Hybrid working from home improves retention without damaging performance.

Working from home has become standard for employees with a university degree. The most common scheme, which has been adopted by around 100 million employees in Europe and North America, is a hybrid schedule, in which individuals spend a mix of days at home and at work each week1,2. However, the effects of hybrid working on employees and firms have been debated, and some executives argue that it damages productivity, innovation and career development3-5. Here we ran a six-month randomized control trial investigating the effects of hybrid working from home on 1,612 employees in a Chinese technology company in 2021-2022. We found that hybrid working improved job satisfaction and reduced quit rates by one-third. The reduction in quit rates was significant for non-managers, female employees and those with long commutes. Null equivalence tests showed that hybrid working did not affect performance grades over the next two years of reviews. We found no evidence for a difference in promotions over the next two years overall, or for any major employee subgroup. Finally, null equivalence tests showed that hybrid working had no effect on the lines of code written by computer-engineer employees. We also found that the 395 managers in the experiment revised their surveyed views about the effect of hybrid working on productivity, from a perceived negative effect (-2.6% on average) before the experiment to a perceived positive one (+1.0%) after the experiment. These results indicate that a hybrid schedule with two days a week working from home does not damage performance.

Positive Leadership within Breast Imaging: Impact on Burnout, Intent to Leave, and Engagement.

Background High rates of provider burnout and turnover, as well as staffing shortages, are creating crises within radiology departments. Identifying ways to support health care workers, such as the Positively Energizing Leadership program, is important during these ongoing crises. Purpose To identify the relationship between leadership behaviors and workplace climate and health care worker outcomes (ie, burnout, intent to leave, and engagement) and to determine whether the positive leadership program could improve workplace climate and health care worker outcomes. Materials and Methods This prospective study involved two parts. First, a web-based survey was administered to faculty and staff in a breast imaging unit of a large academic medical center in February 2021 to identify relationships between leadership behaviors and workplace climate and health care worker outcomes. Second, a web-based survey was administered in February 2023, following the implementation of a positive leadership program, to determine improvement in engagement and reduction of burnout and intent to leave since 2021. Multiple regression, the Sobel test, Pearson correlation, and the t test were used, with a conservative significance level of P < .001. Results The sample consisted of 88 respondents (response rate, 95%) in 2021 and 85 respondents (response rate, 92%) in 2023. Leadership communication was associated with a positive workplace climate (ß = 0.76, P < .001) and a positive workplace climate was associated with improved engagement (ß = 0.53, P < .001), reduction in burnout (ß = -0.42, P < .001), and reduction in intent to leave (ß = -0.49, P < .001). Following a 2-year positive leadership program, improved perceptions were observed for leadership communication (pretest mean, 4.59 ± 1.51 [SD]; posttest mean, 5.80 ± 1.01; t = 5.97, P < .001), workplace climate (pretest mean, 5.09 ± 1.43; posttest mean, 5.77 ± 1.11; t = 3.35, P < .001), and engagement (pretest mean, 5.27 ± 1.20, posttest mean, 5.68 ± 0.96; t = 2.50, P < .01), with a reduction in burnout (pretest mean, 2.69 ± 0.94; posttest mean, 2.18 ± 0.74; t = 3.50, P < .001) and intent to leave (pretest mean, 3.12 ± 2.23; posttest mean, 2.56 ± 1.84; t = 1.78, P < .05). Conclusion After implementation of a positive leadership program in a radiology department breast imaging unit, burnout and intention to leave decreased among health care workers, while engagement increased. © RSNA, 2024 See also the editorial by Thrall in this issue.

Patterns of health workforce turnover and retention in Aboriginal Community Controlled Health Services in remote communities of the Northern Territory and Western Australia, 2017-2019.

