nurses who have experienced workplace violence. Nurses were recruited for an online survey in May 2021 (n = 203). The following four symptom clusters are extracted: (a) depression-anxiety, (b) shame-somatization, (c) nightmare-loss of appetite, and (d) anger-shock. Three symptom cluster groups were identified. Group 1 had the highest score for the anger-shock symptom cluster, as well as the highest symptom scores and turnover intention. Group 2 had the highest score for the nightmare-loss of appetite symptom cluster and the lowest QNWL. Group 3 had a similar symptom cluster pattern to Group 1 but lower scores for all symptom clusters. Symptom monitoring and programs tailored to symptom cluster groups at the institutional level could be useful for managing QNWL and turnover intention.

Turnover Intention and Organizational Commitment of Primary Healthcare Nurses

Turnover intention is a predictor of the decision to leave an organization, which, if carried out, affects the quality of care provided. There is an association between turnover intention and organizational commitment. The more committed nurses are to the unit in which they work, the more committed they become to the unit's organizational goals; thus, they tend to continue working for the organization. Aiming to assess the turnover intention and the organizational commitment of nurses in primary healthcare, we conducted a quantitative, observational, descriptive, and cross-sectional study. The Intention of Turnover Scale and the Organizational Commitment Scale were applied in a sample of 297 nurses. Data were analyzed based on descriptive statistics. About 92.8% of the nurses intend to stay at their current workplace and only 7.3% plan to leave soon, suggesting low turnover intention; 84.5% of the nurses are willing to make an effort beyond what is normal to help their organization succeed, and 88.7% feel really interested in the destiny of the organization, which shows high organizational commitment. Pearson's Coefficient revealed the existence of a significant negative correlation between the factors "Intention to leave" and "Committed to the organization" (r = -0.51, p < 0.01). These findings suggest that, when nurses are more committed to their work and to the organization, they display less intention to leave, keeping the teams committed and motivated towards the organizational goals Our findings may guide nurse managers and policy-makers to develop strategies that retain nurses in organizations, keeping them motivated and engaged, and focusing on higher organizational commitment due to the influence it may have on the turnover intention.

COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave

General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.

Recent Paramedic Graduates' Chronic Stress Adds Intentions to Leave the Profession: A Pilot Study Utilizing a Web-Based Survey

Paramedics have mentally and physically demanding jobs, and chronic stress is not uncommon. Recently graduated paramedics, in particular, have been identified as needing support in their early careers. This pilot study examined chronic stress experienced by recent graduate paramedics and their intentions to leave the paramedic profession. Finnish paramedics encompass qualifications to work in various nursing sectors. This pilot study was a cross-sectional survey study among Finnish paramedics who graduated less than 3 years ago and who were currently working in prehospital EMS (n = 152). They evaluated chronic organizational and operational stressors on the Emergency Medical Services Chronic Stress Questionnaire with 20 statements. Two structured questions related to the intention to leave the paramedic profession. Three summary scales were formed. The differences in stress by the intention to leave were reported descriptively and the differences were tested with Mann-Whitney U test. The influence of potential predictors of the intention to leave prehospital EMS work or the nursing sector completely were explored with a forward stepwise logistic regression model. Those who intended to leave prehospital EMS work (25%, n = 35/152) or to leave the nursing sector completely (33%, n = 50/152) experienced higher levels of stress than those without such intentions. Stress related to organizational inequity and leadership challenges was the strongest and stress related to social, health, and personal impacts was the second strongest predictor of the intention to leave. Reducing chronic stress might be important in terms of paramedic retention. Several further study needs are addressed.

Correlation of the job turnover intention of Iranian nurses with job satisfaction and burnout in the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has led to numerous psychological consequences and a drastic increase in the workload of nurses. The present study aimed to investigate the correlation of the job turnover intention of Iranian nurses with job satisfaction and burnout in the COVID-19 pandemic.

MATERIALS AND METHODS

This cross-sectional descriptive study was conducted on 300 nurses working in the hospitals in Sabzevar, Iran from October 2020 to January 2021. Data were collected using the questionnaires of turnover intention, Spector job satisfaction, and Maslach burnout in a self-report manner. Correlation analysis was used. Then, for assessing a predictive model used a simple linear regression and multiple linear regression analyses. Data analysis was performed using SPSS version 24.

RESULTS

The results showed that the variables of burnout and job satisfaction are effective on nurses' willingness to job turnover. Furthermore, among the background variable, the findings showed that the economic status of nurses and the male gender of patients under their care can be effective on nurses "job turnover intention and can be used as predictor variables of nurses" job turnover intention.

CONCLUSION

According to the results, special attention must be paid to the job satisfaction, burnout, and the economic situation (as a mediator variable) of nurses to prevent their job turnover in the COVID-19 pandemic. Therefore, it is recommended that health managers prevent the job turnover intention of nurses in the COVID-19 pandemic by taking psycho-socio-economic support measures.

Does Empowerment Enhance Nurses' Organizational Commitment?

AIM

We examined whether psychological empowerment was significantly associated with the organizational commitment of licensed practical nurses.

BACKGROUND

Health-care organizations face unprecedented staffing challenges. This study provides insight into potential ways to ameliorate these issues.

METHODS

In early 2010, we distributed a 45-item questionnaire, based on established measures of psychological empowerment and organizational commitment, to the entire population of active, full-time licensed practical nurses throughout a Midwestern U.S. state. Our sample consisted of 1165 respondents.

