The first year: employment patterns and job perceptions of nursing assistants in a rural setting

Meyer D., Raffle H. & Ware L.J. (2014) Journal of Nursing Management 22 , 769–778 The first year: employment patterns and job perceptions of nursing assistants in a rural setting Aim The aim of this study was to follow rural certified nursing assistants (CNAs) (n = 123) in the United States for 1 year post-training to identify retention and turnover issues in the long-term care (LTC) setting by exploring the CNAs’ perceptions of the LTC work experience. Background Turnover among CNAs impacts the quality of care, imposes a financial burden on facilities and taxpayers, and creates increased stress and workloads on those who remain. Method A longitudinal survey design was used to track individuals completing CNA training for 1 year. Results At 1 year post-training, 53.7% of respondents currently worked in LTC, 30.9% worked in LTC and left, and the remaining 15.4% never worked in LTC. Conclusion While the training site does not appear to impact retention, the first 6 months of employment appear critical. The CNAs cited pay as a reason for leaving LTC, but better pay did not characterize the jobs taken by the CNAs who left. Implications for nursing management This study highlights the importance of the first 6 months of employment to retention and provides practical information for nurse managers evaluating the resource-effectiveness of hosting training programmes. Additionally, the key issues influencing retention were identified and practical suggestions for nurse managers to improve retention are provided.     

Structural empowerment and anticipated turnover among critical care nurses

hauck a, quinn griffin mt. & fitzpatrick jj. (2011) Journal of Nursing Management 19 , 269–276
Structural empowerment and anticipated turnover among critical care nurses Aim This study examines the relationship between perceptions of structural empowerment and anticipated turnover among critical care nurses. Background The literature revealed that work environments that provide access to information, resources, support and opportunity create an environment of more satisfied employees, ultimately reducing turnover. Method A sample of 257 nurses completed a background data questionnaire, the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) and the Anticipated Turnover Scale (ATS). Results Nurses in five critical care units perceive themselves to be moderately empowered. Structural empowerment was inversely related to anticipated turnover; those who were more empowered had a lower anticipated turnover score. Conclusion Nurses who perceive themselves as empowered have higher levels of organizational commitment. Organizations that support and recognize these characteristics may experience improved retention rates. Implications for Nursing Management This study is the first to demonstrate a relationship between structural empowerment and anticipated turnover among critical care nurses. Research has demonstrated that workplace behaviours and attitudes are determined by social structures within the workplace. Nurses are responsible for a large portion of health care provided in this country. A serious nursing shortage is expected in the future and will exert pressure on both the supply and the demand of nurses.     

军队疗养院非现役文职护士工作满意度、组织承诺与离职意愿的调查

目的了解军队疗养院非现役文职护士的工作满意度、组织承诺状况以及离职意愿,同时探讨三者的影响因素以及三者之间的相互关系。方法对南京军区杭州疗养院的60名非现役文职护士,采用工作满意度量表、总体工作满意度量表、组织承诺问卷和离职意向问卷进行调查。结果非现役文职护士在工作的满意度、组织承诺、离职意愿三者之间存在不同程度的相互影响,其中工作满意度与组织承诺之间存在密切的正相关,离职意愿与工作满意度及组织承诺存在显著的负相关;而非现役文职护士对薪酬的期望水平对三方面都有影响。结论疗养院的管理者应重视提高非现役文职护士对工作的满意程度,增强组织凝聚力,降低离职率,提高疗养院管理的效率,适当增加非现役文职护士薪酬可降低离职意愿。     

The Job Embeddedness instrument: An evaluation of validity and reliability

A cross sectional correlational mailed survey was used to assess the validity and reliability of the Job Embeddedness (JE) instrument for predicting nurse retention. A regression model using the variables of JE and age were predictive of nurse retention in a sample of Registered Nurses (RNs) working in long term care (LTC) settings. This study supports the multi-dimensionality, validity and reliability of the underlying JE construct. However a different factor structure was suggested that better fit the data. Long term care organizations (LTC) may benefit from a strategy of increasing the embeddedness of their existing employees in order to increase nurse retention. Job embbededness could be used as a foundation to provide effective nurse retention strategies in LTC settings.     