BACKGROUND: Aboriginal Community Controlled Health Services (ACCHSs) in Australia aim to optimise access to comprehensive and culturally safe primary health care (PHC) for Aboriginal populations. Central to quality service provision is the retention of staff. However, there is lack of published research reporting patterns of staff turnover and retention specific to ACCHSs. This study quantified staff turnover and retention in regional and remote ACCHSs in the Northern Territory (NT) and Western Australia (WA), and examined correlations between turnover and retention metrics, and ACCHSs' geographical and demographic characteristics. METHODS: The study used 2017-2019 payroll data for health workers in 22 regional and remote PHC clinics managed by 11 ACCHSs. Primary outcome measures included annual turnover and 12-month stability rates, calculated at both clinic and organisation levels. RESULTS: There was a median of five client-facing (Aboriginal health practitioners, allied health professionals, doctors, nurses/midwives, and 'other health workers' combined) and two non-client-facing (administrative and physical) staff per remote clinic, at any timepoint. Mean annual turnover rates for staff were very high, with 151% turnover rates at the clinic level and 81% turnover rates at the organisation level. Mean annual turnover rates for client-facing staff were 164% and 75%, compared to 120% and 98% for non-client-facing staff, at clinic and organisational levels, respectively. Mean 12-month stability rates were low, with clinic-level stability rates of only 49% and organisation-level stability rates of 58%. Mean annual clinic-level turnover rates were 162% for non-Aboriginal staff and 81% for Aboriginal staff. Both workforce metrics were moderately to highly correlated with the relative remoteness of clinics, size of regular clients serviced, and average annual headcount of employees in each clinic (p values < 0.01). CONCLUSIONS: Participating ACCHSs in remote NT and WA have very high turnover and low retention of healthcare staff. Overall, clinic-level turnover rates increase as distance from regional centres increases and are lower for Aboriginal staff, suggesting that greater employment of Aboriginal staff could help stabilise staffing. Improved retention could reduce burden on ACCHSs' resources and may also support quality of service delivery due to improved cultural safety and continuity of care.

Social support, psychological capital, multidimensional job burnout, and turnover intention of primary medical staff: a path analysis drawing on conservation of resources theory.

BACKGROUND: Job burnout is a prevalent and emerging challenge in the primary medical system, causing mass turnover, especially of primary medical staff. Little attention has been paid to the different dimensions of job burnout (emotional exhaustion, personality disintegration, and reduced sense of achievement), which may hinder efforts to tackle high turnover intention among primary medical staff. From the perspective of conservation of resources theory, social support and psychological capital are basic resources with potential to diminish job burnout and thus lower turnover intention. However, there is insufficient research evidence on the relationships between social support, psychological capital, and the three dimensions of job burnout within the primary medical system. OBJECTIVES: Focusing on primary medical staff, this study conducts a path analysis to examine the correlations between two types of resources (social support and psychological capital) and the three dimensions of job burnout, and to test the impact of the latter on turnover intention. Based on the results, effective management strategies to improve the work stability of primary medical staff are proposed. METHODS: Multi-stage cluster random sampling was used to select participants in Anhui Province, China. Data were collected using a self-administered questionnaire containing measures of the main variables and demographic questions. In total, 1132 valid questionnaires were returned by primary medical staff. Structural equation modeling was used for path analysis of the data. RESULTS: Social support was negatively associated with emotional exhaustion (ß = - 0.088, P = 0.020), personality disintegration (ß = - 0.235, P < 0.001), and reduced sense of achievement (ß = - 0.075, P = 0.040). Moreover, psychological capital was negatively associated with emotional exhaustion (ß = - 0.079, P = 0.030), personality disintegration (ß = - 0.156, P < 0.001), and reduced sense of achievement (ß = - 0.432, P < 0.001). All three dimensions of job burnout positively affected turnover intention (emotional exhaustion: ß = 0.246, P < 0.001; personality disintegration: ß = 0.076, P = 0.040; reduced sense of achievement: ß = 0.119, P = 0.001). CONCLUSIONS: The results highlight the importance of social support and psychological capital for diminishing the three dimensions of job burnout for primary medical staff and, in turn, lowering their turnover intention. Accordingly, to alleviate job burnout and improve staff retention, material and psychological supports from leaders, colleagues, family, relatives, and friends are essential, as are measures to improve the psychological energy of primary medical staff.

Effect of COVID-19 response work experience on turnover intention among employees of dedicated COVID-19 hospitals in Seoul.

