Intention to leave the nursing profession

BACKGROUND: The NEXT Study (Nurses' Exit Study) was initiated in 10 European countries in order to shed light on nurses' working conditions and reasons of shortage. OBJECTIVES: The study objective was to determine organisation and psychosocial conditions that lead to premature departure from the nursing profession. METHODS: The questionnaire we used took into account aspects such as work history, work demands and organisation, career prospectives and individual resources. This article describes steps related to the construction and validation of the questionnaire and sampling methods. Preliminary results are also reported. Data analysis, performed in relation to the intention to leave the nursing profession, showed the distinctiveness of the situation in Italy compared to other European countries. RESULTS: Conditions related to intention to leave are multifaceted, but they can be summarized as inadequacy of facilities to support the family needs of staff low level of trust in official structures, together with poor support by colleagues and superiors, work overload, and lack of independence at work--although the latter is foreseen in current legislation--and scant career and development possibilities. CONCLUSIONS: These results confirm the existence of a difficult situation, although certain legislative changes are aimed at solving these problems.     

Nurse overtime, working conditions, and the presence of mandatory nurse overtime regulations

Although more states have regulated mandatory nurse overtime, limited research has examined the impact of these regulations on the actual time nurses work and their working conditions. The purpose of this study was to compare nurse overtime and working conditions between states with and states without regulations limiting mandatory nurse overtime. Data were collected from registered nurses working in hospitals located in states with and without mandatory nurse overtime regulations; the final sample consisted of 219 nurses. No difference was found in overtime worked between nurses who worked in states with regulations or without. Those nurses working in states with regulations cared for more patients per shift and experienced more chronic nursing shortages on their nursing units than those working in states without regulation. Continuous efforts are needed to improve the implementation of regulations to reduce nurse mandatory overtime and long work hours.     

Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study

BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.     

Nurses' intent to leave the profession: issues related to gender, ethnicity, and educational level

BACKGROUND: The increase in demand for registered nurses will exceed supply by 29% by 2020, which is due in part to difficulties in retaining the existing nursing workforce. The researchers postulated that nursing professionals are experiencing a higher level of job dissatisfiers than motivators, and this is causing a high percentage of nurses to consider leaving the profession. Prior research has found that nurses' dissatisfaction with their working environments is a predictor of their intent to leave their professions; however, few have addressed the demographic characteristics of the population as predictors of this intent. PURPOSE: The purpose of this study was to explore issues relating to the retention of the existing nursing workforce. This article describes the results of a research study that was designed to identify and evaluate the variables that contribute to nurses' intent to leave their profession and the relationships of gender, ethnicity, and educational levels to this intent. METHODOLOGY: Data were collected from 284 nurses, of which 46% indicated that they were considering leaving their profession. Using multiple regression analysis, the researchers were able to test whether certain groups (according to gender, ethnicity, and education levels) had a greater intent to leave the profession and what factors were related to each subgroups' intent to leave. FINDINGS: The results of this study revealed that (a) nurses who are male, are White-non-Hispanic, or have less than a master's degree are more inclined to consider leaving the nursing profession, and (b) benefits were a more important consideration to male and White-non-Hispanic nurses regarding their intent to leave the nursing profession. PRACTICE IMPLICATIONS: In today's environment of low reimbursement and high cost containment, health care managers need to focus on those items that will have the greatest impact on retaining high-quality nurses because nurses "make the critical, cost-effective difference in providing safe, high-quality patient care."     

