Effective machine learning, Meta-heuristic algorithms and multi-criteria decision making to minimizing human resource turnover.

Employee turnover is one of the most important issues in human resource management, which is a combination of soft and hard skills. This makes it difficult for managers to make decisions. In order to make better decisions, this article has been devoted to identifying factors affecting employee turnover using feature selection approaches such as Recursive Feature Elimination algorithm and Mutual Information and Meta-heuristic algorithms such as Gray Wolf Optimizer and Genetic Algorithm. The use of Multi-Criteria Decision-Making techniques is one of the other approaches used to identify the factors affecting the employee turnover in this article. Our expert has used the Best-Worst Method to evaluate each of these variables. In order to check the performance of each of the above methods and to identify the most significant factors on employee turnover, the results are used in some machine learning algorithms to check their accuracy in predicting the employee turnover. These three methods have been implemented on the human resources dataset of a company and the results show that the factors identified by the Mutual Information algorithm can show better results in predicting the employee turnover. Also, the results confirm that managers need a support tool to make decisions because the possibility of making mistakes in their decisions is high. This approach can be used as a decision support tool by managers and help managers and organizations to have a correct insight into the departure of their employees and adopt policies to retain and optimize their employees.

The last resort: Workplace bullying and the consequences of changing jobs.

This study investigated the consequences of changing jobs for employees subjected to workplace bullying. First, we hypothesized that bullied employees would be more likely to change jobs than non-bullied employees. Moreover, we hypothesized that changing jobs would result in a reduction of exposure to bullying behaviors and an alleviation of mental health problems for those bullied at baseline. The study was based on a longitudinal probability sample of the whole Swedish workforce (n = 1,095). The time lag was 18 months. The results supported all hypotheses except one. Those employees who were bullied at baseline were more likely to have changed jobs at follow-up. Also, for the changers there was a reduction in exposure to subsequent bullying. The actual drop in exposure to bullying behaviors was significant and substantial. This gives further support for the work environment hypothesis, suggesting the work context may be a more important cause than individual characteristics. As for mental health problems, the association between bullying and subsequent anxiety was not significant for those changing jobs, suggesting that leaving a toxic workplace may reduce anxiety relatively quickly. However, depression symptoms were not affected by the change of jobs, and the association between bullying and subsequent depression was the same 18 months later. The conclusion is that changing jobs can be a useful, last resort on an individual level, improving the situation for the victim of bullying. However, it is important to note that it does not solve any underlying organizational problems and risk factors.

Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review.

AIM: To examine and synthesize the noneconomic and economic impacts of nurse turnover in acute hospitals. BACKGROUND: Nurse turnover occurs when nurses leave their jobs or the profession and is a major concern for the healthcare industry. Many studies have investigated the determinants of nurse turnover. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was utilized in the current review. Article search was conducted in June 2021. Research articles published since January 2000 were included. Eight databases (e.g., CINAHL, PubMed, PsycINFO, and Web of Science) were used. The following eligibility criteria were applied for inclusion: Articles that (1) were nonexperimental quantitative studies, (2) examined the impact of actual nurse turnover in acute hospitals, (3) were a peer-reviewed original research article, and (4) were written in English or Korean. RESULTS: Among 9,041 searched articles, 16 were included in the review. Seven studies investigated the association of nurse turnover with processes and outcomes (workgroup processes, nurse staffing, nurse outcomes, and patient outcomes), and partially supported the negative impact of turnover. Nine studies found that nurse turnover is very costly. CONCLUSION: Most studies investigated the turnover cost, which is costly. The negative noneconomic impact of nurse turnover was partially supported. IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY: To prevent the adverse noneconomic and economic impacts of nurse turnover and retain nurses, healthcare organizations, nurse managers, and hospital staff nurses need to develop and implement prevention strategies and policies to address nurse turnover. Efforts to address nurse turnover can increase hospital competency to improve the quality of nursing care services and patient safety.

Methodological approach for measuring the effects of organisational-level interventions on employee withdrawal behaviour.

