Factors influencing turnover and absence of nurses: a research review

This review of the nursing literature aims to identify the factors with the greatest influence on turnover and absence of qualified nurses, possible common factors influencing both, and the relationship between absence and turnover. A hypothetical model grounded in the literature which depicts the expected relationships between these variables is presented for testing in an empirical study.

The review identifies intent to stay in current employment as the variable with the greatest influence on turnover. Intent to stay is in turn most strongly associated with job satisfaction. Other variables are identified by single studies as having an influence on intent to stay, but are not supported by the results of other studies; exceptions are pay, opportunity for alternative employment and kinship responsibility, which are supported by the results of two studies. The relationship between job satisfaction and absence is unclear and requires further investigation. However, job satisfaction is identified as possibly influencing both absence and intent to stay and kinship responsibility is identified as a common antecedent of absence and intent to stay. Similarly, absence is identified as an antecedent to turnover. Thus, it is expected that absence would be positively related to turnover and negatively related to intent to stay. Understanding such relationships should allow identification of management strategies to reduce both turnover and absence.     

Factors influencing changes in surgical intensive care unit utilization

OBJECTIVES: To determine the factors that cause changes in surgical intensive care unit (ICU) utilization. The aim was to uncover the causes of these changes and examine whether any could have been predicted statistically. DESIGN: Retrospective analysis of prospectively collected representative data. SETTING: University hospital adult surgical ICU. PATIENTS: A total of 6,571 consecutive patients admitted over 8 yrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Changes in annual admission rates and lengths of stay were examined to determine their causes, whether they were because of structural changes caused by alterations of physical facilities, functional changes caused by changes in personnel or policies, or clinical changes caused by alterations in clinical practice. The medical literature was examined to determine whether these changes reflected medical trends. During the 8 yrs there was a steady increase in the number of admissions and a steady reduction in the length of stay. These changes in unit utilization were often not predictable statistically and were attributable to a combination of clinical, structural, and functional factors. CONCLUSIONS: Surgical ICU utilization was notable for continual, and not predictable, changes. Clinical issues included new surgical techniques and anesthetic practices; structural causes included changes in bed capacity and opening an intermediate care unit; and functional factors involved changes in surgical personnel, policy revisions, and pressures to reduce ICU length of stay. This was further complicated by the observation that changes in the number of admissions were often not paralleled by similar changes in the number of patient days. This complex situation demonstrated the problems of basing predictions of future utilization on previous experiences.     

Factors influencing length of stay in the intensive care unit.

BACKGROUND: Long stays in the intensive care unit are associated with high costs and burdens on patients and patients' families and in turn affect society at large. Although factors that affect length of stay and outcomes of care in the intensive care unit have been studied extensively, the conclusions reached have not been reviewed to determine whether they reveal an organizational pattern that might be of practical use in reducing length of stay in the unit. OBJECTIVE: To identify and categorize the factors associated with prolonged stays in the intensive care unit and to describe briefly the nonmedical interventions to date designed to reduce length of stay. METHODS: Articles published between January 1990 and March 2005 in English-language journals indexed by MEDLINE were searched for studies on outcomes and costs of care in the intensive care unit and on care at the end of life. RESULTS: The emerging consensus is that length of stay in the intensive care unit is exacerbated by several increasingly discernible medical, social, psychological, and institutional factors. At the same time, several nonmedical, experimental interventions have been designed to reduce length of stay. CONCLUSIONS: Interventions involving palliative care, ethics consultations, and other methods to increase communication between healthcare personnel, patients, and patients' families may be helpful in decreasing length of stay in the intensive care unit. Further studies are needed to provide a strategy for targeting specific risk factors indicated by the literature review.     

Factors influencing satisfaction and anticipated turnover for nurses in an academic medical center

OBJECTIVES: The purpose of this study was to examine the relationships between work satisfaction, stress, age, cohesion, work schedule, and anticipated turnover in an academic medical center. BACKGROUND DATA: Nurse turnover is a costly problem that will continue as healthcare faces the impending nursing shortage, a new generation of nurses enter the workforce, and incentives provided to nurses to work for institutions increase. A variety of factors influence the retention of nurses in adult care settings, including work satisfaction, group cohesion, job stress, and work schedule. In general, previous research has documented positive relationships between work satisfaction, group cohesion, strong leadership, and retention rates and a negative relationship between stress, work schedule, and retention. In addition, age and experience in nursing are related to job satisfaction. METHODS: This study used a cross-sectional survey design in which nurses from 12 units in a 908-bed university hospital in the Southeast completed questionnaires on one occasion. The following factors were measured using self-report questionnaires: nurse perception of job stress, work satisfaction, group cohesion, and anticipated turnover. RESULTS: The more job stress, the lower group cohesion, the lower work satisfaction, and the higher the anticipated turnover. The higher the work satisfaction, the higher group cohesion and the lower anticipated turnover. The more stable the work schedule, the less work-related stress, the lower anticipated turnover, the higher group cohesion, and the higher work satisfaction. Job Stress, work satisfaction, group cohesion, and weekend overtime were all predictors of anticipated turnover. There are differences in the factors predicting anticipated turnover for different age groups. CONCLUSIONS: As healthcare institutions face a nursing shortage and a new generation of nurses enter the workforce, consideration of the factors that influence turnover is essential to creating a working environment that retains the nurse.     