BACKGROUND: According to previous studies, stress and job burnout among medical personnel increased during the COVID-19 pandemic. This study analyzed the effect of the experience of COVID-19 response work on the intention of municipal hospital staffs to leave their workplaces during the pandemic. METHODS: The 3556 employees who had worked for more than 1 year at one of the eight Seoul Municipal Hospitals that either provided inpatient treatment for quarantined COVID-19 patients or operated as screening clinics were taken as the study population. In total, 1227 employees completed a web or mobile survey between October 21 and November 18, 2020. A chi-squared test was performed to confirm the difference in the distribution of turnover intention depending on whether the employees performed COVID-19 response tasks. Multiple logistic regression analyses were performed to determine the factors that affected the intention to leave. RESULTS: Of the 1227 respondents, 761 (62.0%) were frontline workers who were the first line of response to COVID-19. Experience with COVID-19 response tasks (OR = 1.59, p = 0.003) was significantly associated with the intention to leave. Additionally, the probability of turnover intention was significantly higher among workers aged 20-29 years (OR = 2.11, p = 0.038) and 40-49 years (OR = 1.57, p = 0.048), unmarried individuals (OR = 1.66, p = 0.005), doctors (OR = 2.41, p = 0.010), nurses (OR = 1.59, p = 0.036), and technical staff members (OR = 2.22, p = 0.009). High turnover intention was found among those who experienced high levels of burnout (OR = 2.03, p < 0.001) and those working in non-directly managed municipal hospitals (OR = 1.87, p = 0.018). CONCLUSION: Employees directly involved in COVID-19 response work displayed higher turnover intention. Various personal, job, and organizational factors significantly influenced employees' intentions to leave their positions in dedicated COVID-19 hospitals. These findings suggest the necessity of introducing management programs to aid workers who have experienced sudden changes in their duties and loss of autonomy while performing COVID-19 response tasks.

Workplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience.

BACKGROUND: Workplace violence is a global public health issue and a major occupational hazard cross borders and environments. Nurses are the primary victims of workplace violence due to their frontline roles and continuous interactions. OBJECTIVE: The present study aimed to investigate the status of workplace violence, turnover intention, compassion fatigue, and psychological resilience among Chinese nurses, and explore the mediating role of compassion fatigue and the moderating role of psychological resilience on relationship between workplace violence and turnover intention among Chinese nurses. METHOD: A cross-sectional study was conducted among a convenience sample of clinical registered nurses from public hospitals in Changsha, Hunan, China. Data was collected through an online questionnaire, which included a demographic information form, the Workplace Violence Scale (WVS), the Turnover Intention Questionnaire (TIQ), the Compassion Fatigue Scale (CF-CN), and the Connor-Davidson Resilience Scale (CD-RISC). Descriptive statistics and correlation analysis were employed to examine the relationships among the main variables. A moderated mediation analysis was further conducted using the PROCESS macro for SPSS (Model 4 and Model 8) to examine the mediating role of compassion fatigue and the moderating role of psychological resilience. RESULT: The present survey recruited a convenience sample of 1,141 clinical registered nurses, who reported experiencing multiple types of workplace violence during the past year. Correlation analysis revealed significant positive correlations between workplace violence and turnover intention (r = 0.466, P < 0.01) as well as compassion fatigue (r = 0.452, P < 0.01), while negative correlation between workplace violence and psychological resilience (r=-0.414, P < 0.01). Moderated mediation analysis revealed that compassion fatigue mediated, while psychological resilience moderated, the positive relationship between workplace violence and turnover intention (all P < 0.05). CONCLUSION: This study underscores the mediating effect of compassion fatigue and the moderating role of psychological resilience in the relationship between workplace violence and turnover intention among Chinese nurses. Future efforts should be undertaken to develop effective preventive measures and intervention strategies at individual, organizational, and national levels to mitigate workplace violence and foster supportive work environment. CLINICAL TRIAL NUMBER: Not applicable.

Effects of perceived stress on turnover intention of female healthcare staff: a serial multiple mediation model.