BACKGROUND: Theoretical frameworks have recommended organisational-level interventions to decrease employee withdrawal behaviours such as sickness absence and employee turnover. However, evaluation of such interventions has produced inconclusive results. The aim of this study was to investigate if mixed-effects models in combination with time series analysis, process evaluation, and reference group comparisons could be used for evaluating the effects of an organisational-level intervention on employee withdrawal behaviour. METHODS: Monthly data on employee withdrawal behaviours (sickness absence, employee turnover, employment rate, and unpaid leave) were collected for 58 consecutive months (before and after the intervention) for intervention and reference groups. In total, eight intervention groups with a total of 1600 employees participated in the intervention. Process evaluation data were collected by process facilitators from the intervention team. Overall intervention effects were assessed using mixed-effects models with an AR (1) covariance structure for the repeated measurements and time as fixed effect. Intervention effects for each intervention group were assessed using time series analysis. Finally, results were compared descriptively with data from process evaluation and reference groups to disentangle the organisational-level intervention effects from other simultaneous effects. RESULTS: All measures of employee withdrawal behaviour indicated statistically significant time trends and seasonal variability. Applying these methods to an organisational-level intervention resulted in an overall decrease in employee withdrawal behaviour. Meanwhile, the intervention effects varied greatly between intervention groups, highlighting the need to perform analyses at multiple levels to obtain a full understanding. Results also indicated that possible delayed intervention effects must be considered and that data from process evaluation and reference group comparisons were vital for disentangling the intervention effects from other simultaneous effects. CONCLUSIONS: When analysing the effects of an intervention, time trends, seasonal variability, and other changes in the work environment must be considered. The use of mixed-effects models in combination with time series analysis, process evaluation, and reference groups is a promising way to improve the evaluation of organisational-level interventions that can easily be adopted by others.

New graduate nurses' satisfaction, adaptation and intention to leave in their first year: A descriptive study.

AIM: To determine the factors affecting the professional and institutional satisfaction of new graduate nurses in their first year of work, their adaptation process and their intentions of leaving the nursing profession. BACKGROUND: The number of new graduates has been increasing in the global labour force, yet a significant proportion of them have left their profession. The first year in the nursing profession is particularly stressful and challenging for new graduate nurses. METHODS: The study was conducted at four hospitals with 428 new graduate nurses who were in the first years of their careers. RESULTS: The nurses' mean score, out of ten, was 5.52 points for job satisfaction and 5.16 points for satisfaction with their institution. Of them, 47.7% had difficulties adapting to nursing, and 53.5% had issues adapting to their jobs. Of them, 42.5% had considered leaving nursing, and 50.9% planned to leave their institutions. CONCLUSIONS: New graduates that perceive high workload, poor communication with patients and families or team members or inadequate skills and knowledge are more likely to consider turnover or leaving the profession. IMPLICATION FOR NURSING MANAGEMENT: New graduates suggested that better cooperation and teamwork, participation in decisions, consideration of requests for placement in a specific department, fair distribution of duties and shifts and in-unit professional development opportunities would all improve the work environment and decrease risk of turnover.

Second victim experiences of nurses in obstetrics and gynaecology: A Second Victim Experience and Support Tool Survey.

AIM (S): To investigate second victim experiences and supportive resources for nurses in obstetrics and gynaecology. BACKGROUND: Nurses are at risk of developing second victim experiences after exposure to work related events. METHODS: Nurses at a single institution were invited to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool to assess symptoms related to second victim experiences and current and desired supportive resources. RESULTS: Of 310 nurses, 115 (37.1%) completed the survey; 74.8% had not heard of the term 'second victim'. Overall, 47.8% reported feeling like a second victim during their career and 19.1% over the previous 12 months. As a result of a second victim experience, 18.4% experienced psychological distress, 14.3% turnover intentions, 13.0% decreased professional self-efficacy, and 12.2% felt that institutional support was poor. Both clinical and non-clinical events were reported as possible triggers for second victim experiences. Peer support was the most desired form of support as reported by 95.5%. CONCLUSION(S): Nurses in obstetrics and gynaecology face clinical and non-clinical situations that lead to potential second victim experiences. IMPLICATIONS FOR NURSING MANAGEMENT: The second victim experiences of nurses should be acknowledged, and resources should be implemented to navigate it. Educational opportunities and peer supportive interventions specific to second victim experiences should be encouraged.

