Predictors of critical care nurses’ intention to leave the unit, the hospital, and the nursing profession

Nursing turnover and shortage are acknowledged as worldwide issues: understanding the factors that foster nurses’ intention to leave (ITL) is essential in retaining them. The present study aims at providing insight into the factors influencing critical care and intensive care nurses’ ITL the unit, the hospital, and the nursing profession. The study was conducted in two hospitals, by a questionnaire administered to all nurses employed in critical and intensive care units. 512 questionnaires (89.4%) were returned. Results revealed that a low job satisfaction (JS) for interaction with physicians and nurses, seniority ≥20 years, and working in Emergency are related to higher ITL the unit. Low JS for work organization policies, seniority ≥11 years, working in a private hospital, and higher educational level are related to higher levels of ITL the hospital. Low JS for professional status, for pay, and for work organization policies, age ≥40 years, part-time schedule are related to higher ITL the nursing profession. The research permitted detection of various predictors of different kinds of ITL, enhancing the importance of regular monitoring of ITL. In order to limit ITL, it would be important to work on the relationship with physicians and colleagues, work demands, organizational policies, and acknowledgement of competence.

Evolution of Programs to Improve Transfers between Hospitals and Nursing Homes at the Community Level

This study described the evolution of programs to improve the efficiency of patient movement between hospitals and nursing homes in the metropolitan area of Syracuse, New York. These programs were needed in order to improve coordination among providers in the absence of networks that included both acute and long term care providers. The mechanisms included the exchange of data and monitoring the movement of Difficult to Place patients from hospitals to nursing homes. Between 2006 and 2014, the annual number of Difficult to Place patients increased from 983 to 1836. During this period, annual hospital medical/surgical discharges increased by 7.5 percent, severity of illness increased by 13.7 percent, and the population aged 65 years and over increased by 9.8 percent. Most of the Difficult to Place patients were admitted by the four largest facilities in the community, which accounted for 60 percent of the nursing home beds. The initiatives also included Subacute and Complex Care Programs that provided financial incentives for admission of certain types of patients, such as intravenous therapy and extensive wound care. The programs described how these programs were implemented using minimal financial resources and without adding positions to the participating provider organizations.

Factors associated with the nurses’intent to stay in China,Japan,and Korea:an integrative review

Objective:Nurse’s dimission and attrition are globally considered as a public health issue.However,few studies have focused on the nurse shortage from the perspective of intent to stay,as previous studies have focused only on why they left.The purpose of this study was to conduct an integrative review of the factors connected with why nurses in China,Japan,and Korea stay in their current workplace.Methods:The review was done using three databases namely CNKI,Wanfang,and Web of science.The relevant studies published by Chinese,Japanese,and Koreans from 2010 were also included in this review.Literature screening and data extraction were performed by the two researchers,and the qualitative research methods were used for analysis.Results:A total of 17 studies were analyzed in this review and of these two were qualitative and 15 were quantitative.Three themes and six sub-themes emerged from the synthesization of the data of 17 studies,which will help us to find the factors for nurses’intent to stay.The three aspects such as professional characteristics,nurses’individual characteristics,and organizational factors are the main contributing factors of nurses’intent to stay.Conclusions:This integrated review has thrown some important factors about nurses’intent to stay.It is increasingly clear that when(1)nurses have a good professional status,(2)nurses could enjoy a good working relationship,(3)the workplace could meet the needs of personal development,and(4)nurses have good organizational support and excellent leaders,they are inclined to stay in their current jobs.Managers need to adopt targeted measures to improve nurses’intent to stay and to provide a practical reference for health care institutions and managers in different countries and areas to increase the retention rate of nurses and to alleviate the current situation of nurse shortage.