RESULTS

The results of our data analysis suggest that even after controlling for a range of potentially confounding variables, three subscales (meaning, self-determination, and impact) were positively and associated with organizational commitment. However, one subscale (competence), was negatively related to the outcome.

CONCLUSIONS

The psychological empowerment dimensions of impact, meaning, and self-determination are associated with increased organizational commitment among licensed practical nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Considering the profound staffing challenges facing the nursing profession-exacerbated by the current global pandemic and retirements-our findings provide nurse administrators with critical information to use in stemming the wave of nurses leaving the profession.

Job change among early career nurses and related factors: A postgraduation 4-year follow-up study

AIMS

This study aimed to identify the job change status and related factors among nurses during the first 4 years of their professional life.

BACKGROUND

The early turnover and job change of nurses results in negative patient and nurse outcomes and financial losses.

METHODS

A prospective longitudinal observational design and convenience sampling were used. From five nursing schools in South Korea, 526 individuals participated in the first survey conducted before graduation; 317 and 338 individuals participated in the second and third surveys, respectively (4 months after employment, and 4 years after graduation).

RESULTS

In total, 42.0% of the participants remained at the hospital of their first job, 26.6% switched hospitals, and 12.1% moved to a nonhospital job. Multinomial logistic regression analyses showed that switching hospitals was associated with nurses' grade point average, type of hospital, first job satisfaction, and current pay. Moving to a nonhospital job was related to gender, type of hospital, current pay, and work-life balance.

CONCLUSION

To reduce the early turnover and job change, hospitals should provide educational programmes for nurses, support male nurses, and increase job satisfaction and work-life balance.

IMPLICATIONS FOR NURSING MANAGEMENT

Since this study addresses the working conditions and satisfaction of individuals who were re-employed after experiencing job turnover, it clarifies how nurse managers may reduce turnover. Namely, nurse managers should establish a work environment promoting good work-life balance.

A systematic review: Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention-to-leave and turnover

AIM

To investigate the association of unfinished nursing care on nurse outcomes.

DESIGN

Systematic review in line with National Institute for Health and Care Excellence guideline.

DATA SOURCES

CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020.

REVIEW METHODS

Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes.

RESULTS

Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136-4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2).

CONCLUSION

Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care.

IMPACT

Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability.

The Factors That Affect Turnover Intention According to Clinical Experience: A Focus on Organizational Justice and Nursing Core Competency

The purpose of this study was to investigate organizational justice and nursing core competency as factors that affect turnover intention among nurses. The participants comprised 153 nurses who worked at tertiary hospitals and general hospitals throughout South Korea. Turnover intention was measured using the Nurse Turnover Intention Scale. Organizational justice was measured using the Justice Scale, and nursing core competency was measured using the Korean Nursing Core Competency Scale. Data were collected via an online survey and analyzed using multiple regression. Among nurses with less than 3 years of clinical experience, a lower distributive justice score (β = −0.47, p < 0.001) was associated with high turnover intention. Among nurses with 3 to 6 years of clinical experience, a lower interactional justice score (β = −0.37, p = 0.042) and high nursing core competency (β = 0.31, p = 0.034) were associated with high turnover intention. The type of organizational justice that influenced turnover intention differed depending on clinical experience. These results highlight the need to understand the professional characteristics of nurses according to their clinical experience and to provide targeted organizational support and effective competency-based human resource management.

A Canadian national survey of informal employed caregivers of older adults with and without dementia: Work and employee outcomes

BACKGROUND

The majority of family caregivers (CG) caring for older adults, many of whom have dementia, are employees concurrently contending with the work demands and the stress and conflicts of caregiving. Both employers and CG employees are challenged by the need to address this problem.

METHOD

A cross-sectional Canadian survey was distributed nationally to working informal CGs of older adults in 2015 to 2016. It was designed to investigate the relative predictive roles of caregiving variables, job demands, balancing work and caregiving variables, and work-related factors on work and employee outcomes. Our sample was comprised of employees (N = 1,839) who were concurrently providing informal care for an older adult with specific attention to those caring for care recipients (CR) with dementia. We employed hierarchical and ordinal multiple regression to examine CG and caregiving characteristics, family and job demands, and balancing job-caregiving variables as predictors of work-related outcomes including work engagement, employment/employee changes index, absenteeism, and intent-to-turnover.

RESULTS

After controlling for CGs' age, sex, and family financial situation, we found dementia demands, job-caregiving conflict, effective manager, and organizational culture were significant predictors of five out of six work and employee outcomes. Role overload was significantly associated with four outcomes.

CONCLUSION

To our knowledge, this is the first study of this size to explore the association of these predictive variables with work-related outcomes and to refine the understanding of the profile of employed CGs of older adults with dementia. Sustaining working CGs of older adults may require new 'talent management' approaches rather than simply increasing the number of benefits.

US Survey of Incidence of and Reasons for Nurse Anesthetists Leaving or Having Considered Leaving Their Jobs

Many nurse anesthetists changing positions or considering leaving their positions can give the impression that suboptimal quality of anesthesia department leadership exists. To provide nationally accurate benchmark data on annual turnovers of nurse anesthetists to assist chief nurse anesthetists who may be scrutinized for the resignation rate of nurse anesthetists at their hospital, we used the 2018 US National Sample Survey of Registered Nurses. Analyses show that, during 2017, approximately 13.6% (99% CI, 6.6%-25.8%) of survey respondents left the positions that they held as of December 31, 2016. Approximately 37.6% considered leaving but did not resign as of December 31, 2017 (CI, 26.2%-50.6%). Estimates for nurse anesthetists were comparable to those for registered nurses (ie, not unique to nurse anesthetists). With both estimates combined, approximately 53% of nurse anesthetists changed or considered leaving their primary position (CI, 37.3%-68.0%, P=.62 compared with half). The most commonly reported reason was "better pay/benefits" (P≤.0064 vs all other reasons, including burnout). Applying the results, in a department with 37 nurse anesthetists, the national incidence of 13.6% would represent a turnover of 5.0 per year. The 13.6% incidence could also result in 1 of 5 years having as many as 11 nurse anesthetists (30%) leaving.

