Jordanian nurses' job satisfaction and intent to stay: comparing teaching and non-teaching hospitals.

The aims of this study were to identify variables of Jordanian nurses' job satisfaction and intent to stay, compare the phenomena of interest in teaching and non-teaching hospitals, and correlate the two concepts of nurses' job satisfaction and intent to stay. A convenience sample of 433 nurses was obtained from three teaching hospitals and two non-teaching hospitals. Nurses were "neither satisfied nor dissatisfied" and were "neutral" in reporting their intent to stay at their current jobs. Nurses who were working in non-teaching hospitals reported higher job satisfaction and intent to stay rates than those working in teaching hospitals. Nurses' job satisfaction and intent to stay were at the borderlines, which require the immediate attention of nursing and hospital administrators. Nurses' job satisfaction and intent to stay, particularly in teaching hospitals, have to be promoted; thus, interventions have to be effectively initiated and maintained at the unit and organizational levels.     

Relationships among conflict, conflict management, job satisfaction, intent to stay, and turnover of professional nurses in Thailand*

Abstract This study was conducted to describe level of conflict, conflict management styles, level of job satisfaction, and intent to stay, and to ascertain relationships among conflict, conflict management styles, level of job satisfaction, intent to stay, and turnover of professional nurses in Thailand. The sample was 354 professional nurses employed in four regional hospitals in Thailand. The findings showed that the overall level of conflict was at a moderate level. The majority of subjects used accommodation most frequently to manage conflict. Subjects were dissatisfied with pay but were neither satisfied nor dissatisfied with work, supervision, opportunities for promotion, co-workers and the job in general facets of job satisfaction. Most subjects had a high intent to stay in their present jobs for 1 year (97.1%) but intent to stay for the next 5 years decreased (78.5%). The result showed some relationships among these variables, but no relationship between intent to stay and turnover of professional nurses.     

The impact of seclusion on the treatment outcomes of psychotic in-patients

The controversial practice of seclusion for the treatment of the acutely emotionally ill continues despite a lack of proven effectiveness. This retrospective cohort study examined the impact of seclusion alone and in combination with other important patient-centred treatment variables (medications), disease severity variables, psycho-social and demographic variables that best predicted outcome (as defined by length of hospital stay and reduced pathology at discharge) for a group of consecutively admitted psychotic in-patients. Comparisons of baseline and outcome measures for secluded and non-secluded cohorts were made via t-test analysis, and patient-related variables were entered as groups for stepwise regression analysis to determine those factors that could best predict outcome. Data were collected via a comprehensive chart review of 85 patients with psychosis, who were consecutively admitted over an 8-month period to a psychiatric in-patient unit of a general community hospital in southern Ontario, Canada. Bigelow's Psychiatric Symptom Assessment Scale (PSAS) was applied to the chart admission and discharge data to determine both initial pathology scores and pathology change scores. Investigator-developed global rating scales measured the early pharmacological and psycho-social variables of interest. Although seclusion itself did not appear to be associated with any more or less improvement in mental status at discharge, seclusion was associated with a 12-day increase in length of hospital stay, raising additional questions about its therapeutic effectiveness. Early medication response together with seclusion predicted 16% of the total variance of length of hospital stay (P = 0.0011) while baseline pathology, being married and being employed together predicted 66% of reduced pathology at discharge (P = 0. 00001). Secluded subjects experienced an earlier age of illness onset, were employed or full-time students, exhibited poorer attitude towards hospital, were more likely to be substance or drug abusers, received greater doses of chlorpromazine-equivalent medications, and had longer lengths of hospital stay than their non-secluded cohorts. Two predictive regression equations were formulated on the basis of these results. This study has raised several questions for further prospective investigation, has validated previous findings in the literature, and has produced new findings that may be of interest to administrators and clinicians providing quality care to this high-risk population.     

A Methodological Approach to Enhance External Validity in Simulation Based Research

Simulation methodology, as exemplified by use of vignettes, has many advantages, such as standardization of data collection procedure, control of extraneous variables, and manipulation of variables of interest. The main shortcoming is its artificiality and therefore its limited external validity.