Empowering certified nurse's aides to improve quality of work life through a team communication program

The purpose of this pilot study was to explore the impact of a certified nurse's aide (CNA)-led interdisciplinary teamwork and communication intervention on perceived quality of work environment and six-month job intentions. CNAs are frequently excluded from team communication and decision-making, which often leads to job dissatisfaction with high levels of staff turnover. Using a mixed quantitative and qualitative approach with pre- post-program design, the intervention utilized the strategy of debriefing from the national patient safety initiative, TeamSTEPPS. Inherent in the program design, entitled Long Term Care (LTC) Team Talk, was the involvement of the CNAs in the development of the intervention as an empowering process on two wings of a transitional care unit in a long-term care facility in upstate NY. CNAs' perceptions of work environment quality were measured using a Quality of Work Life (QWL) instrument. Additionally, job turnover intent within six months was assessed. Results indicated improved scores on nearly all QWL subscales anticipated to be impacted, and enhanced perceived empowerment of the CNAs on each wing albeit through somewhat different experiential processes. The program is highly portable and can potentially be implemented in a variety of long-term care settings.     

Voluntary turnover among nurses working in Kuwaiti hospitals

BACKGROUND: Voluntary turnover rates are high among staff nurses working in Kuwaiti hospitals. It is a major problem, costly and it is presumed to impact on the quality of nursing care delivered. AIMS: The two aims of this study were to (1) find out if nurses' resignations in Kuwaiti hospitals could be ascribed to failure in the recruitment process and (2) examine the feelings of nurses who resigned. METHODS: Two sets of exit interviews with 60 nurses who had resigned were conducted. RESULTS: No evidence emerged that any false information or misleading information was provided except for the salary adjustments. The real insight lay in what might not have been said in the recruitment interviews. While feelings of discontent emerged in the interviews relating to the loss of income, the greatest source of complaint related to the failure of managers to solve the evident problems. CONCLUSIONS: High rates of voluntary turnover require more attention from administrators and policy makers because of its potential consequences in terms of the quality of nursing care delivered. Implications for nursing management This paper identifies many causes of nurses' voluntary turnover. It also shows the need for nursing managers to explore these causes and suggests successful strategies for recruitment and retention practices and policies.     

Nurses' participation in personal knowledge transfer: the role of leader-member exchange (LMX) and structural empowerment

davies a., wong c. a. & laschinger h. (2011) Journal of Nursing Management 19 , 632–643
Nurses' participation in personal knowledge transfer: the role of leader–member exchange (LMX) and structural empowerment Aim The purpose of this study was to test Kanter’s theory by examining relationships among structural empowerment, leader–member exchange (LMX) quality and nurses’ participation in personal knowledge transfer activities. Background Despite the current emphasis on evidence-based practice in health care, research suggests that implementation of research findings in everyday clinical practice is unsystematic at best with mixed outcomes. Methods This study was a secondary analysis of data collected using a non-experimental, predictive mailed survey design. A random sample of 400 registered nurses who worked in urban tertiary care hospitals in Ontario yielded a final sample of 234 for a 58.5% response rate. Results Hierarchical multiple linear regression analysis revealed that the combination of LMX and structural empowerment accounted for 9.1% of the variance in personal knowledge transfer but only total empowerment was a significant independent predictor of knowledge transfer (β = 0.291, t = 4.012, P < 0.001). Conclusions Consistent with Kanter’s Theory, higher levels of empowerment and leader–member exchange quality resulted in increased participation in personal knowledge transfer in practice. Implications for nursing management The results reinforce the pivotal role of nurse managers in supporting empowering work environments that are conducive to transfer of knowledge in practice to provide evidence-based care.     

Predicting nurses' turnover intentions by demographic characteristics,perception of health,quality of work attitudes

The purpose of this paper is to examine the impact of demographic variables, organizational commitment levels, perception of health and quality of work on turnover intentions. A self‐reported cross‐sectional survey design was used to collect data from Jordanian registered nurses who were working between June 2011 and November 2011. The findings showed strong effects of the quality of work, perception of health and normative organizational commitments on turnover intentions. This study sheds the light on the important work outcomes in health‐care organizations. Increasing nursing quality of work and normative organizational commitment are good strategies for reducing turnover intentions.     