临床护士离职意愿影响因素的研究

目的探讨临床护士离职意愿的影响因素。方法采用方便抽样的方法对广州市7所医院的944名注册护士进行问卷调查,内容包括一般人151学特征、工作满意度、组织承诺、离职意愿4个方面。结果影响离职意愿因素有组织承诺（β=-0．340）、年龄（β=-0．264）、工作满意度（β=-0．140）。结论影响临床护士离职意愿的因素依次为：组织承诺、年龄、工作满意度。     

重症监护室护士护患沟通影响因素的质性研究

目的探讨影响监护室护士护患沟通的因素。方法采用质性研究中的诠释现象学理论,对10名监护室护士深入访谈,将获得的资料进行分析、整理,归纳出主题。结果影响监护室护患沟通因素有监护室患者病情危重、护士知识缺乏、护理工作量大、护士非语言沟通技能缺乏、沟通环境不良。结论监护室护患沟通存在诸多影响因素,提升护士主动沟通意识和沟通技能,以提高监护室护理服务质量。     

Registered nurses and burn care facilities. Factors associated with turnover rates

The health care system in the United States is suffering from a severe shortage of registered nurses. Burn treatment facilities are no exception to this phenomenon. As a result of this shortage, institutions have begun hiring less trained personnel such as licensed practical/vocational nurses (LPNs/LVNs), nursing assistants, burn technicians, and nursing students to fill the void. This shortage is so significant that the American Medical Association (AMA) has proposed a new category of bedside care provider, a "Registered Care Technologist" (RCT). The purpose of this paper is to determine the magnitude of the registered nurse shortage in burn care facilities. A second purpose is to identify factors associated with high turnover rates and to document the reasons why registered burn nurses are leaving their positions.     

The sedation practices of paediatric intensive care unit nurses and the influencing factors in China

Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross‐sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric‐validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high‐quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice.     

Burnout among intensive care nurses

The purpose of this study was to examine the relationship between intensive-care nurse burnout and demographic variables. The Maslach Burnout Inventory measured six components of burnout; emotional exhaustion frequency and intensity, depersonalization frequency and intensity, and personal accomplishment frequency and intensity. The sample (N = 89) was drawn from an army medical center. The variables, nursing, age, sex, military status, level of education, and length of time in nursing correlated with more than one aspect of burnout (p less than .05). Older age, less than a baccalaureate degree, female, and civilian status described the intensive care nurse who was less prone to burnout. Further study of the relationship between nurses and burnout is required.     

Factors influencing decision making among ambulance nurses in emergency care situations

The aim of this study was to investigate which factors that influences decision making among Swedish ambulance nurses in emergency care situations. Nurses in ambulance are sometimes forced to make decisions without adequate information. Data collected from interviews with 14 ambulance nurses was analyzed. The informants described 30 incidents during which they had to make fast decisions. A qualitative content analysis of the text was made, from which different categories were identified. It was found that when nurses are called to an emergency, the extent and degree of difficulty of the incident is decisive for how decisions are made. In addition, the nurses’ experience is important for decision making, because the experience factor constitutes a qualitative difference between a novice nurse and a more experienced nurse’s influence on decision-making. Furthermore, external factors, such as the uncertainty of a prehospital environment, expectations and pressures from an environment in which one is working while being observed by other people, and collaborating with many different operators, all contribute to making decisions in an urgent situation even more complex. Further studies are needed to understand the complexity of decision making in emergency situations.     

Performance obstacles of intensive care nurses

BACKGROUND: The work environment of intensive care nurses may have substantial impact on both nursing outcomes and patient safety. The factors in a nurse's immediate work environment, in the local work context, have not been studied in detail to provide useful, specific information for work redesign efforts to improve nurse's work and patient safety. Performance obstacles are the factors that hinder intensive care nurses' capacity to perform their jobs and that are associated closely with their immediate work environment. OBJECTIVES: To identify the performance obstacles experienced by intensive care nurses in their work environment. METHODS: A multisite, cross-sectional study was conducted. Data were collected using a 36-item questionnaire and analyzed using univariate statistical analysis. The frequencies of performance obstacles reported by intensive care nurses were computed. RESULTS: Nurses (n = 272) from 17 intensive care units (ICUs) of seven hospitals in Wisconsin participated in the study. The most frequently experienced performance obstacles included noisy work environment (46%), distractions from families (42%), hectic (40%) and crowded work environments (37%), delay in getting medications from pharmacy (36%), spending considerable amount of time teaching families (34%), equipment not being available-someone else using it (32%), patient rooms not well-stocked (32%), insufficient workspace for completing paperwork (26%), seeking for supplies (24%) or patients' charts (23%), receiving many phone calls from families (23%), delay in seeing new medical orders (21%), and misplaced equipment (20%). DISCUSSION: Intensive care nurses experience a variety of performance obstacles in their work environment. Future research should investigate the impact of various performance obstacles on nursing workload, nursing quality of working life, and quality and safety of care, as well as the impact of interventions aimed at redesigning the work system of ICU nurses to remove performance obstacles.     

ICU护士评判性思维的现状及影响因素分析

目的 调查ICU护士评判性思维的现状,并探讨其相关影响因素.方法 采用一般资料调查表及评判性思维能力量表对长沙市7所三级甲等医院ICU的324名护士进行横断面调查.结果 ICU护士的评判性思维能力总分为（284.22±23.62）分;职称、第一学历、从事ICU工作年限、参加活动频率和学习频率是ICU护士评判性思维能力的影响因素.结论 ICU护士的评判性思维能力总体表现为正性,但离评判性思维能力强的标准还有很大的差距,还有待进一步培养和强化.