Nurse-physician collaboration, intention to leave job, and professional commitment among new graduate nurses

BACKGROUND

The quality of communication and collaboration with colleagues, managers, and physicians affects the intention to leave a job and the profession for new graduate nurses (NGNs). New graduates have difficulties communicating and collaborating with physicians, especially.

AIM

This study aimed to determine the relationship between the attitudes of nurse-physician collaboration and the levels of intention to leave the current job and professional commitment among NGNs.

METHODOLOGY

This descriptive, cross-sectional study was carried out with 231 NGNs in four private hospitals affiliated with an university. Data were collected by using a self-administered questionnaire, including a personal information form, the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration, Intention to Leave Scale, and Nursing Professional Commitment Scale. Data analysis was performed using descriptive statistics, and Spearman's rank correlation coefficients.

RESULTS

NGNs had a high positive attitude towards nurse-physician collaboration with a median score of 49 (45-54). The professional commitment of NGNs was high level with a median score of 75 (69-86). The intention to leave the current job median score was 3 (2.3-3.6) out of 5. There was a statistically significant correlation between attitudes towards nurse-physician collaboration and the levels of intention to leave the current job (r_s  = -0.22; p < 0.01) and professional commitment (r_s  = 0.42; p < 0.01).

CONCLUSION

The results showed that improving NGNs' attitudes towards nurse-physician collaboration increases the professional commitment and reduces turnover intention.

Factors Influencing Turnover Intention among Male Nurses in Korea

The study examined predictors of male nurse turnover intention in Korea using data collected from Korean hospitals. The results were obtained based on a secondary analysis of data previously collected from 306 male nurses in 16 regions of Korea from December 2014 to February 2015. Our findings suggest that male nurse turnover intention is predicted by (1) individual factors: single (B = 0.93, p = 0.008); (2) organizational factors: organizational commitment (B = -0.36, p < 0.001), job satisfaction (B = -0.27, p = 0.001), and job stress (B = 0.24, p < 0.001); and (3) social factors: hospital location in medium-categorized cities (B = 0.70, p = 0.012) and kinship responsibility (B = 0.13, p = 0.026). These factors accounted for 56.9% of the total variance. To lower the rate of turnover intention among male nurses, strategic interventions should be implemented based on the factors identified in this study.

Work environment for hospital nurses in Japan: The relationships between nurses' perceptions of their work environment and nursing outcomes

AIM

To investigate nurses' perceptions of their work environment and to investigate the relationships between variables measuring the work environment (WE) and nursing outcomes (NOs ).

DESIGN

A 2-year prospective longitudinal survey (2013-2015).

METHOD(S)

Descriptive statistics of nurse demographics, organizational WE and NOs were calculated by position. The associations between Practice Environment Scale of the Nursing Work Index (PES-NWI) and NOs were examined for each unit.

RESULTS

The participants were 2,992 staff nurses, 137 nurse managers (NMs), and 8 chief nursing officers in Phase 1 and 7,849, 371 and 23 in Phase 2, respectively. The higher the job position, the better the WE was rated. The higher the PES-NWI scores, the better the outcomes. Descriptive statistics about organizational WEs and NOs and the statistically significant associations between the two were identified.

Workplace spirituality and organizational justice in turnover intention of mental health professionals at small-sized centres

AIM

To investigate the influence of workplace spirituality and organizational justice on the turnover intentions of mental health professionals working in small-sized communities.

BACKGROUND

Many community mental health facilities in Korea are consist of the small size of members, and the turnover rate of mental health professionals is high. However, the influence of individual and organizational factors for lowering the turnover is not clearly identified.

METHOD

This was a descriptive study. Data of 168 participants were collected through a self-reported online questionnaire using a convenience sample, June 2020.

RESULT

Multiple regression analysis uses interactional justice (β = -.437, p = .002), distributional justice (β = -.190, p = .011) and age (β = -.152, p = .033) that were the most important predictors of turnover intention.

CONCLUSION

Orgnisational factors such as distributional and interactional justice affect to reduce turnover intention more than an individual factor like the workplace spirituality of professionals.

IMPLICATIONS FOR NURSING MANAGEMENT

Small-sized mental health institutions in the community should establish a clear working guideline that can make the distribution, procedure and interactional justice. Because only a small percentage of nurses work at community mental health facilities, it is necessary to reduce turnover by creating a work environment where young nurse practitioners can work long-term and grow into leaders.

The prevalence of stress-related outcomes and occupational well-being among emergency nurses in the Netherlands and the role of job factors: A regression tree analysis

Aims

This study aims to assess the prevalence of stress‐related outcomes (burnout, sleep problems and post‐traumatic stress) and occupational well‐being (work engagement, job satisfaction and turnover intention) of Dutch emergency room nurses and to identify job factors related to key outcomes.