To determine the degree to which findings from simulation research are transferable to the real world, a comparison can be made using the same measure on artificial and real situations, or the researcher can determine the degree to which a score on the simulation compares with a score in the field. The predictive validity approach was used in a study that used an artificial method to study patient assault. In this study, the intent was to determine the degree of accuracy that the subjects' causal attribution scores on an assault vignette were predictive of causal attribution scores in the actual assault situation.     

A methodological approach to enhance external validity in simulation based research

Simulation methodology, as exemplified by use of vignettes, has many advantages, such as standardization of data collection procedure, control of extraneous variables, and manipulation of variables of interest. The main shortcoming is its artificiality and therefore its limited external validity. To determine the degree to which findings from simulation research are transferable to the real world, a comparison can be made using the same measure on artificial and real situations, or the researcher can determine the degree to which a score on the simulation compares with a score in the field. The predictive validity approach was used in a study that used an artificial method to study patient assault. In this study, the intent was to determine the degree of accuracy that the subjects' causal attribution scores on an assault vignette were predictive of causal attribution scores in the actual assault situation.     

Work and non‐work social support and intent to stay at work among Jordanian hospital nurses

ABUALRUB R.F. (2010) Work and non‐work social support and intent to stay at work among Jordanian hospital nurses. International Nursing Review 57 , 195–201 Purpose: To examine (1) the level of intent to stay at work among Jordanian nurses; (2) the levels of at‐work and non‐work social support; and (3) the extent of variance in the level of intent to stay at work because of the demographic and social support variables. Design: A survey design was used to investigate the predictors of intent to stay at work among the population of Jordanian nurses in three public hospitals. Two hundred and seventy five participants submitted complete and usable questionnaires. The response rates were 50%, 55% and 70%, respectively. Methods: Data were collected using a questionnaire that included a scale for measuring social support, the McCain's Intent to Stay Scale and the demographic form. Findings: The results showed that support from supervisors, marital status, number of friends at work, number of children at home, gender, time commitment, support from co‐workers and support from family accounted for 60% of the variation in the level of intent to stay. The results indicated that nurses who were females, had children at home, worked full time and perceived having more support from co‐workers and supervisors tended to stay at work more than others. On the other hand, the results showed that marital status, number of friends at work and family support were associated negatively with intent to stay at work. Conclusion: The findings of the study suggest the important role of workplace social support in enhancing the level of intent to stay at work.     

Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma

OBJECTIVE: To determine the utility of thoracic computed tomography (TCT) in the initial assessment of critically ill patients with chest injuries. DESIGN: Prospective observational study of cohorts. SETTING: Trauma intensive care unit (ICU) of a Spanish Level III hospital (US equivalent Level I). PATIENTS: Three hundred seventy-five patients with chest injuries were studied, grouped into two cohorts according to whether they underwent admission TCT (exposed cohort, group I, n = 104) or not (unexposed cohort, group II, n = 271). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic data, initial severity scores, and chest radiograph (CXR)-based diagnosis were collected in all patients as independent variables. In patients of group I, we also recorded the TCT-based diagnosis and any incidents, complications, or therapy changes resulting from the TCT. The need for and duration of mechanical ventilation, length of ICU stay, and ICU mortality were gathered in the whole sample as dependent variables. The admission data were similar in the two groups, except for a higher Injury Severity Score (ISS) and thoracic ISS in group I. TCT proved to be more sensitive than CXR in detecting pulmonary contusion, hemothorax, pneumothorax, and vertebral fractures and in identifying the faulty placement of chest drainage tubes. TCT findings induced therapy changes in approximately 30% of patients in group I. In the other dependent variables studied, there were no differences between the two groups. In the multivariate analysis, the TCT screening had no effects on the time on mechanical ventilation, length of ICU stay, or mortality. CONCLUSIONS: TCT detects more chest injuries in trauma patients than does CXR and induces therapy changes in a considerable number of patients. However, this does not translate into an improvement in clinical outcomes.     