Bullying and employee turnover among healthcare workers: a three-wave prospective study

hogh a., hoel h. & carneiro i.g. (2011) Journal of Nursing Management 19, 742–751
Bullying and employee turnover among healthcare workers: a three-wave prospective study Aim To investigate the risk of turnover among targets of bullying at work. Background Exposure to bullying seems to leave targets with intentions to leave their workplaces. However, it is uncertain to what extent they actually leave. Method Data were collected by questionnaires in a three-wave study among Danish healthcare workers at the time of graduation (T₁), 1 (T₂) and 2 years (T₃) later. We followed 2154 respondents who participated in all three waves. Results The first year after graduation, 9.2% reported being bullied at work, 1.8% frequently. Follow-up analyses showed a strong relationship between exposure to bullying at T₂ and turnover at T₃ [odds ratio (OR) for frequently bullied = 3.1]. The inclusion of push factors such as low social support and low sense of community, intention to leave and ill health did not change the relation between bullying and turnover significantly. Three reasons for quitting stood out among reasons given by the bullied respondents: poor leadership, being exposed to negative behaviour and health problems. Conclusion Bullying may be costly to an organization in terms of staff turnover and subsequent recruitment and training of replacements. Impact for Nursing Management Managers should regularly monitor the psychosocial work environment. To prevent bullying local policies and procedures should be developed, implemented and evaluated.     

The relationship between South Korean clinical nurses' attitudes toward organizations and voluntary turnover intention: A path analysis

The purpose of this study was to examine the relationship between attitudes toward their organizations and voluntary turnover intention among South Korean clinical nurses. Data from a total of 312 clinical nurses in six hospitals in South Korea were collected for the study. Both hierarchical multiple regression analysis and path analysis were used to analyse the data. The overall fit of the hypothetical model was good. Voluntary turnover intention was found to have significant direct pathways to job embeddedness and organizational commitment. Organizational commitment and satisfaction with organizational rewards had indirect pathways to voluntary turnover intention through job embeddedness. All variances explained 62.3% of the voluntary turnover intention scores. The findings suggest that greater job embeddedness, organizational commitment and satisfaction with organizational rewards lead to lower voluntary turnover intention among clinical nurses in South Korea.     

Nursing staff turnover at a Swedish university hospital: an exploratory study

Aim. The aim was to explore opinions on individual needs and other factors that may influence nursing staff turnover. Background. High staff turnover is a great problem for many hospitals. It is shown to have a negative effect on the quality of nursing care and to increase hospital costs. Design. In 2004 in a large university hospital in Sweden five focus group discussions (FGDs) including department heads (1), nursing managers (2) and members of nursing staff (2) were carried out. The questions to be addressed were ‘Why do nurses leave?’ and ‘Why do nurses stay?’ In addition, register data of staff turnover for 2002–2003 were analysed in relation to different facts about the units, such as number of employees, type of care and medical specialty. Categories of opinions identified in the FGDs were compared with results of the statistical analyses on the relationship between staff turnover and unit parameters to identify overall factors that may influence on nurse staff turnover. Findings. Four major factors were identified as having a possible influence on staff turnover: ‘intrinsic values of motivation’, ‘work load’, ‘unit size ‘and ‘leadership’. Smaller units had lower staff turnover as well as outpatient units and day care. It was not possible to compare statements from participants from smaller units with those from participants from larger units. Two factors had diverging data, ‘salary’ and ‘spirit of the time’. A surprising finding was the little mention of patient care in relation to staff turnover. Relevance to clinical practice. It is important for managers to ensure that intrinsic values of nurses are met to minimise the risk for high turnover rates. Inpatient care must receive adequate staffing and nursing care could be organised into smaller units or work teams to avoid dissatisfaction and high turnover.     

Evaluation of a low-threshold clinic for opiate-dependent drug users

This study reports on the development and outcome of a Low Threshold Clinic (LTC) for opiate-dependent drug users. The service originated as a nursing initiative within an inner city Drug Dependency Centre (DDC) and its rationale and treatment approach are explored in relation to the literature and local circumstances. Client baseline and outcome data were systematically gathered to assess service uptake and service efficacy in terms of client outcome. Data are presented for the first two years of operation during which a total of 59 clients entered the LTC. The sociodemographic characteristics and patterns of drug use among this group suggest the service was successful in targeting clients who previously failed to enter traditional treatment programmes despite initial referral to the DDC. Outcome data indicate a tendency for clients to inject less frequently, engage in less criminal activity and, by 12 months, to reduce their dose of prescribed methadone whilst attending the LTC. Tentative conclusions are drawn concerning the value of this service for 'hard-to-reach' drug users and those who may be at a precontemplation stage of change. Recommendations are made for a more comprehensive evaluative study that involves comparison with other treatment approaches.     

Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals

Purpose: The aim of this study was to examine how nursing unit turnover affects key workgroup processes and how these processes mediate the impact of nursing turnover on patient outcomes.
Methods: A secondary data analysis was used to test the hypothesized model. This study used registered nurse and patient data from 268 nursing units at 141 hospitals collected as part of the Outcomes Research in Nursing Administration (ORNA II) project. Nursing units provided monthly nursing unit turnover rates for 6 consecutive months, and registered nurses completed questionnaires measuring workgroup processes (group cohesion, relational coordination, and workgroup learning). Patient outcome measures included unit-level average length of patient stay, patient falls, medication errors, and patient satisfaction scores.
Results: Nursing units with moderate levels of turnover were likely to have lower levels of workgroup learning compared to those with no turnover ( p <.01). Nursing units with low levels of turnover were likely to have fewer patient falls than nursing units with no turnover ( p <.05). Additionally, workgroup cohesion and relational coordination had a positive impact on patient satisfaction ( p <.01), and increased workgroup learning led to fewer occurrences of severe medication errors ( p <.05).
Conclusions: The findings of this study provide specific information on the operational impact of turnover so as to better design, fund, and implement appropriate intervention strategies to prevent registered nurse exit from nursing units. Further investigation is needed to assess the turnover-outcomes relationship as well as the mediating effect of workgroup processes on this relationship.
Clinical Relevance: Managing nursing unit turnover within appropriate levels at the nursing unit is critical to delivering high-quality patient care.     

Mediating role of work engagement in the relationship between job resources and personal resources with turnover intention among female nurses

BackgroundOne of the latest models proposed with regard to work engagement is the detailed model put forward by Bakker and Demerouti (2007). The present study aims at investigating the effect of job resources and personal resources on turnover intention with the mediator role of work engagement among female nurses at Isfahan Alzahra Hospital. In the current study, job and personal resources were considered as the predictors of job turnover and work engagement was considered as the mediator variable among predictive and criterion variables.MethodThe data of the present study were collected from 208 female nurses who were selected by systematic random sampling. As for the analysis of the collected data, structural equations model, normal distribution method, and Bootstrap method in Macro, Preacher and Hayes, (2004) program were deployed.FindingThe findings showed that the personal resources affect the turnover intention both directly and indirectly (through work engagement); however, job resources are just associated with turnover intention with the mediating role of work engagement.ConclusionThe results of the study have important implications for organizations' managers about improving work engagement.     

Does geriatric nursing staff burnout predict well-being of LTC residents?

Nursing staff in residential settings are exposed to a large number of stressors. This study examined the relationship between geriatric nursing staff (GNS) burnout and the well-being of residents in long-term care (LTC) facilities. Data were obtained concerning 590 older residents who were served by 315 GNS in 172 LTC facilities in Taiwan, using multilevel modeling. The depersonalization (DP) dimension of burnout in GNS was consistently related to various resident well-being outcomes. Higher DP among GNS was associated with lower residential satisfaction and perceived quality-of-life, as well as more depressive symptoms among older LTC residents. The findings support the claim that DP among GNS has a greater role in determining LTC resident well-being than other dimensions of burnout. Efforts should be made to mitigate the emergence of DP among GNS. Support and education are also needed to enable GNS to foster positive interactions and relationships with LTC residents.     

Subjectivity About Turnover Intention Among Male Nurses in South Korea: A Q-Methodological Study

Purpose

Around the world, male nurses face a variety of difficulties within clinical settings; accordingly, a large number of male nurses consider changing their occupation. In particular, male nurses in a number of Asian countries with a Confucian heritage experience difficulties. Thus, the purpose of this study was to explore individual differences in turnover intention among male nurses in one such country, South Korea, and on that basis to suggest concrete strategies for reducing turnover among male nurses in Confucian cultures.

Retooling the RN workforce in long-term care: Nursing certification as a pathway to quality improvement

This article describes a project to improve nursing care quality in long-term care (LTC) by retooling registered nurses' (RN) geriatric clinical competence. A continuing education course was developed to prepare LTC RNs (N = 84) for national board certification and improve technological competence. The certification pass-rate was 98.5%. The study used a mixed methods design with retrospective pretests administered to RN participants. Multivariate analysis examined the impact of RN certification on empowerment, job satisfaction, intent to turnover, and clinical competence. Results showed certification significantly improved empowerment, satisfaction, and competence. A fixed effects analysis showed intent to turnover was a function of changes in empowerment, job dissatisfaction, and competency (F = 79.2; p < 0.001). Changes in empowerment (t = 1.63, p = 0.11) and competency (t = -0.04, p = 0.97) did not affect changes in job satisfaction. Findings suggest RN certification can reduce persistently high RN turnover rates that negatively impact patient safety and LTC quality.