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.

The effects of colleague solidarity and affective commitment on nurses＇ intent to stay

Objective： The purpose of this paper was to determine the effects of colleague solidarity and affective commit- ment on intent to stay among nurses, and to provide the basis for developing more effective retention strategies. Methods： A cross-sectional survey was carried out and a sample of 346 registered nurses was recruited in convenience sampling method from three tertiary hospitals in Tianjin, China. A self-administrative questionnaire was used in order to collect data. All analyses were performed using SPSS 17.0 software. Results： The mean scores for colleague soli- darity, a_ffective commitment and intent to stay of nurses were 3.61±0.50, 3.26±0.55, and 3.54±0.67, respectively. The nurses＇ colleague solidarity and each dimension, affective commitment and intent to stay showed a positive correlation （r=0.141-0.709, P〈0.01）. Multiple linear regression analysis showed that emotional solidarity, academic solidarity and a_ffective commitment entered intent to stay regression equation （β=0.170-0.437, P〈0.001） and explained 45.3% of the total variation in nurses＇ intent to stay, and emotional solidarity became the strongest predictor （β=0.437, P〈0.001）. Hierarchical regression analysis revealed that affective commitment played a partial moderating role on the relation- ship between colleague solidarity and intent to stay （β=0.174-0.659, P〈0.001）. Conclusion： Hospital administrators and managers should develop effective strategies to enhance colleague solidarity and affective commitment among nurses, which will ultimately increase nurses＇ intent to stay.

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.

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.

养老机构护理员留职意愿影响因素研究——以嘉兴市为例

[目的]研究嘉兴市养老机构护理员留职意愿及其影响因素,为提高养老机构护理员队伍稳定性提供参考。[方法]采用描述性统计分析、单因素方差分析、线性回归分析等方法,对嘉兴市13家养老机构的196名在职养老机构护理人员的留职意愿和影响因素进行调查研究。[结果]调查对象留职意愿得分为(18.48±3.03)分,单因素方差分析和线性回归分析结果显示:年龄、在当前机构工作年限、健康状况、工作满意度和职业获益感对养老机构护理员留职意愿有显著正向影响,文化程度呈现显著负向影响(P<0.05)。[结论]养老机构护理员留职意愿整体得分较高,同时受到多种因素的影响。

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。

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。

人文关怀视角下临床护士工作强度对留职意愿影响的研究

通过调查护士工作强度、对夜班感受及留职意愿现状,并分析护士工作强度、对夜班感受对留职意愿的影响,为提高护士留职意愿提供参考。采用工作强度调查表、留职意愿量表对陕西省497名护士进行问卷调查。结果显示护士留职意愿得分为(19.95±4.28)分;57.3%的护士每周工作时间大于40小时,36.6%的护士日工作时长超过8小时,42.3%的护士日岗位持续走动或站立时间大于6小时,54.7%的护士日均弯腰≥31次。多元回归分析结果显示,是否上夜班、婚姻状态、日岗位持续走动或站立时间、日均弯腰时间、每日工作时长;对目前夜班频次的满意程度、下夜班当天是否参加过医院或科室的公共活动、对目前夜班的费用的满意程度、上夜班影响生活节律以及和伴侣的感情是留职意愿的影响因素(P<0.05,P<0.01)。由此可知护士留职意愿处于中等水平,工作强度及对夜班感受对留职意愿有显著影响,医院管理者要合理配置护理人力资源,减少护士工作强度;加强护士职业精神教育,提升其职业认同感;控制夜班频次,适当提高护士夜班收入,增加对值夜班护士人文关怀,提高护士对夜班满意度,从而增强其留职意愿,稳定护士队伍。

导师制对ICU规培护士胜任力及定科意向的影响性研究

目的探讨导师制对ICU规培护士岗位胜任力及定科意向的影响效果。方法通过整群抽样将2017年11月—2018年1月入ICU规培的25名护士作为对照组,采用传统带教;将2018年3—5月入ICU规培的24名护士作为实验组,采用导师制带教。规培结束后一周,比较两组岗位胜任力及定科意向情况。结果实验组岗位胜任力优于对照组(P <0.05),其中,岗位胜任力各维度中,实验组专业知识、专业技术和专业能力显著高于对照组(P <0.05);实验组规培护士在今后职业定向中更愿意留ICU工作(P <0.05)。结论导师制带教模式能有效提高规培护士的岗位胜任力,增加在ICU的职业信心,使其在今后的职业规划中,更有意愿从事重症护理工作。

妇幼保健机构护士付出-回报失衡与离职倾向的关系

目的:探讨妇幼保健机构护士离职意愿与付出-回报失衡的关系。方法:随机抽取武汉市两家三级甲等妇幼保健机构的277名护士完成离职意愿问卷、付出-回报失衡问卷和医院护士离职影响因素问卷调查。结果:妇幼保健机构护士的离职意愿率为30.68%;离职意愿产生的危险因素(OR)为高付出-低获得工作模式(3.13)、聘用类别为合同制(2.53)、目前医院为自己第1家工作单位(2.11)、超负荷工作模式(2.02)、医院文化(1.35)、晋升与培训(1.20)和工作激励与成就(1.14)。结论:妇幼保健机构护士的离职意愿与高付出-低获得工作模式及其他职业因素有关,需要改善不良的职业因素,以减少护士离职的发生。

护理人员HIV职业暴露风险认知对护理服务态度和行为意向的影响

目的采用构建的风险认知测量模型,探讨护理人员HIV职业暴露风险认知对护理服务态度、行为意向的影响。方法确定风险认知的定义和测量模型,在此基础上设计调查问卷,调查内容包括风险认知4维度、态度、行为意向、自我效能等。采用方便抽样的方法对武汉市4所三甲医院的护理人员匿名问卷调查,运用结构方程模型对调查结果进行分析。结果风险认知对护理人员对待HIV感染者的态度为负向影响(标准化路径系数为-0.16),态度对行为意向为正向影响(标准化路径系数为0.60),风险认知对行为意向没有直接影响,间接影响为-0.10。自我效能可以降低风险认知水平,促进其采取正向态度和行为意向。结论护理人员的HIV职业暴露风险认知与护理服务态度、行为意向的关系符合一般的知信行模型。

护理专科毕业生基层就业意向及其影响因素分析

调查某省护理专科毕业生基层就业意向现状,并对其影响因素分析探讨。2019年5月至6月,采用便利抽样方法选取某省符合纳入标准的2 396名护理专科毕业生作为调查对象进行问卷调查。他们中大部分(56.64%)不愿意到基层医院从事护理工作,大多数会选择城市社区服务中心(60.77%);愿意到基层医院就业的最主要影响因素是目前就业形势所迫(32.01%),不愿意到基层医院就业的最主要影响因素是福利待遇低(29.76%),最需要改进的措施是基层医院要与省、市级医院薪酬待遇持平(30.22%)。护理专业专科毕业生基层医院就业意向偏低,需要学校加强基层医院及相关就业政策的宣传和教育指导,政府相关的政策支持也是非常必要的。