Intention to leave among staff nurses in small- and medium-sized hospitals.

AIMS AND OBJECTIVES: To explore the factors associated with the intention to leave among nurses in small- and medium-sized hospitals and to determine the predictors about work environment and rewards. BACKGROUND: Compared with large hospitals, insight into the working conditions, rewards and turnover of nurses working for these hospitals is lacking internationally. DESIGN: Cross-sectional study design. METHODS: Data were obtained from the Korean Nurses Association's 2016 Welfare Policy and System Improvement Survey. Of the participants, data from 951 staff nurses working three shifts were analysed using hierarchical multiple regression to explore the predictors of nurses' turnover intention. This study complied with the Strengthening the Reporting of Observational studies in Epidemiology. RESULTS: The perceived pay level satisfaction was the most obvious and persistent predictor of the intention to leave. Living benefits were shown to be scarcely satisfied, rendering considerable influence on turnover intention. Concerning aspects related to the working environment, the implementation of contract-abiding working hours and nurse-friendly night shift schedules reduced the turnover intention of nurses. CONCLUSIONS: Nurses in small- and medium-sized hospitals are likely to have particular challenges in terms of professional growth. When fundamental rewards and basic working conditions are acceptable to nurses, their turnover can be reduced, and the professional growth can also be expected. Hospitals with a high nurse turnover rate need to preferentially verify these factors perceived by their nurses and to improve to increase nurses' retention. RELEVANCE TO CLINICAL PRACTICE: Understanding the determinants of intention to leave can lead to the development of strategies that persuade nurses to remain employed. These findings inform policymakers, nurse managers and hospital managers of the causes of nurses' intentions to leave in small- and medium-sized hospitals. Our findings also provide empirical data on the working conditions and rewards of these nurses and suggest strategies for their retention.

Impact of workplace violence against nurses' thriving at work, job satisfaction and turnover intention: A cross-sectional study.

AIMS AND OBJECTIVES: To investigate the interrelationships between workplace violence, thriving at work and turnover intention among Chinese nurses and to explore the action mechanism among these variables. BACKGROUND: Workplace violence is a dangerous occupational hazard globally, and it is pervasive in the health service industry. As a corollary, workplace violence may produce many negative outcomes among nursing staff. Consequently, it hinders nurses' professional performance and reduces nursing quality. DESIGN: A cross-sectional online survey was conducted. METHODS: A total of 1,024 nurses from 26 cities in China were recruited from February-May 2016. An anonymous questionnaire was used in this survey. Participants' completed data were collected using a demographics form and a 26-item questionnaire consisting of scales addressing workplace violence, thriving at work, job satisfaction, subjective well-being and turnover intention. To evaluate multivariate relationships, some multiple linear hierarchical regression analyses were performed. RESULTS: Workplace violence significantly negatively influenced nurses' job satisfaction and thriving at work, and significantly positively influenced nurses' turnover intention. Job satisfaction significantly predicted thriving at work and turnover intention. Job satisfaction not only fully mediated the relationship between workplace violence and thriving at work, but also partially mediated the relationship between workplace violence and turnover intention. Subjective well-being moderated the relationship between workplace violence and job satisfaction and the relationship between workplace violence and nurses' turnover intention. CONCLUSIONS: Adverse effects of workplace violence were demonstrated in this study. Decreases in job satisfaction were a vital mediating factor. The moderating effect of subjective well-being was helpful in reducing the harm of workplace violence to nurses and in decreasing their turnover intention. RELEVANCE TO CLINICAL PRACTICE: Workplace violence and its negative impact on nursing work should not go unnoticed by nursing managers. Nurses' subjective well-being is critical in controlling and mitigating the adverse effects of workplace violence.

Potential predictors of susceptibility to occupational stress in Japanese novice nurses - a pilot study.