Nurse practitioner coverage is associated with a decrease in length of stay in a pediatric chronic ventilator dependent unit

AIM: To hypothesize a dedicated critical care nurse practitioner(NP) is associated with a decreased length of stay(LOS) from a pediatric chronic ventilator dependent unit(PCVDU).METHODS: We retrospectively reviewed patients requiring care in the PCVDU from May 2001 through May 2011 comparing the 5 years prior to the 5 years post implementation of the critical care NP in 2005. LOS and room charges were obtained. RESULTS: The average LOS decreased from a median of 55 d [interquartile range(IQR): 9.8-108.3] to a median of 12(IQR: 4.0-41.0) with the implementation of a dedicated critical care NP(P < 1.0001). Post implementation of a dedicated NP, a savings of 25738049 in room charges was noted over 5 years.CONCLUSION: Our data demonstrates a critical care NP coverage model in a PCVDU is associated with a significantly reduced LOS demonstrating that the NP is an efficient and likely cost-effective addition to a medically comprehensive service.

PICU护士谵妄管理行为意向及影响因素的质性研究

目的 以计划行为理论为框架,深入了解PICU护士谵妄管理行为意向及影响因素,为提高PICU谵妄管理质量提供参考。方法 采用目的抽样法对6所三级甲等医院的16名PICU护士进行半结构式访谈,根据Colaizzi七步分析法对访谈资料进行分析,提取主题。结果 共获得3个主题及8个亚主题,包括行为态度(正性态度,负性态度)、主观规范(自我感知压力增加,团队的影响)及知觉行为控制(谵妄认知及应对技能不足,缺乏相关制度与流程,工作负荷过重,缺乏谵妄管理能力培训)。结论 PICU护士对谵妄管理总体持积极态度,但影响因素较多。应提高护理人员对谵妄的认知,加强相关培训力度,建立多学科团队合作机制,以提高PICU谵妄管理质量。

Part-Time Nurse Faculty Intent to Remain Employed in Academia: A Cross-Sectional Study

The purpose of this study was to test and refine a model of part-time nurse faculty intent to remain employed in the academic organization. Cross-sectional survey methods were used. A total of 282 part-time nurse faculty working in colleges or universities in Ontario, Canada were invited to participate. Survey instruments and items measured demographic, workplace, nurse responses to the workplace, and external variables. Correlation, multiple regression, and mediation analyses were conducted using data from 119 participants (47.6% response rate). Of the 19 variables hypothesized to affect intent to remain employed in the academic organization, seven influenced intent to remain. The resulting model indicated that the older the part-time nurse faculty member, the lower the level of intent to remain and the more years worked in the organization, the higher the level of intent to remain. The more opportunities perceived to exist outside of the employing organization, the higher the level of intent to remain. Additionally, the more satisfied part-time nurse faculty were with their job overall, the higher their level of intent to remain. In the workplace, the more support from the leader, the more formal or informal recognition received, and the more fair work procedures were perceived to be, the higher levels of part-time nurse faculty intent to remain employed in the academic organization, mediated by job satisfaction. Although age, organizational tenure, and external career opportunities are non-modifiable variables, deans and directors can encourage part-time nurse faculty to remain employed in their academic job by focusing on enhancing overall job satisfaction. Effective strategies may include formal or informal acknowledgement of good performance, consistent verbal and behavioural support, and implementation of procedural practices, such as performance evaluations and pay raises in a fair manner.

Nurses Perception towards Determinants of Turnover in Psychiatric and General Hospital, Makkah Province

Background: Nurses leaving the profession are of concern to the government. This turnover can take the form of leakage and waste of both human and financial resources for governments that spend money on training nurses. Little is known about the intention to stay or determinants of job satisfaction among nurses in the Makkah region of Saudi Arabia. Aims: The study explores the determinants of intention to stay, job satisfaction, organizational commitment and self-efficacy among nurses. Methods: A cross-sectional study was designed, with a total of 175 nurses in the period between March 2017-July 2017. Results: No statistically significant differences were identified in intention to stay, job satisfaction, organizational commitment and self-efficacy between the psychiatric and the general nurses. A significant correlation was found between nationality, education and income, and intention to stay, job satisfaction, organization commitment and self-efficacy (p Conclusions: The study added various determinants of nurse turnover to the existing body of knowledge, relating to the factors concerning intention to stay, job satisfaction, organizational commitment and self-efficacy amongst general and psychiatric nurses.