Retaining nurses in their employing hospitals and in the profession: effects of job preference, unpaid overtime, importance of earnings and stress

The purpose of this paper is to examine the effects of job preference, unpaid overtime, importance of earnings, and stress in retaining nurses in their employing hospitals and in the profession. Data come from our survey of 1396 nurses employed in three teaching hospitals in Southern Ontario, Canada. Data are analyzed first for all nurses, then separately for full-time, part-time, and casual nurses. Results show that the key to understanding the effects of these variables may be to pay attention to the work status of nurses. With regards to retaining nurses in their hospitals, working in their preferred type of job is important, particularly for part-time nurses. Working unpaid and longer than agreed hours is also a factor for increasing the likelihood of part-time nurses to leave the profession. All nurses are less inclined to leave as the importance of their earnings for the family increases, but it is particularly important for part-time nurses. Stress is an ongoing concern for retaining nurses in their hospitals and within the profession. We suggest managers and policy makers pay attention to employing nurses in jobs they prefer, decrease unpaid overtime, and consider the importance of earnings for them and their families in developing policies and programs to retain nurses. More importantly, stress levels should be lowered to retain nurses.     

Factors associated with work ability and intention to leave nursing profession: a nested case-control study

This study aims to identify factors associated with impaired work ability and intention to leave the nursing profession. This is a case-control nested within a cross-sectional study. Samples were randomly selected for work ability (475 controls and 158 cases) and intention to leave profession (454 controls and 151 cases). Data on demographic, lifestyle, occupational features, work environment, work ability and intention to leave profession were collected. Multiple logistic regression analysis was performed. Factors associated with work ability impairment were: risk for moderate (OR=1.28) and high (OR=2.26) job strain, effort-reward imbalance (OR=2.82), high overcommitment (OR=1.77), situations that may contribute to musculoskeletal pain/injury with moderate (OR=1.82) or high (OR=2.58) exposures, degree level (OR=2.13) or elementary/high school level (OR=1.67), and low physical activity (OR=1.74). Age of 31–40 years (OR=0.26) and ≥41 years (OR=0.27) were protective factors. Factors associated with intention to leave profession were: high risk for job strain (OR=1.81), effort-reward imbalance (OR=3.25), situations that may contribute to musculoskeletal pain/injury with high exposure (OR=1.54), and insomnia symptoms (OR=2.72). Age >40 years was a protective factor (OR=0.50). Individual characteristics and occupational conditions were associated with work ability impairment and intention to leave profession. Measures to improve working conditions and individual resources were recommended.     

乡镇卫生院护理人员工作现状及离职意愿研究

目的:描述乡镇卫生院护理人员工作现状和离职意愿,并分析工作量和工作内容对离职意愿的影响,为改善基层护理工作提出建议。方法:采用多阶段分层整群随机抽样,对我国三个省45家乡镇卫生院的167名护理人员进行问卷调查,并深度访谈44名护理人员。结果:深化医改以来,农村基层护理人员工作量增加,62%认为自己的工作量大。护理工作占护理人员平均工作时间的60%;公共卫生服务工作占平均工作时间的21%。30%的被调查者具有离职意愿。在控制省份、工作量、婚姻状况、编制、文化程度和从医年限等混杂因素后,公共卫生服务参与情况与护理人员离职意愿显著相关(P0.05)。结论:医改后乡镇卫生院护理人员工作内容扩展、工作量增加,工作内容的扩展降低了护理人员的离职意愿。     

Violence risks in nursing--results from the European 'NEXT' Study

BACKGROUND: Recent research suggests that violence in health care is increasing and that it strongly influences the recruitment and retention of nurses as well as sick leave and burnout levels. AIMS: To identify the prevalence of violence in nursing and to provide a basis for appropriate interventions. METHODS: Nurses from 10 European countries answered to a questionnaire and to a follow-up assessment. Stepwise adjusted multiple logistic regression was used to assess the association between frequency of violence, factors related to teamwork and other work-related factors and outcomes, such as burnout, intention to leave nursing and intention to change institution. RESULTS: A total of 39,894 nurses responded to the baseline questionnaire (51% response rate). After adjustment for age, gender and other risk factors, quality of teamwork appeared to be a major factor with odds ratio (OR) 1.35 (1.24-1.48) for medium quality and 1.52 (1.33-1.74) for low quality. Uncertainty regarding patients' treatments was linked with violence, with a clear gradient (OR 1.59, 1.47-1.72 for medium uncertainty and 2.13, 1.88-2.41 for high uncertainty). Working only night shift was at high risk (OR 2.17, 1.76-2.67). High levels of time pressure and physical load were associated with violence OR 1.45 (1.24-1.69) and 1.84 (1.66-2.04), respectively. High and medium frequency of violence was associated with higher levels of burnout, intent to leave nursing and intent to change institution. A 1-year follow-up assessment indicated stability in the relationships between outcomes. CONCLUSION: This study supports efforts aimed at improving teamwork-related factors as they are associated with a decrease in violence against nurses.     