Background

While emergency nurses are prone to stress‐related outcomes, no large‐scale studies have been conducted in the Netherlands. Furthermore, few studies considered combined effects of job factors on emergency nurses' well‐being.

Methods

In 2017, an occupation‐specific survey was filled out by 701 (response: 74%) emergency nurses from 19 Dutch hospitals. Decision tree methods were used to identify the most important (combination of) job factors related to key outcomes.

Results

High prevalence of stress‐related outcomes and turnover intention were found, while the majority experienced work engagement and were satisfied with their job. Emotional exhaustion was mainly associated with worktime demands and aggression/conflict situations. Work engagement was mainly associated with developmental opportunities.

Conclusions

Dutch emergency room nurses are at risk of stress‐related outcomes and have high turnover intention, while feeling engaged and satisfied with their job.

Implications for Nursing Management

To retain and attract emergency room nurses, it is recommended to focus efforts on increasing developmental opportunities, while reducing worktime demands and aggression incidents.

Nurses' turnover intention in secondary hospitals in China: A structural equation modelling approach

Aim

To identify the factors affecting nurses’ turnover intention.

Background

The shortage of nurses has been a great challenge worldwide, and nurses’ turnover may exacerbate the situation.

Methods

A cross‐sectional study was conducted among nurses in six secondary hospitals in China. A model was constructed, and structured questionnaires were adopted to measure model variables. Structural equation modelling was used to verify the model.

Results

Totally, 594 valid questionnaires were collected. The final model showed an acceptable fit, and 35.0% of the total variation was explained. Nine of the ten pathways were statistically significant. The model verified the contribution of professional value, nursing practice, job stress and social support to turnover intention and their effects were mediated by job satisfaction and organisational commitment. As hypothesized, there existed a significant effect between job satisfaction and organisational commitment. Unexpectedly, job stress had a greater direct effect on turnover intention than job satisfaction and organisational commitment.

Conclusions

The structural model provided a feasible model that could explain nurses’ turnover intention in China.

Implications for Nursing Management

To prevent the turnover of nurses, administrators and managers should advisably prioritize the effect of job stress, especially in hospitals with similar medical context.

Experience of Workplace Incivility and Its Impact on Stress and Turnover Intention among the Nurses Working at a Hospital: Cross-Sectional Survey Approach

Background:

Incivility in the workplace drowns the mental health of the nurses and hampers the daily routine. The majority of the nurses working at hospitals were experiencing incivility. It affects the physical and psychological health of the nurses. Experience of workplace incivility and its impact on stress and turnover among nurses was discussed in this study.

Materials and Methods:

Cross-sectional survey approach was used to select 50 nurses by simple random sampling technique. Standard scales for incivility, stress, and pre-tested scale for the turnover intention was used to collect the data.

Result:

Nurses experience incivility in their workplace almost from all the sources. The majority (64%) of the staff nurses had a moderate level of stress and 30% had average intention to leave the present job. There was a positive relationship found between the experience of incivility and stress (r = 0.43, p < 0.002), stress, and turnover intention (r = 0.40, p < 0.004).

Conclusions:

Experience of incivility provokes stress among the nurses, and this may influence turnover intention.

Struggle Turning Back to Professional Nursing Practice in Iran: A Qualitative Study

Background

Current nursing shortage is becoming more complicated because of turnover intention among nurses. Most of the inactive nurses in Iran after a long time for various rations Returned To Professional Nursing Practice (RTPNP). Because the RTPNP program does not exist in Iran to prepare inactive nurses returning to practice, this study aimed to explore the strategies that contribute to preparing nurses for RTPNP.

Materials and Methods

The present study was a part of the findings of a larger grounded theory study that lasted about 9 months from April 2019 to December 2019. The data were collected through semi-structured interviews with participants after signing an informed consent form. The average interview duration was 40 minutes. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Participants included eight nurses, two education supervisors, two matrons, and two head nurses. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method.

Results

Struggle turning back to PNP was the main category that emerged from four categories of "seeking learning resources," "return to practice support," "getting used to a practice," and "building a new family life" from the data analysis process.

Conclusions

Returners struggle to get prepared for providing PNP to clients if there is no definite process of RTPNP. Organizational support and RTPNP programs are efficient strategies and could help these returners get prepared for PNP.

Swedish occupational therapists' considerations for leaving their profession: outcomes from a national survey

BACKGROUND

Occupational therapists are an essential healthcare profession and play a vital role in rehabilitating patients in the activities of daily life. Nevertheless, many occupational therapists in Sweden are leaving the profession and this jeopardises occupational therapy services.

OBJECTIVE

To explore factors that cause occupational therapists to seriously consider leaving their profession.

MATERIAL AND METHODS

As part of a larger national study of Swedish occupational therapists' health and work environment, qualitative content analysis with a summative approach was applied to explore the reasons for considering leaving their profession among 1279 Swedish occupational therapists.

RESULTS

Three themes emerged: (1) facing work environment deficiencies, (2) pursuing own development and (3) Personal factors and external constraints. The largest category, belonging to theme 1, was stress and high work pressure given 344 times as a reason to consider leaving the profession.

CONCLUSIONS AND SIGNIFICANCE

This article provides new and important insights on the reasons why occupational therapists may seriously consider leaving their profession. The results are significant for managers and employing organizations to consider in order to prevent a shortage of occupational therapy services.

The effects of facility dogs on burnout, job-related well-being, and mental health in paediatric hospital professionals

AIMS AND OBJECTIVES

To examine the effect of working with a facility dog on paediatric healthcare professionals' work-related burnout, job perceptions and mental health.