Improving Hospital Stays with Community Wide Programs

This study described a series of programs implemented in Syracuse, New York to support the movement of long term acute care patients to skilled nursing facilities. The Difficult to Place Program involved the identification of these patients and the communication of information concerning them between hospitals and nursing homes on a continuing basis. These patients involved approximately 20 percent of new admissions to nursing homes. The Subacute Programs included services such as intravenous therapy and offsite transportation that were not originally available in area nursing homes. The Subacute Program stimulated the development of these services in long term care. The Complex Care Programs have included services for patients with high severity of illness such as multiple intravenous antibiotic therapy and high cost medications. The Subacute and Complex Care Programs included 5 - 6 percent of Difficult to Place patients. The study demonstrated that these programs reduced the number of annual adult medicine and adult surgery patient days by 2288 between 2011 and 2017.

高校护理本科生养老机构从业意愿调查

目的:了解护理本科生养老机构从业意愿现况,分析其影响因素,为我国老年护理人才培养提供参考依据。方法:采用整群抽样方法选取济宁医学院护理学院16个班级,共734名在校护生。采用一般资料问卷、养老机构从业意愿问卷、老年知识问卷(FAQ1)及对老年人态度量表(KAOP)进行调查。结果:734名护理本科生中有300名(40.9%)护生愿意在养老机构从业,70名(9.5%)护生不愿意在养老机构从业,364名(49.6%)护生表示不确定。是否为独生子女、不同专业方向、不同年级、与老年人共同居住时间、与老年人关系、家人对老年人态度、有无被老年人照顾经历、有无照顾老年人经历、FAQ1及KAOP得分是护理本科生老年机构从业意愿的影响因素。结论:济宁医学院护理本科生老年机构从业意愿率较低,但有很大潜在发展空间,需要政府和用人单位积极改善老年护理的行业现况,同时需要学校的积极引导和教育。

职业疲溃感对ICU护士离职倾向的影响研究

目的:调查三级甲等医院重症监护病房(ICU)护士职业疲溃感与离职倾向现状并分析二者的相关性。方法:采用便利抽样法,采用一般资料问卷、职业疲溃感量表、离职意愿量表,对217名三级甲等医院ICU护士进行调查。结果:217名ICU护士职业疲溃感及离职意愿得分分别为(53.75±10.62)、(14.26±2.64)分,处于中等水平。相关分析显示,ICU护士职业疲溃感总分及各维度得分与离职意愿总分及各维度得分均呈正相关关系(r=0.161~0.398,P<0.05)。单因素分析显示,不同工龄、人事关系、月均收入、夜班情况及自评健康状况的ICU护士离职意愿得分差异均具有统计学意义(P<0.01);不同人事关系、工作压力及自评健康状况ICU护士职业疲溃感得分差异均具有统计学意义(P<0.01)。多元回归分析显示,工龄、月均收入、夜班情况、自评健康状况及情绪疲溃感是ICU护士离职意向的主要影响因素(P<0.05),可解释总变异的45.9%。结论:三级甲等医院ICU护士离职意愿水平较高,职业疲溃感是其重要影响因素,二者具有相关性。护理管理者应根据其影响因素,采取针对性干预策略,降低护士职业疲溃感及离职意向,促进护理队伍健康发展。

广东省二、三级医院护士留职意愿及影响因素研究

目的 描述广东省二、三级医院护士留职意愿现状,分析其影响因素。方法 采用问卷调查法,收集广东省36所二、三级综合医院4 163名护士的一般资料、留职意愿、护理工作环境、护理服务受限以及工作场所暴力情况。结果 广东省二、三级医院中79.87%的护士有留职意愿。工作年限长、职称高、对护理工作环境评价高是护士留职意愿的保护因素,而护理服务受限、来自同事的工作场所暴力则是护士留职意愿的危险因素。结论 广东省二、三级医院有留职意愿护士的比例需进一步提高,护理管理者应根据影响因素采取针对性措施,以切实提高护士留职意愿,稳定护士队伍。