优质护理服务示范工程对护士工作压力与职业倦怠的影响

目的 探讨开展“优质护理服务示范工程”活动对护士工作压力与职业倦怠的影响.方法 将参加“示范工程”的3个病区60名护士为试验组,其他选择未参加“示范工程”的3个病区42名护士为对照组,两组均采用护士工作压力量表和工作倦怠量表.结果 试验组护士在护理专业及工作方面的问题、患者护理方面问题工作压力明显低于对照组护士.两组护士在护理专业、时间分配、工作环境、患者护理,以及工作压力源总分方面有统计学差异（P＜0.01）,但在管理方面得分无统计学差异（P＞0.05）;试验组护士在情绪耗竭、倦怠和成就感低落方面明显高于对照组,差异有统计学意义（P＜0.01）.结论 “示范工程”和护士工作压力源与职业倦怠存在相关性.     

Impact of States' Nurse Work Hour Regulations on Overtime Practices and Work Hours among Registered Nurses

Objectives

To examine the degree to which states’ work hour regulations for nurses—policies regarding mandatory overtime and consecutive work hours—decrease mandatory overtime practice and hours of work among registered nurses.

Methods

We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes.

Principal Findings

The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively.

Conclusions

State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses.     

Effort-reward imbalance among nurses in stable countries and in countries in transition

The effort-reward imbalance (ERI) model was used to analyze burnout and intention to leave the nursing profession (ITL) in nurses (n = 21,229) in seven European countries, as part of the NEXT-Study. Data were gathered using the short form of the ERI questionnaire. Burnout was assessed using the Copenhagen Burnout Inventory. Multivariate logistic regression analysis controlled for age and gender. ERI was very high in Poland, Germany, Italy, and Slovakia. High ERI was associated with burnout. Odds ratios (ORs) ranged from 2.6 to 13.2 for ERI and from 3.0 to 5.5 for overcommitment (OC). Nurses with high ERI also had high ORs for ITL (2.6-5.7). The association of OC and ITL was weaker (1.1-1.7). The strong and consistent associations of ERI model results with psychological health and with ITL support the relevance of the model for examining different outcome levels. Nurses in transitional countries, as expected, experienced high ERI. High ERI in stable countries suggests that their economic sectors, particularly health care, may be in transition.     

Premature departure from nursing in Germany as a growing problem for the health care system -- a review

There is a shortage of nursing staff in almost all of the countries in the European Union. This problem is expected to increase within the next decades as a result of demographic changes. Efforts to improve training or recruiting nurses from other countries such as future EU member states are unlikely to solve the problem. Premature departure from the nursing profession occurs more frequently than in other professional fields in Germany. There is little known about the underlying reasons of this. The authors present data regarding the early departure of nursing staff from the profession. They propose that a lengthened stay in nursing could help solve the above problem. In order for specific measures to take place (to solve this), more knowledge is needed regarding the causes and circumstances surrounding the early departure of nursing staff. This is the object of the European NEXT-Study ( http://www.next-study.net ), in which research groups from 10 European countries are taking part. Starting in Autumn 2002, between 5000 and 8000 nurses will be questioned in each of the 9 countries, in this longitudinal study. The first findings will be submitted in Summer 2003.     

