Retaining the nursing workforce: factors contributing to the reduction of nurses' turnover intention in Japan.

AIM: The aim of this study was to investigate the effects of psychological contract fulfilment, perceived advancement opportunities and age on reducing the turnover intention of nurses in Japan. BACKGROUND: The factors that contribute to and mitigate the intentions of nurses to leave their organisations need to be investigated to understand the determinants of nurse turnover better. However, there is a paucity of studies identifying these mitigating factors. METHODS: Potential participants were 1337 registered nurses and midwives, of whom 766 participated in the study (a return rate of 57%). The data were analysed using a moderated regression analysis. RESULTS: Fulfilment of the psychological contract and perceived advancement opportunities independently and jointly contributed to a reduction in nurses' turnover intentions. The results also showed that nurses' ages were negatively correlated with their turnover intentions. CONCLUSIONS: Fulfilment of the psychological contract and advancement opportunities are important for reducing nurses' turnover intentions, especially among younger nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Clear guidelines/evaluations of contributions made by nurses and their organisations are needed to enhance the experience of nurses in terms of psychological contract fulfilment. Moreover, a structured advancement support system needs to be implemented to reduce nurses' turnover intentions.

Investigating the adequacy of the Competence-Turnover Intention Model: how does nursing competence affect nurses' turnover intention?

AIMS AND OBJECTIVES: The aim of this study was to test the adequacy of the Competence-Turnover Intention Model, which was developed to identify how nursing competence could affect nurses' turnover intention (nurses' intention to voluntarily leave an organisation). BACKGROUND: Recent studies have suggested that the level of nursing competence is negatively related to nurses' intention to leave their jobs, suggesting that a lack of competence threatens both the quality and quantity of the nursing workforce. However, the mechanism of how nursing competence affects nurses' turnover intention has not been explored previously. DESIGN: A cross-sectional survey design was used. METHODS: Surveys were distributed to 1337 Japanese registered nurses/midwives in October, 2013. The adequacy of the model was analysed using structural equation modelling. RESULTS: In total, 766 questionnaires were returned, with a return rate of 57%. The model fitted well with the data. The results showed that the level of nursing competence was related positively to the quantity of organisational rewards they felt they had received, and negatively related to the level of exhaustion they experienced. Moreover, the perceived organisational rewards and exhaustion were correlated with nurses' turnover intention through affective commitment. CONCLUSIONS: The Competence-Turnover Intention Model is useful for explaining how nursing competence impacts on their turnover intention. RELEVANCE TO CLINICAL PRACTICE: Clinical implications derived from the findings are that: promoting nursing competence is key to improving not only the quality of care provided by nurses, but also to retaining the nursing workforce, and the model can be used to develop strategies that would mitigate their turnover intention.

Competence development as perceived by degree and non-degree graduates in Japan: a longitudinal study.

BACKGROUND: A degree programme is believed to prepare graduates with a higher level of competence than their diploma counterparts. However, there have been inconsistent findings reported as to whether or not degree-graduates outperformed those who take diplomas. OBJECTIVES: This study aimed to identify graduates' perceptions of competence development in their first year of employment, and to compare the competence levels of graduates with different educational backgrounds. DESIGN: This study adopted a longitudinal design. SETTINGS: This study has been performed in five hospitals in Japan. PARTICIPANTS: 122 Japanese graduates participated in this study. METHODS: The self-assessed competence of the graduates was collected in the 3rd, 6th, 9th, and 12th months of their employment using a survey method. The data were analysed using a linear mixed model. RESULTS: The results suggested that the graduates perceived their competence to be rapidly growing during the first half of the graduate year, and slowly later. The results also indicated that the graduates' perception of their competence showed a significant variation. The most striking finding of the study was that, on average, the non-degree graduates rated their competence higher than their degree counterparts. CONCLUSIONS: The current university orientation on emphasising intellectual and theoretical components of education, with less focus on practical components might have led to the development of lower competence among the BN graduates. A fine balance between theoretical and practical components needs to be established in a university curriculum.

Graduate nurses' perceptions of mismatches between themselves and their jobs and association with intent to leave employment: a longitudinal survey.

BACKGROUND: Graduate nurses experience mismatches between themselves and their jobs. One of these is the demands-abilities misfit, which is a mismatch between the abilities of employees and those required by a job (demands). Another is the supplies-needs misfit, which occurs when employees' work-specific needs are not fulfilled by opportunities (called environmental supplies) work can supply to reinforce them. OBJECTIVES: The aim of this study was to investigate how graduate nurses' perceptions of the demands-abilities and supplies-needs misfits changed over time, and to examine how these misfits impact their intention to leave the jobs. DESIGN: A longitudinal study design was used. SETTING: Five hospitals in the western region of Japan cooperated in the study. PARTICIPANTS: A total of 176 graduate nurses participated in the study one or more times. From among them, 150, 109, 102, and 96 graduates participated in the study conducted in the 3rd, 6th, 9th, and 12th months of the employment, respectively. In addition, 62 graduates participated in all studies. METHODS: Surveys were distributed to the graduates 3, 6, 9 and 12 months after their employment commenced. The results were analysed using multiple regression analysis. RESULTS: The results showed that the graduates perceived both demands-abilities and supplies-needs misfits, although the degree of the demands-abilities misfit became smaller towards the end of the graduate year. As for the impact on graduates' turnover intention, the graduates' abilities and their perception of the environmental supplies served as more significant predictors of their turnover intention, rather than the misfits per se. The variances of turnover intention explained by the supplies-needs variables were greater than those explained by the demands-abilities variables from the third to ninth months into the employment. On the other hand, the variance explained by the demands-abilities variables increased towards the end of the year, and finally exceeded that of the supplies-needs variables. CONCLUSIONS: The graduates' turnover intention is complex, and may not be explained by simple demands-abilities and supplies-needs misfits. Different factors influence their turnover intention at different times to different degrees.

Development of the Holistic Nursing Competence Scale.

This study developed a scale to measure the nursing competence of Japanese registered nurses and to test its psychometric properties. Following the derivation of scale items and pilot testing, the final version of the scale was administered to 331 nurses to establish its internal consistency, as well as its construct and criterion-related validity. Using an exploratory and a confirmatory factor analysis, 36 items with a five-factor structure were retained to form the Holistic Nursing Competence Scale. These factors illustrate nurses' general aptitude and their competencies in staff education and management, ethical practice, the provision of nursing care, and professional development. The Scale has a positive correlation with the length of clinical experience. A Cronbach's alpha coefficient was 0.967. The Scale is a reliable and valid measure, helping both nurses and organizations to correctly evaluate nurses' competence and identify their needs for professional development.