职业倦怠在ICU护士情绪劳动与离职意向间的中介效应分析

目的探讨职业倦怠在ICU护士情绪劳动与离职意向间的中介效应。方法2022年7月-10月,采用便利抽样法选取山东省6所三级甲等医院的415名ICU护士为调查对象,采用一般资料调查表、护士情绪劳动量表、护士职业倦怠量表和离职意向量表进行调查。结果回收有效问卷412份。ICU护士情绪劳动量表总分为(63.50±8.65)分,属于中等水平;ICU护士职业倦怠总发生率为90.29%;离职意向量表条目均分为(2.30±0.75)分,处于低离职意向。情绪劳动和职业倦怠能直接正向预测离职意向;同时,职业倦怠在情绪劳动与离职意向关系中起部分中介作用,中介效应占总效应的31%。结论管理者需采取多种有效措施改善ICU护士的情绪劳动能力,缓解因情绪劳动而产生的职业倦怠感,从而降低离职意向。

养老机构护理员离职意愿研究进展

综述养老机构护理员离职意愿的测量工具、影响因素和干预方式,总结养老机构护理员离职意愿的干预措施,提高养老机构护理员对工作的满意度,为减少我国养老机构护理员的流失提供参考依据。

贵州医养结合机构工作人员离职意愿及影响因素研究

目的了解贵州医养结合机构工作人员离职意愿现状及其影响因素。方法采用便利抽样法,对贵州21家医养结合机构中352名工作人员进行问卷调查,20位机构管理者、17位医生、16位护士和13位养老护理员进行访谈。结果医养结合机构中有28.1%的工作人员有离职意愿。医护人员离职意愿率显著高于养老护理员。单位性质、月收入、工作负荷、自评健康状况、职业上升空间、组织支持感、护理对象的特殊性、家庭住址与工作单位的距离是医护人员离职意愿的主要影响因素;文化程度、工作负荷、付出-回报比例、组织支持感、职业认同感为养老护理员离职意愿的主要影响因素。结论贵州医养结合机构工作人员的离职风险较高,应从多层面制定针对性措施以降低其离职意愿。

美国护士工作投入与工作满意度、护理质量、离职意愿的关联性研究

目的员工的工作投入、工作满意度、护理质量和离职意愿是医疗卫生机构绩效的关键指标。本研究旨在调查美国护士工作投入现状及关联因素,分析护士工作投入、工作满意度、感知护理质量和离职意愿之间的关系。方法采用横断面描述性研究设计。2022年3—9月,通过在线方式对美国注册护士进行调查。采用Utrecht工作投入量表(Utrecht Work Engagement Scale)测量护士工作投入状况,收集护士的一般资料,通过问题询问方式调查他们的工作满意度、感知护理质量和离职意愿。结果共有900名护士参与调查。其中,79.2%报告持有专业认证资格,59.4%在工作满意度方面得分较高或非常高,82.2%报告感知护理质量较高或非常高,但有28.4%的人表示在接下来的一年里可能或非常可能离职。护士的工作投入水平受到护士工作满意度、感知护理质量和离职意愿的影响。工作满意度高、感知护理质量高以及离职意愿更低的护士表现出更高水平的工作投入。线性回归分析显示,年龄较大、白种人并获得博士学位的护士与其同行相比,表现出更高水平的工作投入。结论本研究表明,护士的工作投入与其工作满意度、感知护理质量和离职意愿存在关联。护士的工作投入与工作满意度明显关联,护理管理者需要采取积极措施提高护士的工作满意度和留任率。

ICU护士心理资本与离职意愿的相关性研究

目的调查ICU护士心理资本与其离职意愿的现状,并探讨二者之间的相关性。方法 2015年1~6月采用一般资料调查表、护士心理资本问卷和离职意愿问卷对随机抽取的某市6所三级甲等医院的182名ICU护士进行调查。结果 ICU护士心理资本均分为(4.36±0.58)分,处于中度水平;离职意愿总分为(2.18±0.72)分,处在较高水平;ICU护士心理资本与离职意愿呈负相关(P<0.01,r=-0.448)。结论提高护士心理资本是改善其离职意愿的有效途径,护理管理者应该从自我效能和希望两个方面去采取相关措施来提升ICU护士心理资本。