Predicting Nurses’ Turnover: The Aversive Effects of Decreased Identity,Poor Interpersonal Communication,and Learned Helplessness

Through a social identity theoretical lens, this study examines how nurses’ identification with their working small group, unit, or floor, nursing role (e.g., staff ER nurse, nurse practitioner), and nursing profession relate to nurses’ interaction involvement, willingness to confront conflict, feelings of learned helplessness, and tenure (employment turnover) intentions. A cross-sectional survey (N = 466) was conducted at a large, quaternary care hospital system. Structural equation modeling uncovered direct and indirect effects between the five primary variables. Findings demonstrate direct relationships between nurse identity (as a latent variable) and interaction involvement, willingness to confront conflict, and tenure intentions. Feelings of learned helplessness are attenuated by increased nurse identity through interaction involvement and willingness to confront conflict. In addition, willingness to confront conflict and learned helplessness mediate the relationship between interaction involvement and nurses’ tenure intentions. Theoretical extensions include indirect links between nurse identity and learned helplessness via interaction involvement and willingness to confront conflict. Implications for interpersonal communication theory development, health communication, and the nursing profession are discussed.     

Professional and clinical differences amongst clinicians dealing with sexual problems in the United Kingdom

The varied practices of physicians, psychologists, nurses and therapists were recorded as part of a collaboration between seven European countries. This paper describes sexual and relationship problems presented by patients to UK clinicians working in the field of human sexuality. Differences in the professional groups and approaches towards treating these problems by physicians and non-physicians are reported and discussed. The majority of clinicians working in human sexuality within the United Kingdom are female non-physicians. Nurses and marital counsellors were the largest professional group within the multidisciplinary profession of sexology working in the United Kingdom. Fewer UK clinicians have undergone training in sexology that their European counterparts and only 46% of clinicians working in the field describe themselves as a sexologist or sex therapist. The vast majority of clinicians did not devote more than a quarter of their work time to sexual problems and sexual dysfunction.     

Leaving nursing: an event-history analysis of nurses' careers

OBJECTIVES: The current shortage of nurses is a major problem for health care systems around the world and has revitalized interest in the dynamics of nurses' careers. This paper investigates the factors associated with qualified nurses in Britain moving to different employment statuses, including jobs outside nursing, unemployment, maternity leave and family care over time.METHODS: British Household Panel Survey (BHPS) data collected between 1991 and 2001 were used to estimate the effects of covariates on transition rates between different employment statuses.RESULTS: Individual characteristics associated with shorter tenure in the profession include being male, being younger, having a degree, and having been born in the UK. Many nurses leave to care for their families, which suggests the possibility of returning to the profession at a later date. A number of job characteristics are also related to leaving, including low pay, managerial responsibility, full-time work and lack of opportunities to use initiative. Nurses seem to be particularly vulnerable to leaving early in their careers, but those who survive the first few years are likely to remain in the profession for the rest of their working lives.CONCLUSIONS: It is particularly important in policy terms that ability to use initiative is related to leaving nursing for another form of full-time employment and, in particular, to leaving for a better job. This finding is consistent with results from studies of the Magnet hospitals in the US. Taken together, these results suggest that strategies to improve nurse retention must attend to nurses' status, authority and position in the hierarchy if they are to be successful. The results also provide strong support for those who argue that better rates of pay are necessary in order to improve nurse retention.     

The NHS Plan: nurse satisfaction, commitment and retention strategies.

The NHS Plan envisages a paradigm shift from a centralized, producer-led National Health Service (NHS) to a devolved, patient-centred health care service, fuelled by a substantial investment in human resources, beds, hospitals and infrastructure. The planned net increase of 20,000 nurses by 2004 is examined in the light of findings from a qualitative study of nurse satisfaction, commitment or intention to leave their hospital, nursing or the NHS, involving 124 nurses in four London hospitals. This paper presents nurses' perceptions and rankings of retention strategies and we compare these with the Plan's proposals. Lastly we propose an integrated approach to examining and dealing with the complex issue of nurse recruitment, retention and quality of patient care, based on a conceptual framework, the Nurse Satisfaction, Service Quality and Nurse Retention Chain, which highlights the scope of the challenges confronting the Plan, in both design and implementation of proposals designed to improve working conditions as a foundation for nurse recruitment and retention. Our principal findings are that just 57% of our interviewees may be viewed as 'core loyals' to the profession, 12% are serious in their intention to leave and the remainder may be sensitive to further deterioration in working conditions or a failure to meet expectations on pay. Such findings if realized clearly threaten the Plan's success.     