BACKGROUND: Healthcare staff in China, especially females, work in a high-pressure, high-load, and high-risk environment, which affects the physical and mental health, the efficiency and quality of work, and increases turnover intention. The present study investigated the relationship between perceived stress and turnover intention in female healthcare staff, and the effects of future-oriented coping and work-family balance on this relationship. METHODS: Four hundred thirty-five female medical workers were recruited to perform a perceived stress scale, future-oriented coping inventory, work-family balance scale and turnover intention scale. Meanwhile, serial multiple mediation analysis was performed using PROCESS. RESULTS: 1) Perceived stress positively predicted the level of turnover intention in female healthcare staff; 2) Preventive coping and proactive coping showed mediation effects on the relationship between perceived stress and turnover intention, and preventive coping positively related to proactive coping; 3) The work-family balance also showed mediation effects on the relationship between perceived stress and turnover intention; 4) Preventive coping, proactive coping and work-family balance showed a serial multiple mediation on the relationship between perceived stress and turnover intention in female healthcare workers. CONCLUSIONS: Perceived stress affects the level of turnover intention in female healthcare staff through preventive coping, proactive coping, and work-family balance. In addition, the sequential model of future-oriented coping was validated among female healthcare staff.

Understanding the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: There is limited evidence about the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic. The objectives of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave among the Canadian public health workforce, and associations with individual and workplace factors. METHODS: A cross-sectional study was conducted using data collected by a Canada-wide survey from November 2022 to January 2023, where participants reported sociodemographic and workplace factors. Mental health outcomes were measured using validated tools including the Oldenburg Burnout Inventory, the 7-item Generalized Anxiety Disorder scale, and the 2-item Patient Health Questionnaire to measure symptoms of depression. Participants were asked to report if they intended to leave their position in public health. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the associations between explanatory variables such as sociodemographic, workplace factors, and outcomes of mental health, and intention to leave public health. RESULTS: Among the 671 participants, the prevalence of burnout, and symptoms of depression and anxiety in the two weeks prior were 64%, 26%, and 22% respectively. 33% of participants reported they were intending to leave their public health position in the coming year. Across all outcomes, sociodemographic factors were largely not associated with mental health and intention to leave. However, an exception to this was that those with 16-20 years of work experience had higher odds of burnout (aOR = 2.16; 95% CI = 1.12-4.18) compared to those with ≤ 5 years of work experience. Many workplace factors were associated with mental health outcomes and intention to leave public health. Those who felt bullied, threatened, or harassed because of work had increased odds of depressive symptoms (aOR = 1.85; 95% CI = 1.28-2.68), burnout (aOR = 1.61; 95% CI = 1.16-2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13-2.37). CONCLUSIONS: During the COVID-19 pandemic, some of the public health workforce experienced negative impacts on their mental health. 33% of the sample indicated an intention to leave their role, which has the potential to exacerbate pre-existing challenges in workforce retention. Study findings create an impetus for policy and practice changes to mitigate risks to mental health and attrition to create safe and healthy working environments for public health workers during public health crises.

Mediating Role of Rumination in Second Victim Experience to Turnover Intention in Psychiatric Nurses.

BACKGROUND: Psychiatric nurses often face patient safety incidents that can cause physical and emotional harm, even leading to s econd victim syndrome and staff shortages. Rumination-a common response after nurses suffer a patient safety event-may play a specific role between the second victim experience and turnover intention. Understanding these mechanisms is crucial for supporting psychiatric nurses and retaining psychiatric nursing resources. OBJECTIVES: The study aimed to explore the associations among second victim experience, rumination, and turnover intention in psychiatric nurses and confirm how second victim experience influences turnover intention through rumination and its subtypes. METHODS: A descriptive, cross-sectional study was adapted to survey 252 psychiatric nurses who experienced a patient safety incident at three hospitals in China between March and April 2023. We used the Sociodemographic and Patient Safety Incident Characteristics Questionnaire (the Chinese version of the Second Victim Experience and Support Tool), the Event-Related Rumination Inventory, and the Turnover Intention Scale. Path analysis with bootstrapping was employed to accurately analyze and estimate relationships among the study variables. RESULTS: There was a positive association between second victim experience and turnover intention. In addition, both invasive and deliberate rumination showed significant associations with second victim experience and turnover intention. Notably, our results revealed that invasive and deliberate rumination played partial mediating roles in the relationship between second victim experience and turnover intention in psychiatric nurses. DISCUSSION: The negative experience and turnover intention of the psychiatric nurse second victims are at a high level. Our results showed that invasive rumination positively mediated the relationship between second victim experience and turnover intention, and deliberate rumination could weaken this effect. This study expands the knowledge of the mechanisms underlying the effect of the second victim experience on turnover intention. Organizations must attach importance to the professional dilemmas of the psychiatric nurses' second victims. Nurse managers can reduce nurses' turnover intention by taking measures to reduce invasive rumination and fostering deliberate meditation to help second victims recover from negative experiences.