BACKGROUND: Occupational stress is a known factor behind employee resignations; thus, early identification of individuals prone to such stress is important. Accordingly, in this pilot study we evaluated potential predictors of susceptibility to occupational stress in Japanese novice nurses. METHODS: Forty-two female novice nurses at Kagoshima University Hospital were recruited for the study population. Each underwent physical health and urinary examinations, and completed a lifestyle questionnaire at the time of job entry. Each also completed a Brief Job Stress Questionnaire (BJSQ), related to mental health status, at job entry and 5 months post-entry. Psychological stress, somatic symptoms, and combined BJSQ scores were determined for each time point. RESULTS: All three stress condition scores had significantly decreased at 5 months post-entry, suggesting occupational stress. Systolic blood pressure (r = -0.324, p < 0.05) and urinary sodium (r = -0.313, p < 0.05) were significantly negatively correlated with combined BJSQ score at 5 months post-entry. Post-entry stress condition scores were significantly low in subjects reporting substantial 1-year body weight change (≤ ± 3 kg) and short times between dinner and bedtimes (≤2 h), though baseline stress condition scores were not. Urinary sodium concentration, 1-year body weight change, and pre-sleep evening meals were then targeted for multivariate analysis, and confirmed as independent explanatory variables for post-entry stress condition scores. CONCLUSIONS: One-year body weight change, times between dinner and bedtimes, and urinary sodium concentration are promising potential predictors of susceptibility to occupational stress, and should be further investigated in future research. TRIAL REGISTRATION: ISRCTN ISRCTN17516023. Retrospectively registered 7 December 2016.

Sport medicine and sport science practitioners' experiences of organizational change.

Despite the emergence of and widespread uptake of a growing range of medical and scientific professions in elite sport, such environs present a volatile professional domain characterized by change and unprecedentedly high turnover of personnel. This study explored sport medicine and science practitioners' experiences of organizational change using a longitudinal design over a 2-year period. Specifically, data were collected in three temporally defined phases via 49 semi-structured interviews with 20 sport medics and scientists employed by three organizations competing in the top tiers of English football and cricket. The findings indicated that change occurred over four distinct stages; anticipation and uncertainty, upheaval and realization, integration and experimentation, normalization and learning. Moreover, these data highlight salient emotional, behavioral, and attitudinal experiences of medics and scientists, the existence of poor employment practices, and direct and indirect implications for on-field performance following organizational change. The findings are discussed in line with advances to extant change theory and applied implications for prospective sport medics and scientists, sport organizations, and professional bodies responsible for the training and development of neophyte practitioners.

Hospital doctor turnover and retention: a systematic review and new research pathway.

PURPOSE: Society is critically dependent on an adequate supply of hospital doctors to ensure optimal health care. Voluntary turnover amongst hospital doctors is, however, an increasing problem for hospitals. The aim of this study was to systematically review the extant academic literature to obtain a comprehensive understanding of the current knowledge base on hospital doctor turnover and retention. In addition to this, we synthesise the most common methodological approaches used before then offering an agenda to guide future research. DESIGN/METHODOLOGY/APPROACH: Adopting the PRISMA methodology, we conducted a systematic literature search of four databases, namely CINAHL, MEDLINE, PsycINFO and Web of Science. FINDINGS: We identified 51 papers that empirically examined hospital doctor turnover and retention. Most of these papers were quantitative, cross-sectional studies focussed on meso-level predictors of doctor turnover. RESEARCH LIMITATIONS/IMPLICATIONS: Selection criteria concentrated on doctors who worked in hospitals, which limited knowledge of one area of the healthcare environment. The review could disregard relevant articles, such as those that discuss the turnover and retention of doctors in other specialities, including general practitioners. Additionally, being limited to peer-reviewed published journals eliminates grey literature such as dissertations, reports and case studies, which may bring impactful results. PRACTICAL IMPLICATIONS: Globally, hospital doctor turnover is a prevalent issue that is influenced by a variety of factors. However, a lack of focus on doctors who remain in their job hinders a comprehensive understanding of the issue. Conducting "stay interviews" with doctors could provide valuable insight into what motivates them to remain and what could be done to enhance their work conditions. In addition, hospital management and recruiters should consider aspects of job embeddedness that occur outside of the workplace, such as facilitating connections outside of work. By resolving these concerns, hospitals can retain physicians more effectively and enhance their overall retention efforts. SOCIAL IMPLICATIONS: Focussing on the reasons why employees remain with an organisation can have significant social repercussions. When organisations invest in gaining an understanding of what motivates their employees to stay in the job, they are better able to establish a positive work environment that likely to promote employee well-being and job satisfaction. This can result in enhanced job performance, increased productivity and higher employee retention rates, all of which are advantageous to the organisation and its employees. ORIGINALITY/VALUE: The review concludes that there has been little consideration of the retention, as opposed to the turnover, of hospital doctors. We argue that more expansive methodological approaches would be useful, with more qualitative approaches likely to be particularly useful. We also call on future researchers to consider focussing further on why doctors remain in posts when so many are leaving.