The relationship between dual practice,intention to work abroad and job satisfaction: A population-based study in the Serbian public healthcare sector

Increasing dual practice and emigration of health workers threatens the effectiveness of the healthcare system. Insufficient information exists about these phenomena in the transitional countries of South-East Europe. Serbia, a European Union candidate, permits dual practice and there is a high intention to work abroad among its prospective healthcare professionals. A population-based, cross-sectional study was conducted to determine the prevalence and predictors of job satisfaction, dual practice, and intention to work abroad of all workers in the Serbian public healthcare sector (73,940 employees, a response rate of 83.8%). This study observed that 22.6% of the respondents were dissatisfied with their jobs, 11.7% reported dual practice, and 14.3% had an intention to work abroad. Physicians and nurses younger than 55 years of age employed in a tertiary healthcare institution, and males were more likely to be dissatisfied than other workers. Poor management and working conditions increased job dissatisfaction, with a subsequent increased odds for dual practice and intention to work abroad by 1.5 and 3.6 times, respectively. The national and institutional framework for health workforce policy and management must be powerful and efficient when taking advantage of the positive effects and managing the negative aspects of dual practice and the intention to work abroad.     

北京市ICU护士工作压力、工作-家庭冲突对灵活工作实践归因的影响

目的 分析北京市重症监护室(ICU)护士工作压力、工作-家庭冲突与灵活工作实践归因相关性.方法 运用便利抽样方法选取2017年1月—2018年1月北京市6家医院364名ICU护士作为研究对象,调查其基本情况、工作压力、工作-家庭冲突和灵活工作实践归因得分.采用单因素比较、Pearson相关性和多元线性回归,分析灵活工作...     

团体心理咨询在合同制护士心理调适中的应用

目的探讨团体心理咨询对合同制护士工作压力的影响。方法选取某军队医院合同制护士80名作为干预组进行6周团体心理咨询,同时选取该院80名合同制护士作为观察组,不进行任何心理干预。采用自编护士一般资料调查表、护士工作压力源量表对两组护士分别进行评估。结果两组护士在年龄、级别、受教育程度、工作年限和婚姻状况方面均无统计学差异（P〉0.01）;采取干预措施后干预组护士在护理专业及工作方面的问题、时间分配及工作量问题、患者护理方面问题、管理及人际关系方面的问题工作压力明显低于观察组护士。两组护士在护理专业、时间分配、工作环境、患者护理、管理以及工作压力源总分方面有统计学差异（P〈0.01）。结论团体心理咨询有助于帮助合同制护士了解自己、减轻工作压力、改善人际关系,提高工作积极性和效率。     

The changing context of Western European healthcare systems: convergence versus divergence in nursing problematics

Many countries reorganizing their health services are drawn toward similar reform programs and tend to experience what seem to be similar problems relating to implementation outcomes. One such problem is the major crisis within the nursing profession relating to the labor market, working conditions and level of autonomy. This research examines the thesis that the profile of nursing problems is global (the 'convergence' thesis) by comparing the changing hospital contexts nursing has been confronting in 20 Western European countries between 1990 and 2001. The analysis indicates that in spite of growing convergence, the divergence in patient care processes, workforce composition and resources allocated for care is still rather remarkable and that similarity or divergence between countries changes over time. This contextual variability highlights why problems such as the crisis of the nursing profession must be analysed from a divergent rather than a convergent perspective.