Functional status of patients with end-stage renal disease

A longitudinal study of 979 patients with end-stage renal disease from 27 dialysis centers in the Upper Midwest was conducted to measure the patients' functional status with use of the Karnofsky Activity Scale. At the initiation of dialysis, 50% of all patients were rehabilitated or caring for themselves, and the three variables that most influenced the initial rehabilitation score were age, diabetic status, and sex. Initial functional status was also analyzed for three cohorts of dialysis patients, grouped according to outcome (renal transplantation, continued dialysis, and death). Patients who received a renal transplant had initial rehabilitation scores that were higher than those who underwent dialysis for 2 years or those who died. In the group of patients who underwent dialysis for 2 years, a statistically significant improvement in rehabilitation scores was noted at 2 years in comparison with the scores obtained at the initiation of dialysis. Initial rehabilitation scores were good predictors of the 2-year scores. Of the patients in the 2-year dialysis cohort, 78% maintained or had improvement in their functional status.     

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.     

Leadership practices and staff nurses' intent to stay: a systematic review

cowden t., cummings g. & profetto-mcgrath j (2011) Journal of Nursing Management 19 , 461–477
Leadership practices and staff nurses’ intent to stay: a systematic review Aim The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers’ leadership practices and staff nurses’ intent to stay in their current position. Background The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses’ intent to stay is fundamental to retaining nurses in the workforce. Methods Published English language articles on leadership practices and staff nurses’ intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles. Results Relational leadership practices influence staff nurses’ intentions to remain in their current position. Conclusion This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses’ intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research. Implications for Nurse Managers Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge.     

Characteristics associated with intent to stay among Quality Improvement nurses

Kim E.K. & Hwang J.I. (2011) Characteristics associated with intent to stay among Quality Improvement nurses. International Nursing Review 58 , 89–95 Aim: The study aims to investigate characteristics associated with intent to stay among Quality Improvement (QI) nurses in Korean hospitals. Background: QI nurses have recently emerged as a new specialty area in the nursing profession in Korea. They have played a major role in coordinating and facilitating hospital‐wide QI activities. However, their frequent turnover degrades the continuity of overall QI programmes and incurs additional costs in human resource management. Methods: A cross‐sectional questionnaire survey was administered to 123 QI nurses in 123 general hospitals. The collected data included their hospital and department characteristics, work demand, job satisfaction, organizational commitment and demographics. The response rate was 94.3% (n = 116). Multiple logistic regression analysis was performed to determine the factors associated with intent to stay. Findings: Only 32.8% intended to stay in their current job. Significant factors associated with intent to stay were affective commitment and work demands. QI nurses with a higher level of affective commitment were more likely to stay [odds ratios (OR) = 2.50], whereas those with higher quantitative work demands in QI education and support were less likely to stay (OR = 0.40). Conclusion: The findings indicated that intent to stay was closely associated with work environment characteristics. Efforts to enhance their affective commitment and support their workload management are needed to increase the retention of qualified and experienced QI nurses.     

Predictive validity of Rappaport's Disability Rating Scale in subjects with acute brain dysfunction

We implemented a correlational study to evaluate the effectiveness of Rappaport's Disability Rating Scale in predicting length of hospital stay and discharge status. We evaluated 128 patients who had had cerebrovascular accidents or head injuries using Rappaport's Disability Rating Scale and documented their lengths of stay and discharge dispositions. Significant correlations were obtained between initial Disability Rating scores and lengths of hospital stay (r = .50, p less than .01), discharge Disability Rating scores (r = .66, p less than .01), and discharge status (r = .40, p less than .01). Higher initial ratings of disability were associated with higher discharge ratings and longer terms of hospitalization. Higher ratings of disability were also associated with discharge to another treatment facility rather than home. Despite this evidence supporting the predictive validity of Rappaport's Disability Rating Scale, accurate prediction of length of hospitalization remains difficult because of extreme sample variability. Areas of further investigation are considered.     

The CNS's impact on process and outcome of patients with total knee replacement

This study was designed to determine whether differences exist between patients with total knee replacement on hospital units with or without clinical nurse specialists (CNSs) in terms of selected process and outcome variables. The charts of 128 randomly chosen patients who had undergone total knee replacement were reviewed. Sixty-four patients were from orthopedic units with CNSs and 64 were from orthopedic units without CNSs. This study was based on Donabedian's framework for assessment of quality of care using structure, process, and outcome variables. Structural variables were collected on institutional and unit demographics. Data were gathered on nursing care interventions (process variables) using process instruments designed by the investigator. Length of stay, total length of stay, which included rehabilitation length of stay, and complications were the outcome variables used. Patients on units with CNSs had significantly higher process scores, shorter total length of stay, and fewer complications than patients on units without CNSs. In addition, significant negative correlations were found between process instrument scores and total length of stay. Higher scores on the process instruments (with CNS units) were correlated with shorter total length of stay. The number of complications was also negatively correlated to the process instrument scores.     