Research Topic Trends on Turnover Intention among Korean Registered Nurses: An Analysis Using Topic Modeling.

This study aimed to explore research topic trends on turnover intention among Korean hospital nurses by analyzing the keywords and topics of related articles. Methods: This text-mining study collected, processed, and analyzed text data from 390 nursing articles published between 1 January 2010 and 30 June 2021 that were collected via search engines. The collected unstructured text data were preprocessed, and the NetMiner program was used to perform keyword analysis and topic modeling. Results: The word with the highest degree centrality was "job satisfaction", the word with the highest betweenness centrality was "job satisfaction", and the word with the highest closeness centrality and frequency was "job stress". The top 10 keywords in both the frequency analysis and the 3 centrality analyses included "job stress", "burnout", "organizational commitment", "emotional labor", "job", and "job embeddedness". The 676 preprocessed key words were categorized into five topics: "job", "burnout", "workplace bullying", "job stress", and "emotional labor". Since many individual-level factors have already been thoroughly investigated, future research should concentrate on enabling successful organizational interventions that extend beyond the microsystem.

Working through a pandemic: The mediating effect of nurses' health on the relationship between working conditions and turnover intent.

AIM: While research has demonstrated that nurses' health and working conditions are important predictors of turnover in COVID-19, the relationship between these factors is not well understood. Our study investigated the mechanism through which working conditions and nurses' physical and mental health could impact intent to leave the nursing profession. DESIGN: Secondary data from a cross-sectional survey of 3478 nurses in British Columbia administered in May 2021 were analysed using structural equation modelling. METHODS: Two models were assessed utilizing workplace conditions as the predictor, nurses' health as the mediator, and reported turnover intent (Model 1), and anticipated time to turnover (Model 2) as the outcomes. RESULTS: Nurses' health partially mediated the relationship between working conditions and turnover intent, where poorer workplace conditions were directly and indirectly associated with greater likelihood of leaving the profession. Nurses' health fully mediated the relationship between working conditions and nurses' anticipated time to turnover, after controlling for age. The findings from this study underscore the importance of enhancing working conditions and improving nurses' mental health and safety on the job. PATIENT OR PUBLIC CONTRIBUTION: The British Columbia Nurses' Union provided the data for this study; survey data from 3478 nurses were utilized in our study.

An employee retention model using organizational network analysis for voluntary turnover.

Contemporary research of employee social network analysis has grown far beyond the conventional wisdom of network and turnover theory; however, what is missing is a comprehensive review highlighting new perspectives and network constructs from a retention viewpoint. Since turnover is a concurrent component of retention, the analysis of the factors of quit propensity can result in a pre-emptive strategy for retention. This paper aims to capture the current state of the field and proposes a conceptual model for retention by exploring network position, centrality measures, network type, and the snowball effect. We identified 30 papers exploring voluntary turnover in social network constructs. Findings show that central network position is not always associated with negative turnover. Eigenvector, structural holes, and K-shell also prove to be a strong predictor of turnover. The snowball turnover of employees in similar network positions is pronounced in scenarios where employee sentiment is negative with poor group efficacy, entrepreneurship, and group values. This paper focuses on several themes to coalesce different determinants of an organizational network to demonstrate how social network theory has evolved to predict employee turnover. The resulting conceptual model suggests how to identify star performers and propose retention strategies.