Turnover intention and its associated factors among nurses in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Nurses turnover intention, representing the extent to which nurses express a desire to leave their current positions, is a critical global public health challenge. This issue significantly affects the healthcare workforce, contributing to disruptions in healthcare delivery and organizational stability. In Ethiopia, a country facing its own unique set of healthcare challenges, understanding and mitigating nursing turnover are of paramount importance. Hence, the objectives of this systematic review and meta-analysis were to determine the pooled proportion ofturnover intention among nurses and to identify factors associated to it in Ethiopia. METHODS: A comprehensive search carried out for studies with full document and written in English language through an electronic web-based search strategy from databases including PubMed, CINAHL, Cochrane Library, Embase, Google Scholar and Ethiopian University Repository online. Checklist from the Joanna Briggs Institute (JBI) was used to assess the studies' quality. STATA version 17 software was used for statistical analyses. Meta-analysis was done using a random-effects method. Heterogeneity between the primary studies was assessed by Cochran Q and I-square tests. Subgroup and sensitivity analyses were carried out to clarify the source of heterogeneity. RESULT: This systematic review and meta-analysis incorporated 8 articles, involving 3033 nurses in the analysis. The pooled proportion of turnover intention among nurses in Ethiopia was 53.35% (95% CI (41.64, 65.05%)), with significant heterogeneity between studies (I2 = 97.9, P = 0.001). Significant association of turnover intention among nurses was found with autonomous decision-making (OR: 0.28, CI: 0.14, 0.70) and promotion/development (OR: 0.67, C.I: 0.46, 0.89). CONCLUSION AND RECOMMENDATION: Our meta-analysis on turnover intention among Ethiopian nurses highlights a significant challenge, with a pooled proportion of 53.35%. Regional variations, such as the highest turnover in Addis Ababa and the lowest in Sidama, underscore the need for tailored interventions. The findings reveal a strong link between turnover intention and factors like autonomous decision-making and promotion/development. Recommendations for stakeholders and concerned bodies involve formulating targeted retention strategies, addressing regional variations, collaborating for nurse welfare advocacy, prioritizing career advancement, reviewing policies for nurse retention improvement.

Job satisfaction and intent to stay in neonatal nursing in England and Wales: a study protocol.

BACKGROUND: Nursing shortages are an ongoing concern for neonatal units, with many struggling to meet recommended nurse to patient ratios. Workforce data underlines the high proportion of neonatal nurses nearing retirement and a reduced number of nurses joining the profession. In order to recommend strategies to increase recruitment and retention to neonatal nursing, we need to understand the current challenges nurses are facing within the profession. The aim of this study is to investigate current job satisfaction, burnout, and intent to stay in neonatal nursing in England and Wales. METHODS: This study has two parts: (1) a systematic review exploring job satisfaction, burnout and intent to stay in neonatal nursing, and any previous interventions undertaken to enhance nurse retention, (2) an online survey of neonatal nurses in England and Wales exploring job satisfaction, burnout and intent to stay in neonatal nursing. We will measure job satisfaction using the McCloskey Mueller Satisfaction Scale (MMSS), burnout using the Copenhagen Burnout Inventory (CBI) and the Nurse Retention Index (NRI) will be used to measure intent to stay. All nurses working in neonatal units in England and Wales will be eligible to participate in the nursing survey. DISCUSSION: Retention of neonatal nurses is a significant issue affecting neonatal units across England and Wales, which can impact the delivery of safe patient care. Exploring job satisfaction and intent to stay will enable the understanding of challenges being faced and how best to support neonatal nurses. Identifying localised initiatives for the geographical areas most at risk of nurses leaving would help to improve nurse retention.