BACKGROUND

Due to their roles caring for ill children and distressed families, paediatric healthcare professionals often experience substantial depression and burnout. According to prior research, facility dogs in children's hospitals may provide significant benefits to paediatric patients. However, their potential effects on healthcare professionals have been minimally explored.

DESIGN

A cross-sectional design was used in adherence to the STROBE checklist.

METHOD

Among 130 participants, n = 65 paediatric healthcare professionals working with a facility dog were compared to n = 65 control participants matched on age, gender identity, job position category and pet ownership. Hierarchical regression assessed the effect of working with a facility dog on standardised self-report measures of work-related burnout, job perceptions and mental health.

RESULTS

For work-related burnout, working with a facility dog was associated with higher perceived personal accomplishment, but had no effect on emotional exhaustion. With respect to job perceptions, working with a facility dog was associated with more positive job descriptions and lower intention to quit, but not with perceptions about co-workers or workplace social support. Finally, in relation to mental health, working with a facility dog was associated with more positive emotions, better perceived mental health and less depression, but had no effect on anxiety.

CONCLUSION

Findings suggest that facility dogs may be related to several benefits for healthcare professionals' work-related burnout, job perceptions and mental health, but that they do not influence all components of these areas.

RELEVANCE TO CLINICAL PRACTICE

The present research functions to inform personnel in paediatric hospitals with existing facility dog programmes on the scope of their effects, in addition to shaping the expectations of hospitals considering the addition of a facility dog programme.

Strategies for reducing hospital nurse turnover in South Korea: Nurses' perceptions and suggestions

AIM

To explore the South Korean nurses' perspectives on the current hospital working conditions in order to identify causes of persistent high turnover rates among the nurses.

BACKGROUND

High turnover rates of hospital nurses continue to pose a serious challenge to South Korean health care system despite the government's recent efforts to improve working conditions. Many studies in the past had examined factors related to the turnover and provided only a partial understanding of turnover predictors. However, nurses' perceptions on the current working conditions must be considered to explore possible causes of continued high turnover, to identify solutions and to improve working conditions by addressing nurses' concerns.

METHOD

This study is a qualitative study using focus group interviews with 33 nurses from 11 South Korean hospitals.

RESULTS

Three main themes and eight subthemes related to reducing hospital nurse turnover were identified.

CONCLUSIONS

To address hospitals' nursing shortages in South Korea, it is important to address poor work environments.

IMPLICATION FOR NURSING MANAGEMENT

This study showed that more transformational policies should be developed and implemented to change working conditions by reducing excessive workloads and improve how nurses are treated and viewed so as to retain existing nurses and ease the nurse turnover rates.

Turnover Rates and Factors Influencing Turnover of Korean Acute Care Hospital Nurses: A Retrospective Study Based on Survival Analysis

PURPOSE

This study aimed to explore turnover rates for Korean acute care hospital nurses and identify factors influencing their turnover.

METHODS

The study was retrospective in nature. Nurse cohort data were obtained from hospital status data from Korea's Health Insurance Review Assessment Service. The observation period was from January 1, 2012 to December 31, 2016, and data for 96,158 nurses were analyzed. Independent variables included nurses' age and sex and hospital setting, type, ownership, and nurse staffing level. Kaplan-Meier analysis was performed to estimate survival curves, and factors influencing turnover were analyzed using Cox's proportional hazard regression.

RESULTS

The cumulative turnover probability for all nurses was .17, .29, .38, .45, and .50 for the first, second, third, fourth, and fifth years, respectively. The results showed that the longer the career duration, the lower the turnover rates. According to the factors influencing nurse turnover, both nurses' (i.e., sex and career duration) and hospitals' (i.e., hospital setting, type, ownership, and nurse staffing level) characteristics were statistically significant.

CONCLUSION

It should be noted that the turnover rate of nurses with less than three year of career duration and of those with less than one year has been shown to be quite high. Therefore, target populations for acute care hospital nurse turnover should be expanded from new graduate nurses to experienced nurses with less than 3 years of career. Further studies are required to examine the causes of high turnover rates in hospitals that are small and/or have low nurse staffing levels.

Pathways to Retention: Job Satisfaction, Burnout, & Organizational Commitment among Social Workers

Purpose: Job satisfaction, burnout, and organizational commitment remain concerns for human service organizations. Few studies have utilized a large sample of social workers to investigate these factors while also considering practice setting. In the present study, work-related burnout, satisfaction with workload, and satisfaction with organizational environment are examined as factors contributing to organizational commitment while comparing the measurement and predictive strength of these factors based on practice setting. Method: Confirmatory factor analyses and structural equation modeling were used to estimate and compare factors related to organizational commitment with a sample of 1,786 social workers practicing in the United States. Results: Satisfaction with organizational environment showed a strong positive relationship with organizational commitment. Work-related burnout was confirmed to have a negative relationship with organizational commitment. No measurement or structural model differences existed between social workers from different types of practice settings. Discussion: Findings suggest that increasing satisfaction with organizational environment is a better target for retaining employees than reducing workloads. Results emphasize the need for human service organizations to foster work environments which provide a climate of wellness, support, and recognition of employees' contributions at work.

Work patterns and a tendency among Polish nurses to leave their job

BACKGROUND

Work patterns are important factors in employees' decisions to change their job or leave their profession. The majority of nurses in Poland are women who play other social roles besides work. For this reason, satisfaction with their work patterns including input into work schedules, has a particularly significant impact on considering the idea of quitting their job.