护士感知的管理关怀现状及其与职业倦怠、离职意愿的关系

目的:调查护士感知的管理关怀、职业倦怠、离职意愿状况,分析护士感知到的管理关怀水平与护士职业倦怠、离职意愿的关系。方法:采用方便抽样法选取北京市某三级甲等医院539名护士为调查对象,采用中文版管理关怀性评估量表、马氏人际工作者倦怠量表和离职意愿量表进行调查。结果:护士感知的管理关怀总分为(139.29±27.92)分;马氏人际工作者倦怠量表总分为38.00(22.00,55.00)分,其中情感耗竭维度得分为19.00(11.00,30.00)分,去人格化维度得分为2.00(0,5.00)分,低个人成就感维度得分为14.00(6.00,22.00)分;离职意愿总分为(14.57±3.67)分。护士感知到的管理关怀与职业倦怠呈负相关(r=-0.45,P<0.05)、与离职意愿呈负相关(r=-0.22,P<0.05)。结论:护士的职业倦怠严重,离职意愿较强,护理管理者对护士的关怀有待提高,应根据护士在生活和工作中的需要提供相应的人文关怀,以减轻其职业倦怠水平并降低离职意愿,从而稳定护士队伍。

泉州市ICU护士工作倦怠及其对离职意愿的影响

目的探讨ICU护士工作倦怠及其对离职意愿的影响。方法使用Maslach工作倦怠量表与离职意愿量表,对泉州市168名ICU护士进行问卷调查。结果 ICU护士工作倦怠得分（54.31±15.28）分,离职意愿得分（16.24±4.27）分。多元回归分析显示,影响ICU护士离职意愿的主要因素为个人成就感、去人格化、职称、年龄。结论工作倦怠水平越高,离职意愿越高。其中,个人成就感、去人格化对离职意愿有良好的预测作用。

儿科低年资护士培训中应用人文关怀对其留职意愿的影响

目的探讨在儿科低年资护士培训中应用人文关怀对其留职意愿的影响。方法 2012年7月,便利抽样法选取武汉同济医院儿科在岗的低年资护士(工作年限≤3年)85名为研究对象,在培训过程中融入人文关怀的理念,积极营造人文环境,对低年资护士在工作中照顾、生活上关心、科学排班、人尽其才;实施人文关怀前后分别采用护士留职意愿量表和护士工作满意度量表进行效果评价。结果人文关怀实施后,低年资护士留职意愿的得分高于人文关怀实施前,差异有统计学意义(P<0.01)。人文关怀实施后,除工资及福利外,低年资护士的工作满意度及其他各因子的得分均高于人文关怀实施前,差异均有统计学意义(均P<0.01)。结论儿科低年资护士培训中运用人文关怀,有助于提高低年资护士的工作满意度,提升其留职意愿。

民营养老机构护理员留职意愿影响因素实证研究——以陕西西安为例

构建了以工作满意度为中介的机构养老护理员留职意愿理论模型,采用Logistic回归和逐步回归法,对陕西西安民营养老机构护理员留职意愿影响因素进行了实证分析。结果表明,在个体特征维度,文化程度对护理员留职意愿产生负向影响,技术职称、护理工作年限对其产生正向影响;在工作外在特征维度,工资收入、工作环境、发展空间对其留职意愿产生正向影响,日均工作时间产生负向影响;在组织内在特征维度,管理方式、工作自主度、与照料对象关系、同事协助、领导支持对其产生正向影响;在工作满意度维度,工资满意度、管理方式满意度和总体满意度对留职意愿均产生显著的正向影响;养老护理员总体满意度水平在工作外在特征、组织内在特征与留职意愿间均扮演中介角色。