Factors associated with the non-retention of health sector employees recruited in Iran: a survival analysis.

BACKGROUND: Health staff are an essential component of the health system and a significant factor in improving health outcomes. As a result, without a suitable number of trained and supported workforces, health-related goals will not be achieved. As a result, one of the most significant tasks of the government and healthcare human resource management in healthcare organizations is focusing on development and maintenance of personnel. METHOD: This study was a longitudinal and historical cohort study. Data was collected on the 40 medical universities and healthcare organizations under the jurisdiction of Iran Ministry of Health and Medical Education from 2008 to 2018 from the human resources database. In this study the COX regression and survival analysis was used to assess the factors of staff maintenance, retention rate, and the risk of turnover. RESULT: 46,939 health workforces were included in the study, of which 13,328 (28.4%) were men and 33,611 (71.6%) were women. Based on the finding of cox regression model, the retention of staff were statistically different between male and female. Employees whose current work place and birthplace were similar had a significantly higher probability of retention. Accordingly, the cox regression result showed, the risk of employee turnover for single personnel was higher than the married ones. CONCLUSION: an applicable policy for increasing maintenance among workforce recruitment, could be considering the native born professionals instead of non-natives born which reduce the costs of employee turnover, including re-hiring, initial and on-the-job training, housing, and other extra living expenses away from home and family.

New insights into physician burnout and turnover intent: a validated measure of physician fortitude.

BACKGROUND: Given the increasing prevalence of the physician burnout, this study provides new insights into the antecedents driving burnout and turnover intent. By introducing the concept of physician fortitude, we develop a valid and statistically-reliable measure that increases our understanding of these issues. METHODS: A two-sample design was employed. Using a sample of 909 physicians, Advanced Practice Providers (APPs) and healthcare leaders, exploratory factor analysis was employed to create a 12-item fortitude scale. In the second study, using a sample of 212 of practicing physicians, APPs and healthcare leaders, bivariate and tetrachoric correlations, and ordinary least square regression modeling were able to establish reliability and validity. RESULTS: The fortitude scale shows sufficient reliability. Moreover, we found significant support for convergent and criterion-related validity. Fortitude was significantly related to all three subdimensions of burnout, including emotional exhaustion (r = -.62, p < .01), depersonalization (r = -.70, p < .01) and personal accomplishment (r = .65, p < .01), and turnover intent (r = -.55, p < .01). Moreover, the fortitude measure explained more variance in all three subdimensions of burnout and turnover intent compared to common measures, including grit, hardiness, mental toughness and resilience (p < .01). CONCLUSIONS: Results from this study empirically demonstrate that fortitude is significantly related to burnout, and turnover intent. This new fortitude measure adds a new perspective to assist in the development of more effective interventions. Opportunities for future research are discussed.

Job satisfaction, professional competence, and self-efficacy: a multicenter cross-sectional study among registered nurses in Sweden and Norway.