Do Embedded and Peripheral Corporate Social Responsibility Activities Lower Employees' Turnover Intentions?

Corporate social responsibility (CSR) remains a topic of interest for both theory and practice due to its multifaceted avenues and potential for growth. We have chosen embedded CSR and peripheral CSR measures to evaluate how these activities affect the employee turnover intentions via a mediation mechanism of organizational citizenship behavior (OCB). In doing so, this study addresses important stakeholder concerns and provides meaningful managerial contributions for the employers to encourage more employee participation (through lowering turnover intention) toward sustainable corporate performance. This study incorporates four hypotheses that are tested in a structural equation modeling framework by employing Warp-PLS software. Data were collected from 297 employees working in firms that are renowned for their CSR initiatives. We found support for our key hypotheses leading to strong theoretical contributions to the stakeholder theory. We have addressed the main issues of stakeholders' response to the CSR tradeoffs and have tried to develop a deeper understanding of managers in initiating peripheral and embedded CSR activities for their firms.

A systematic review of the research on telework and organizational economic performance indicators.

Introduction: A systematic review is conducted in the study to investigate the relationship between telework and organizational economic performance indicators such as self-reported employee performance, organizational performance, actual employee turnover rates, or intentions. Methods: The databases Scopus, Business Source Premier, and Web of Science were used to conduct a literature search. Original articles published from 2000 and up to May 2021 were selected. Studies were screened for inclusion independently by review pairs and data were extracted. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the quality of the studies included. Results: Forty-three studies were included with some addressing multiple outcomes. Self-reported performance was higher for teleworking employees compared to those working in the ordinary workplace. The extent of the change in performance was dependent on individual characteristics and the extent of the teleworking practice in the organization. Telework was also associated with increased organizational performance, particularly in homogenous samples with unique work tasks. When telework is voluntary, it appears that both actual employee turnover rates and intentions to leave the organization are lower. Discussion: Further research with high-quality prospective designs is necessary to properly understand the contribution of telework to organizational economic performance indicators.

Effect of Despotic Leadership on Employee Turnover Intention: Mediating Toxic Workplace Environment and Cognitive Distraction in Academic Institutions.

Despotic leadership builds adverse emotions and turnover intentions in the employees of an educational organization. This study investigated the relationships among despotic leadership, toxic workplace environment, cognitive distraction, and employee turnover intention. This study is based on social exchange theory (SET), social psychology theories of behavioral intention formation (such as the theory of reasoned action and the theory of planned behavior), and of the despotic leadership style. A survey questionnaire containing 28 items was completed by 240 faculty members from four Chinese universities. The responses were documented on a seven-point Likert scale. We applied PLS-SEM (partial least squares structural equation modeling) to measure the effects. The outcomes showed that despotic leadership influenced employee turnover intention in academic institutions. Toxic workplace environment correlates with employee turnover intention. Cognitive distraction also correlates with employee turnover intention. Toxic workplace environment mediates the relationship between despotic leadership and employee turnover intention. Similarly, cognitive distraction mediates the relationship between despotic leadership and employee turnover intention. The study concluded that despotic leadership, toxic workplace environment, and cognitive distraction might increase employee turnover intention. This study adds to the literature in the field of despotic leadership, toxic workplace environment, cognitive distraction, and employee turnover intention in academic institutions. Furthermore, it offers valuable and practical implications along with recommendations for future research.

Workplace Conflict in Applied Behavior Analysis: Prevalence, Impact, and Training.