社区护士工作嵌入与留职意愿调查

目的：了解社区护士工作嵌入和留职意愿情况。方法;采取便利取样方法,选取某市28个社区的140名社区护士进行问卷调查,并进行统计学分析。结果：社区护士的工作嵌入平均分为（3．38±0．44）分,留职意愿平均分为（3．85±0．69）分,工作嵌入与留职意愿之间存在显著的正相关（r=0．523,P〈0．05）,工作嵌入是预测社区护士留职的重要变量。结论：社区护士的工作嵌人处于中等水平,留职意愿处于高水平;若提高社区护士的工作嵌入水平,将会增强护士的留职意愿。     

Demographic diversity, value congruence, and workplace outcomes in acute care

Nursing scholars and healthcare administrators often assume that a more diverse nursing workforce will lead to better patient and nurse outcomes, but this assumption has not been subject to rigorous empirical testing. In a study of nursing units in acute care hospitals, the influence of age, gender, education, race/ethnicity, and perceived value diversity on nurse job satisfaction, nurse intent to stay, and patient satisfaction were examined. Support was found for a negative relationship between perceived value diversity and all outcomes and for a negative relationship between education diversity and intent to stay. Additionally, positive relationships were found between race/ethnicity diversity and nurse job satisfaction as well as between age diversity and intent to stay. From a practice perspective, the findings suggest that implementing retention, recruitment, and management practices that foster a strong shared value system among nurses may lead to better workplace outcomes.     

Early assessment of post-stroke patients entering acute inpatient rehabilitation: utility of the WASI and HVLT-R

OBJECTIVE: To examine the clinical utility of two brief assessment tools, the Wechsler Abbreviated Scale of Intelligence (WASI) and the Hopkins Verbal Learning Test-Revised (HVLT-R). We hypothesized that these measures would predict continued need for supervision and functional outcome at discharge. DESIGN: In this retrospective review, 44 patients with stroke who were admitted for acute inpatient rehabilitation were measured on five variables: WASI, HVLT-R, length of stay, FIM discharge scores, and need for supervision on discharge. RESULTS: Performance on the HVLT-R and WASI matrix reasoning subtest of the WASI was predictive of cognitive discharge scores on the FIM and need for supervision on discharge. The WASI similarities subtest was not associated with outcome. CONCLUSIONS: WASI matrix reasoning and HVLT-R are brief neuropsychological measures that are predictive of need for supervision and functional outcome in the acute stroke rehabilitation setting.     

A resource-based perspective on retention strategies for nurse epidemiologists

AIM: This paper is a report of a study to evaluate the intent of epidemiologists to remain in their chosen career and identify the variables that contributed to or predicted their intent to stay. BACKGROUND: Recently, emerging new infections, such as severe acute respiratory syndrome or bird flu, have placed significant occupational and psychological stress on epidemiologists, especially in South-East Asia, resulting in a high intent to change their career. In the light of possible staff shortages, retention strategies for epidemiologists have gained importance. METHODS: A self-administered questionnaire survey and stratified sampling were used to collect data from 351 epidemiologists including nurse epidemiologists in Taiwan in 2005; response rate was 70.6%. Correlation analysis and hierarchical multiple regression analysis were used to examine relationships among occupational stress, psychological stress, human resources and intent to stay in their career. RESULTS: Occupational stress, psychological stress and human resources had an impact on epidemiologists' intent to stay in their career. Results show that the relationship between occupational stress (operation and personal safety hazard) and intent to stay could be influenced by organizational capital, and the relationship between emotional distress and intent to stay could be influenced by a broad spectrum of human resources (organizational, social and human capital). CONCLUSION: The severe acute respiratory syndrome epidemic raised worldwide attention and challenged epidemiologists' intent to stay. Results indicate that human resources play an important role in this issue. Managers should enhance human resources in organizations as much as possible to attenuate epidemiologists' stress, which may, in turn, strengthen their intent to stay.