BACKGROUND: Healthcare organizations worldwide face persistent challenges relating to turnover and intention to leave the nursing profession among registered nurses. Factors contributing to their retention and well-being at work include high job satisfaction, professional competence, and self-efficacy. Few multicenter studies have investigated these factors in relation to work experience in a Nordic context. Therefore, this study aimed to investigate job satisfaction, professional competence, and self-efficacy among registered nurses. METHODS: This multicenter cross-sectional study survey was part of a larger overarching Swedish-Norwegian project, and was conducted among registered nurses (n = 1137) in September 2021. The participants worked in a variety of health care units, e.g., hospital units, primary health care, and home care. Data was subjected to descriptive and comparative statistical analysis; chi-square test, one-way between-groups analysis of variance (ANOVA) and Kruskal-Wallis test. RESULTS: The findings show that job satisfaction is reported as lowest in registered nurses with medium-term work experience as compared to newly qualified and long-term work-experienced registered nurses. Professional competence and self-efficacy are reported as higher among registered nurses with long-term work experience as compared to those with medium-term work experience and newly qualified registered nurses. However, the participants reported their professional competence as highest in relation to the same factor - "Value-based nursing care" - regardless of their work experience. CONCLUSIONS AND IMPLICATIONS: This study underscores the need for continuous support and professional development for registered nurses throughout their careers. Proactive support for newly qualified nurses may improve job satisfaction as they progress to being registered nurses with medium-term work experience. Tailored interventions to address the distinct needs of both newly qualified and medium-term work-experienced registered nurses are crucial for nurturing a sustainable nursing workforce.

Moral distress, coping mechanisms, and turnover intent among healthcare providers in British Columbia: a race and gender-based analysis.

BACKGROUND: This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences. METHODS: Our cross-sectional observational study utilized a structured online survey. Participants included doctors, nurses, and in-home/community care providers. The survey measured moral distress using established scales, assessed coping mechanisms, and evaluated turnover intentions. Statistical analysis examined the relationships between race, gender, moral distress, and turnover intention, focusing on identifying disparities across different healthcare roles. Complex interactions were examined through Classification and Regression Trees. RESULTS: Racialized and gender minority groups faced higher levels of moral distress. Profession played a significant role in these experiences. White women reported a higher intention to leave due to moral distress compared to other groups, especially white men. Nurses and care providers experienced higher moral distress and turnover intentions than physicians. Furthermore, coping strategies varied across different racial and gender identities. CONCLUSION: Targeted interventions are required to mitigate moral distress and reduce turnover, especially among healthcare workers facing intersectional inequities.

A Bayesian approach to reveal the role of psychological factors on turnover intention among nurses during the COVID-19 pandemic.

BACKGROUND: Turnover intention is considered a significant challenge for healthcare and treatment organizations. The challenging conditions of treating COVID-19 patients and the physical and mental stress imposed on nurses during the pandemic may lead them to leave their jobs. The present study aimed to determine the role of psychological factors (general health, mental workload, work-family conflicts, and resilience) on turnover intention using a Bayesian approach during the COVID-19 pandemic. METHODS: The present cross-sectional study was carried out during the winter of 2021 at three hospitals in Khuzestan Province, Iran. To collect data for this investigation, 300 nurses were chosen based on Cochran's formula and random sampling technique. Seven questionnaires, including General Health, Mental Workload, Work-Family Conflict, Resilience, Job Stress, Fear of COVID-19, and Turnover Intention Questionnaires. Bayesian Networks (BNs) were used to draw probabilistic and graphical models. A sensitivity analysis also was performed to study the effects of the variables. The GeNIe academic software, version 2.3, facilitated the examination of the Bayesian network. RESULTS: The statistically significant associations occurred between the variables of fear of COVID-19 and job stress (0.313), job stress and turnover intention (0.302), and resilience and job stress (0.298), respectively. Job stress had the highest association with the fear of COVID-19 (0.313), and resilience had the greatest association with the work-family conflict (0.296). Also, the association between turnover intention and job stress (0.302) was higher than the association between this variable and resilience (0.219). At the low resilience and high job stress with the probability of 100%, the turnover intention variable increased by 20%, while at high resilience and low job stress with the probability of 100%, turnover intention was found to decrease by 32%. CONCLUSION: In general, the results showed that four psychological factors affect job turnover intention. However, the greatest impact was related to job stress and resilience. These results can be used to manage job turnover intention in medical environments, especially in critical situations such as COVID-19.

Intent to stay, moral distress, and nurse practice environment among long-term care nurses: A cross-sectional questionnaire survey study.