Conflict, albeit normal in every relationship, can increase stress and tension. Workplace conflict is highly prevalent in the field of health care and has been correlated with lowered job satisfaction and burnout. However, little is known about workplace conflict for practicing Board Certified Behavior Analysts® (BCBAs®). We distributed an electronic survey through the Behavior Analysis Certification Board® (BACB®) to determine the impact and prevalence of workplace conflict for practicing BCBAs. Most of our participants reported various levels of conflict with different workplace professionals including teachers, caregivers, colleagues, and supervisees. We found that a high proportion of practitioners reported losing cases and wanting to leave their jobs because of workplace conflict. Most of our participants did not feel that they had the training they needed to have sufficient skills to resolve workplace conflict effectively. Therefore, in this article we outlined the component skills necessary to manage conflict effectively and made recommendations for training these skills.

Association between nursing home staff turnover and infection control citations.

OBJECTIVE: To describe the association between nursing home staff turnover and the presence and scope of infection control citations. DATA SOURCES: Secondary data for all US nursing homes between March 31, 2017, through December 31, 2019 were obtained from Payroll-Based Journal (PBJ), Nursing Home Compare, and Long-Term Care: Facts on Care in the US (LTC Focus). STUDY DESIGN: We estimated the association between nurse turnover and the probability of an infection control citation and the scope of the citation while controlling for nursing home fixed effects. Our turnover measure is the percent of the facility's nursing staff hours that were provided by new staff (less than 60 days of experience in the last 180 days) during the 2 weeks prior to the health inspection. We calculated turnover for all staff together and separately for registered nurses, licensed practical nurses (LPNs), and certified nursing assistants. DATA COLLECTION/EXTRACTION METHODS: We linked nursing homes standard inspection surveys to 650 million shifts from the PBJ data. We excluded any nursing home with incomplete or missing staffing data. Our final analytic sample included 12,550 nursing homes with 30,536 surveys. PRINCIPAL FINDINGS: Staff turnover was associated with an increased likelihood of an infection control citation (average marginal effect [AME] = 0.12 percentage points [pp]; 95% confidence interval [CI]: 0.05, 0.18). LPN (AME = 0.06 pp; 95% CI: 0.01, 0.11) turnover was conditionally associated with an infection control citation. Conditional on having at least an isolated citation for infection control, staff turnover was positively associated with receiving a citation coded as a "pattern" (AME = 0.21 pp; 95% CI: 0.10, 0.32). Conditional of having at least a pattern citation, staff turnover was positively associated with receiving a widespread citation (AME = 0.21 pp; 95% CI: 0.10, 0.32). CONCLUSIONS: Turnover was positively associated with the probability of an infection control citation. Staff turnover should be considered an important factor related to the spread of infections within nursing homes.

What drives pharmacists' turnover intention: A systematic review.

Background: Pharmacist turnover can negatively impact not only on work efficiency, organizational performance, work productivity and customer satisfaction, but also on the quality of pharmaceutical services and patient safety. Turnover intention is a core antecedent of turnover. Turnover intention of the pharmacists is affected by many factors related to their organization or job. Objective: To elaborate the factors affecting the pharmacists' turnover intention and their associations. Studies related to any factors affecting pharmacists' turnover intention in all pharmacy settings were included. The QualSyst assessment tool was used for assessing the quality of the included studies. Result: For this systematic review, 3,822 studies were identified. Of these studies,20 studies were included. Thirty factors were explored and a model for pharmacists' turnover intention was produced. Organizational commitment, job satisfaction, career commitment, job stress, perceived organizational support, and work climate were frequently found as drivers to pharmacist turnover intention. Some of 24 other factors had both direct and indirect effects on pharmacist turnover intention via organizational commitment, job satisfaction, career commitment, job stress, and perceived organizational support. Many studies have reported that organizational commitment and job satisfaction had significant influence on pharmacist turnover intention in all settings. Job stress and work climate had direct and indirect effects on turnover intention of hospital pharmacists. Career commitment and perceived organizational support had direct and indirect effects on community pharmacist turnover intention. Conclusion: The factors driving the turnover intention of the pharmacists in different pharmacy practices were different. It indicated that the further interventions should be different to improve the pharmacists' retention in each pharmacy practice setting. Our systematic review is beneficial to guide human resource management in pharmacy and useful for guiding the conceptual framework of future research studies.