MATERIAL AND METHODS

The study was conducted in 2008-2011 in 8 out of 10 higher education institutions which train nurses. Data obtained from 1045 questionnaires collected from a total of 1049 respondents from 3 randomly selected higher education institutions was used in this research paper. The relationship between the qualitative features and dichotomus quality features under examination was assessed using univariate and multivariate logistic regression models.

RESULTS

The results of the univariate logistic regression indicate that the risk of quitting increases to the highest extent with a mixed work pattern; it is lower for 12/24 h, and slightly lower for 2 day/night shifts.

CONCLUSIONS

A pattern with a single day shift was adopted as the reference level to reduce the risk of Polish nurses' quitting their job. Med Pr. 2018;70(2):145-53.

Exploring preceptorship programmes: Implications for future design

AIMS AND OBJECTIVES

To review and analyse current preceptorship programmes within NHS trusts in the North West of England. To evaluate the pedagogic rigour of the programme and suggest recommendations to inform the future design of preceptorship programmes.

BACKGROUND

Enhancing the retention of newly qualified staff is of particular importance given that the journey from a new registrant to a competent healthcare professional poses a number of challenges, for both the individual staff member and organisations.

DESIGN

A mixed methods evaluative approach was employed, using online questionnaires and content analysis of preceptorship documentation.

METHODS

Forty-one NHS trusts across the North West region employing newly qualified nurses were invited to participate in the completion of an online questionnaire. In addition, preceptorship programme documentation was requested for inclusion in the content analysis. This study used the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines.

RESULTS

The response rate for the questionnaire was 56.1% (n = 23). Eighteen trusts (43.9%) forwarded their programme documentation. Findings highlighted the wide variation in preceptorship programmes across the geographical footprint.

CONCLUSIONS

There were instances of outstanding preceptorship and preceptorship programmes where there was a clear link between the strategic vision, that is, trust policy, and its delivery, that is, preceptorship offering. There was no one framework that would universally meet the needs of all trusts; yet, there are key components which should be included in all preceptorship programmes. Therefore, we would encourage innovation and creativity in preceptorship programmes, cognisant of local context.

RELEVANCE TO CLINICAL PRACTICE

The significant shortage of nursing staff in England is an ongoing issue. Recruitment and retention are key to ameliorating the shortfall, and formal support mechanisms like preceptorship, can improve the retention of newly qualified staff. Understanding current preceptorship programmes is an important first step in establishing the fundamental building blocks of successful preceptorship programmes and enabling the sharing of exemplary good practice across organisations.

Influencing Factors and Consequences of Workplace Bullying among Nurses: A Structural Equation Modeling

PURPOSE

The purpose of this study was to build and test a model outlining the factors related to workplace bullying among nurses. The hypothesized model included authentic leadership and a relationship-oriented organizational culture as influencing factors, symptom experience and turnover intention as consequences, and positive psychological capital as a mediator of workplace bullying among nurses.

METHODS

We obtained structured questionnaire data from 301 nurses working at hospitals in South Korea. Based on these data, the developed model was verified via a structural equation modeling analysis using SPSS and AMOS program.

RESULTS

The fit indices of the hypothesized model satisfied recommended levels; χ² = 397.58 (p < .001), normed χ² (χ²/df) = 1.82, RMR = .05, TLI = .93, CFI = .94, RMSEA = .05. A relationship-oriented organizational culture had a direct effect on workplace bullying (β = -.48, p < .001). Furthermore, workplace bullying had a direct effect on symptom experience (β = .36, p < .001), and this relationship was mediated by positive psychological capital (β = .15, p = .003). Workplace bullying also had an indirect effect on turnover intention (β = .20, p = .007). Finally, symptom experience had a direct effect on turnover intention (β = .31, p = .002).

CONCLUSION

These results suggest that workplace bullying among nurses may be prevented by constructing a relationship-oriented organizational culture, as long as employees have sufficient positive psychological capital. In this regard, workplace bullying among nurses should be addressed using a comprehensive strategy that considers both individual and organizational factors.

Association of Burnout with Workforce-Reducing Factors among EMS Professionals

OBJECTIVES

Emergency medical services (EMS) professionals often work long hours at multiple jobs and endure frequent exposure to traumatic events. The stressors inherent to the prehospital setting may increase the likelihood of experiencing burnout and lead providers to exit the profession, representing a serious workforce and public health concern. Our objectives were to estimate the prevalence of burnout, identify characteristics associated with experiencing burnout, and quantify its relationship with factors that negatively impact EMS workforce stability, namely sickness absence and turnover intentions.

METHODS

A random sample of 10,620 emergency medical technicians (EMTs) and 10,540 paramedics was selected from the National EMS Certification database to receive an electronic questionnaire between October, 2015 and November, 2015. Using the validated Copenhagen Burnout Inventory (CBI), we assessed burnout across three dimensions: personal, work-related, and patient-related. We used multivariable logistic regression modeling to identify burnout predictors and quantify the association between burnout and our workforce-related outcomes: reporting ten or more days of work absence due to personal illness in the past 12 months, and intending to leave an EMS job or the profession within the next 12 months.