BACKGROUND: Many long-term care facilities in the United States face significant problems with nurse retention and turnover. These challenges are attributed, at least in part, to moral distress and a negative nurse practice environment. OBJECTIVE: The purpose of the study was divided into two parts: first, to investigate the relationships among nurse practice environment, moral distress, and intent to stay; second, to explore the potential mediating effect of the nurse practice environment on the intent to stay among those with high levels of moral distress. DESIGN: This study was a descriptive, cross-sectional survey using targeted sampling. PARTICIPANTS: A total of 215 participants completed the surveys. Participants were nationally representative of long-term care nurses by age, years of experience, employment status, and type of health setting. METHODS: This study was an online national survey of long-term care nurses' perceptions of their intent to stay, moral distress level (Moral Distress Questionnaire), and nurse practice environment (Direct Care Staff Survey). Structural equation modeling analysis explored intent to stay, moral distress, and the nurse practice environment among long-term care nurses. RESULTS: The mean moral distress score was low, while the mean nurse practice environment and intent to stay scores were high. Moral distress had a significant, moderately negative association with the nurse practice environment (ß = -0.41), while the nurse practice environment had a significant, moderately positive association with intent to stay (ß = 0.46). The moral distress had a significant, moderately negative association with intent to stay (ß = -0.20). The computed structural equation modeling suggested a partially mediated model (indirect effect = -0.19, p = 0.001). CONCLUSION: Since the nurse practice environment partially mediates the relationship between moral distress and intent to stay, interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession. CLINICAL RELEVANCE: Our study demonstrated that the nurse practice environment mediates moral distress and intent to stay. Interventions to improve the nurse practice environment are crucial to alleviating moral distress and enhancing nurses' intent to stay in their jobs, organizations, and the nursing profession.

Nurses That Stay.

The 2024 NSI National Health Care Retention & RN Staffing Report published by NSI Nursing Solutions, Inc, was released early this year and indicated hospitals' average turnover and vacancy rates for RNs nearly returned to their 2019 levels in 2023 after peaking in the middle of that timeframe. Simultaneously, healthcare organizations continue to struggle with nurse retention. As nurses begin to return or enter the nursing profession, the time is here to ask why nurses are leaving your organization. In 1983, the original study, "Magnet Hospitals: Attraction and Retention of Professional Nurses," identified hospital characteristics that were able to "attract and retain a staff of well-qualified nurses and are therefore consistently able to provide quality care."

Thriving Through Calamity: Healthcare Worker Commitment During a Public Health Crisis.

OBJECTIVE: The study purpose was to generate theory to explain why some hospital staff chose to stay on the job during a prolonged public health crisis. BACKGROUND: The "great resignation" of 2021 created shortages across the healthcare industry. Why some healthcare staff chose to stay at work when coworkers were leaving in large numbers through retirement, transition to different careers, or perceived suddenly better clinical opportunities was not clear. METHODS: Qualitative Grounded Theory methods guided this research study. Sixteen healthcare workers participated in open-ended interviews that provided data to identify major concepts in an emerging model of commitment during crisis. RESULTS: A "Commit to Stay" model emerged showing 4 major influences including sense of personal agency, supportive organization, social connections at work, and external connections and influence. CONCLUSIONS: The Commit to Stay conceptual model can help guide nurse leaders as they grapple with supporting those who choose to stay at work in healthcare during intense, sustained healthcare crises.

The Impact of Transitional Shock on Newer Nurses in a Contemporary Healthcare Environment.

OBJECTIVE: The aim of this study was to understand newer nurses' perception and expectations of their work environment, professional and institutional satisfaction, and motivating/decision-making factors around nursing and intent to leave their positions. BACKGROUND: Studies have shown newly graduated nurses face many challenges transitioning from a student to an independently practicing nurse. The COVID pandemic complicated this transition and created new stressors resulting in discouragement and turnover for newer nurses. METHODS: This study used a qualitative approach through purposive sampling, semistructured qualitative interviews, and content analytic techniques. Transitional Shock Theory was used as the theoretical framework. RESULTS: Four themes emerged from the study: 1) confronting the reality; 2) betrayal/mistrust; 3) relational integrity; and 4) enablers of clinical competence. CONCLUSIONS: The findings will help nurse leaders understand the importance of organizational-level supports to improve the transition of newer nurses in typical periods and in times of additional stress.