RESULTS

Burnout was more prevalent among paramedics than EMTs (personal: 38.3% vs. 24.9%, work-related: 30.1% vs. 19.1%, and patient-related: 14.4% vs. 5.5%). Variables associated with increased burnout in all dimensions included certification at the paramedic level, having between five and 15 years of EMS experience, and increased weekly call volume. After adjustment, burnout was associated with over a two-fold increase in odds of reporting ten or more days of sickness absence in the past year. Burnout was associated with greater odds of intending to leave an EMS job (personal OR:2.45, 95% CI:1.95-3.06, work-related OR:3.37, 95% CI:2.67-4.26, patient-related OR: 2.38, 95% CI:1.74-3.26) or the EMS profession (personal OR:2.70, 95% CI:1.94-3.74, work-related OR:3.43, 95% CI:2.47-4.75, patient-related OR:3.69, 95% CI:2.42-5.63).

CONCLUSIONS

The high estimated prevalence of burnout among EMS professionals represents a significant concern for the physical and mental well-being of this critical healthcare workforce. Further, the strong association between burnout and variables that negatively impact the number of available EMS professionals signals an important workforce concern that warrants further prospective investigation.

Threats or violence from patients was associated with turnover intention among foreign-born GPs - a comparison of four workplace factors associated with attitudes of wanting to quit one's job as a GP

OBJECTIVE

General practitioners (GPs) are crucial in medical healthcare, but there is currently a shortage of GPs in Sweden and elsewhere. Recruitment of GPs from abroad is essential, but foreign-born physicians face difficulties at work that may be related to turnover intention, i.e. wanting to quit one's job. The study aims to explore the reasons to why foreign-born GPs may intend to quit their job.

DESIGN

Survey data were used to compare four work-related factors that can be associated with turnover intentions; patient-related stress, threats or violence from patients, control of work pace, and empowering leadership, among native-born and foreign-born GPs. These work-related factors were subsequently examined in relation to turnover intention among the foreign-born GPs by means of linear hierarchical regression analyses. The questionnaire consisted of items from the QPS Nordic and items constructed by the authors.

SETTING

A primary care setting in a central area of Sweden.

SUBJECTS

Native-born (n = 208) and foreign-born GPs (n = 73).

RESULTS

Turnover intention was more common among foreign-born GPs (19.2% compared with 14.9%), as was the experience of threats or violence from patients (22% compared with 3% of the native-born GPs). Threats or violence was also associated with increased turnover intention. Control of work pace and an empowering leadership was associated with reduced turnover intention.

PRACTICE IMPLICATIONS

The organisations need to recognise that foreign-born GPs may face increased rates of threats and/or violence from patients, which may ultimately cause job turnover and be harmful to the exposed individual.

Career anchors of dentist leaders

OBJECTIVE

The work of a health care leader is demanding; in order to cope, leaders need motivation and support. The occurrence of intrinsic factors called career anchors (combination of one's competence, motives and values) could be a contributing factor in dentist leaders' career decisions. The aim of our study was to identify dentist leaders' career anchors and their association to dentist leaders' retention or turnover of the leadership position.

MATERIAL AND METHODS

Materials were gathered in 2014 via an electronic questionnaire from 156 current (Leaders) or former (Leavers) Finnish dentist leaders. Career anchor evaluation was conducted by the questionnaire and scoring-table taken from Edgar Schein's Career Anchors Self-Assessment. Both the most and the least important career anchors were detected by the highest and lowest scores and their occurrence reported as percentages. Associations between career anchor scores and tendency to stay were analyzed with logistic regression.

RESULTS

'Technical/Functional Competence' and 'Lifestyle' were most frequently reported as the most important and 'Entrepreneurial Creativity' and 'General Managerial Competence' as the least important career anchors. However, a higher level of 'General Managerial Competence' anchor was most significantly associated with staying in a leadership position. Instead, 'Pure Challenge' and 'Lifestyle' decreased the odds to stay.

CONCLUSIONS

The knowledge of the important and essential career anchors of dentist leaders' and individuals' could perform crucial part in career choices and also in planning education, work opportunities and human resource policies promoting retention of dentist leaders and probably also other health care leaders.

Thoughts of Quitting General Surgery Residency: Factors in Canada

OBJECTIVE

Attrition rates in general surgery training are higher than other surgical disciplines. We sought to determine the prevalence with which Canadian general surgery residents consider leaving their training and the contributing factors.

DESIGN, SETTING, AND PARTICIPANTS

An anonymous survey was administered to all general surgery residents in Canada. Responses from residents who considered leaving their training were assessed for importance of contributing factors. The study was conducted at the Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, a tertiary academic center.

RESULTS

The response rate was approximately 34.0%. A minority (32.0%) reported very seriously or somewhat seriously considering leaving their training, whereas 35.2% casually considered doing so. Poor work-life balance in residency (38.9%) was the single-most important factor, whereas concern about future unemployment (16.7%) and poor future quality of life (15.7%) were next. Enjoyment of work (41.7%) was the most frequent mitigating factor. Harassment and intimidation were reported factors in 16.7%. On analysis, only intention to practice in a nonacademic setting approached significant association with thoughts of leaving (odds ratio = 1.92, CI = 0.99-3.74, p = 0.052). There was no association with sex, program, postgraduate year, relationship status, or subspecialty interest. There was a nonsignificant trend toward more thoughts of leaving with older age.

CONCLUSION

Canadian general surgery residents appear less likely to seriously consider quitting than their American counterparts. Poor work-life balance in residency, fear of future unemployment, and anticipated poor future quality of life are significant contributors to thoughts of quitting. Efforts to educate prospective residents about the reality of the surgical lifestyle, and to assist residents in securing employment, may improve completion rates.

Interpersonal behaviour in relation to burnout

Organisational and work-related challenges faced by midwives make them vulnerable to burnout, but individual factors, such as interpersonal behaviour, can also contribute. A study in eight hospitals in the Dutch-speaking part of Belgium investigated the prevalence of burnout among Flemish midwives, assessed their interpersonal behaviour, and explored the relationship between interpersonal behaviour, burnout, job satisfaction and intention to leave. This article describes the study and reports the findings.

Marginal structural modelling of associations of occupational injuries with voluntary and involuntary job loss among nursing home workers

OBJECTIVES

Qualitative studies have highlighted the possibility of job loss following occupational injuries for some workers, but prospective investigations are scant. We used a sample of nursing home workers from the Work, Family and Health Network to prospectively investigate association between occupational injuries and job loss.

METHODS

We merged data on 1331 workers assessed 4 times over an 18-month period with administrative data that include job loss from employers and publicly available data on their workplaces. Workers self-reported occupational injuries in surveys. Multivariable logistic regression models estimated risk ratios for the impact of occupational injuries on overall job loss, whereas multinomial models were used to estimate OR of voluntary and involuntary job loss. Use of marginal structural models allowed for adjustments of multilevel lists of confounders that may be time varying and/or on the causal pathway.

RESULTS

By 12 months, 30.3% of workers experienced occupational injury, whereas 24.2% experienced job loss by 18 months. Comparing workers who reported occupational injuries to those reporting no injuries, risk ratio of overall job loss within the subsequent 6 months was 1.31 (95% CI 0.93 to 1.86). Comparing the same groups, injured workers had higher odds of experiencing involuntary job loss (OR 2.19; 95% CI 1.27 to 3.77). Also, compared with uninjured workers, those injured more than once had higher odds of voluntary job loss (OR 1.95; 95% CI 1.03 to 3.67), while those injured once had higher odds of involuntary job loss (OR 2.19; 95% CI 1.18 to 4.05).

CONCLUSIONS

Despite regulatory protections, occupational injuries were associated with increased risk of voluntary and involuntary job loss for nursing home workers.

Significant factors for work attractiveness and how these differ from the current work situation among operating department nurses

AIMS AND OBJECTIVES

The aim was to examine significant factors for work attractiveness and how these differ from the current work situation among operating department nurses. A second objective was to examine the associations between age, gender, length of employment, work engagement, work ability, self-rated health indicators and attractiveness of the current work situation.

BACKGROUND

The attractiveness of work is rarely taken into account in research on nurse retention. To expand this knowledge, it is relevant to examine factors that make work attractive and their associations with related concepts.

DESIGN

Correlational, cross-sectional survey using a convenience sample.

METHODS

Questionnaires were answered by 147 nurses in four operating departments in Sweden. Correlation and regression analyses were conducted.

RESULTS

The nurses rated the significance of all factors of work attractiveness higher than they rated those factors in their current work situation; salary, organisation and physical work environment had the largest differences. The most significant attractive factors were relationships, leadership and status. A statistically significant positive correlation between work engagement and attractive work was found. In the multiple regression model, the independent variables work engagement and older age significantly predicted work attractiveness.

CONCLUSIONS

Several factors should be considered in the effort to increase work attractiveness in operating departments and thereby to encourage nurse retention. Positive aspects of work seem to unite work engagement and attractive work, while work ability and self-rated health indicators are other important dimensions in nurse retention.

RELEVANCE TO CLINICAL PRACTICE

The great discrepancies between the significance of attractive factors and the current work situation in salary, organisation and physical work environment suggest ways in which work attractiveness may be increased. To discover exactly what needs to be improved may require a deeper look into the construct of the examined factors.

The value of survival analyses for evidence-based rural medical workforce planning

BACKGROUND

Globally, abundant opportunities exist for policymakers to improve the accessibility of rural and remote populations to primary health care through improving workforce retention. This paper aims to identify and quantify the most important factors associated with rural and remote Australian family physician turnover, and to demonstrate how evidence generated by survival analysis of health workforce data can inform rural workforce policy making.

METHODS

A secondary analysis of longitudinal data collected by the New South Wales (NSW) Rural Doctors Network for all family physicians working in rural or remote NSW between January 1(st) 2003 and December 31(st) 2012 was performed. The Prentice, Williams and Peterson statistical model for survival analysis was used to identify and quantify risk factors for rural NSW family physician turnover.

RESULTS

Multivariate modelling revealed a higher (2.65-fold) risk of family physician turnover in small, remote locations compared to that in small closely settled locations. Family physicians who graduated from countries other than Australia, United Kingdom, United States of America, New Zealand, Ireland, and Canada also had a higher (1.45-fold) risk of turnover compared to Australian trained family physicians. This was after adjusting for the effects of conditional registration. Procedural skills and public hospital admitting rights were associated with a lower risk of turnover. These risks translate to a predicted median survival of 11 years for Australian-trained family physician non-proceduralists with hospital admitting rights working in small coastal closely settled locations compared to 3 years for family physicians in remote locations.

CONCLUSIONS

This study provides rigorous empirical evidence of the strong association between population size and geographical location and the retention of family physicians in rural and remote NSW. This has important policy ramifications since retention grants for rural and remote family physicians in Australia are currently based on a geographical 'remoteness' classification rather than population size. In addition, this study demonstrates how survival analysis assists health workforce planning, such as through generating evidence to assist in benchmarking 'reasonable' lengths of practice in different geographic settings that might guide service obligation requirements.