Associations between paramedics' salutogenic health experience and the intention to stay in the profession: A cross-sectional survey.

AIM: To investigate the association between paramedics' salutogenic health and their intentions to stay in their profession. DESIGN: A cross-sectional survey. METHODS: Paramedics from eight purposively selected organizations participated in this study (n = 433). The data were collected in 2022 with the Salutogenic Health Indicator Scale and validated single questions that assessed work ability, recovery and self-rated stress. Intention to stay was measured using two questions about the intention to leave prehospital emergency medical service work and leave the nursing sector completely during the next 2 years. Data were analysed using logistic regression and statistical significance tests. RESULTS: Men had higher mean salutogenic health scores than women. No significant differences in salutogenic health were observed across work experience or occupational groups. Paramedics intending to stay in their profession exhibited higher salutogenic health scores than those intending to leave. In the logistic regression models, increasing levels of salutogenic health and work ability were associated with intention to stay in the profession.

Turnover Rates and Factors Associated With Turnover: A Longitudinal Analysis of the Retention Period of Clinical Nurses in Korea Using National Data.

Many countries, including Korea, are struggling with a nursing workforce shortage. This study aimed to identify the actual turnover rate of Korean clinical nurses and the factors affecting the turnover rate, considering the time required for nurses to gain experience at their current medical institution. This longitudinal study followed up on a cohort consisting of all 107,682 nurses from January 1, 2017 to July 30, 2020. Differences in the distribution of retention and turnover according to the medical institutions' and nurses' characteristics were analyzed using the chi-square test. The hazard ratios (HRs) for turnover in each analysis interval were analyzed using multilevel Cox proportional-hazards analysis. The mean turnover rate was 10.0% within 1 year and 33.4% within 3.5 years. Several organizational characteristics (the type and ownership of the hospital, its location, and the bed-to-nurse ratio) and individual characteristics (gender, age, and clinical experience) were found to be associated with turnover risk. Among these factors, compared to hospitals with a bed-to-nurse ratio in general wards of 6.0 or more, those with a ratio of 3.5-3.9 had an HR for 1-year turnover of 0.81 (95% confidence interval [CI] = 0.67-0.98), and those with a ratio of 2.5-2.9 had an HR for 3.5-year turnover of 0.77 (95% CI = 0.66-0.90). The bed-to-nurse ratio is a condition that can be modified through collaboration between government policy-makers and medical institutions. To reduce nurse turnover and retain experienced nurses, appropriate staffing should be implemented.

A prospective cohort study of presenteeism and increased risk of unemployment among Japanese workers during the COVID-19 pandemic.

OBJECTIVES: Presenteeism adversely affects workers' quality of life, leading to further deterioration of their health and affecting their ability to continue working. Unemployment is one of the most serious consequences for workers experiencing presenteeism. A worker's ability to work depends on the degree of mismatch between their health status and job demands and work factors. The COVID-19 pandemic has affected workers' experiences of presenteeism as well as their employment status. We examined the association between presenteeism and risk of job resignations and unemployment among Japanese workers during the COVID-19 pandemic. METHODS: A prospective study of 27 036 internet monitors was conducted, starting in December 2020, with 18 560 (68.7%) participating in the follow-up by December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment. RESULTS: The group with the highest WFun scores had higher odds ratios (ORs) for both retirement and unemployment for health reasons than the group with the lowest WFun scores. ORs were 2.99 (95% CI, 2.48-3.62; P < .001) and 1.82 (95% CI, 1.65-2.00; P < .001), respectively. CONCLUSIONS: Workers with work functioning impairment are at increased risk of resignation or unemployment. Management strategies for workers with work functioning impairment are needed to reduce their disadvantages in employment.

Utility of salivary cortisol profile as a predictive biomarker in nurses' turnover risk: a preliminary study.

BACKGROUND: Predicting nurse turnover risk is crucial due to the global nursing shortage; however, existing predictors, such as fatigue and burnout, lack objectivity. Salivary cortisol is a non-invasive marker of stress and fatigue, but its utility in predicting nurse turnover risk is unknown. We examined whether salivary cortisol profiles across three different day shifts in a month are predictors of the extent of nurses' reluctance to stay in their current jobs. METHODS: This preliminary longitudinal study followed forty female nurses who engaged in shift work at a university hospital for 3 months. Data at enrollment were collected including demographics, working conditions, chronic fatigue (the Japanese version of the Occupational Fatigue/Exhaustion Recovery Scale), and burnout (Japanese Burnout scale). Salivary cortisol was measured before the three different day shifts (after awakening) during the first month, and the means of these measurements were used as the cortisol profile. The extent of reluctance to stay was assessed using the numerical rating scale at 3 months. RESULTS: Among the forty female nurses (mean [SD] age, 28.3 [5.1]), all completed follow-up and were included in the analysis. The cortisol profile was associated with the extent of reluctance to stay (P = 0.017), and this association was significant despite adjustments for chronic fatigue and burnout (P = 0.005). A multiple regression model with chronic fatigue, burnout, and job tenure explained 41.5% of the variation in reluctance to stay. When the cortisol profile was added to this model, the association of the cortisol profile was significant (P = 0.006) with an R2 of 0.529 (ΔR2 = 0.114). CONCLUSIONS: This preliminary study conducted in an actual clinical setting indicated the potential of the salivary cortisol profile across three different day shifts in a month to predict nurses' reluctance to stay in their current jobs. The combination of subjective indicators and the cortisol profile would be useful in predicting nurses' turnover risk.

Implementation of a technician success and onboarding coordinator to reduce technician turnover.

PURPOSE: This article provides an overview of changes implemented at an academic medical center to reduce pharmacy technician turnover. SUMMARY: Pharmacy technician turnover has been a problem for years. Technicians come and go; they move on to other positions, and continuous turnover is an avoidable expense. With greater focus on creating a successful onboarding experience for newly hired technicians, turnover should decrease and satisfaction and engagement should increase. When a newly hired technician leaves a department within the first year, it can have a negative impact on the engagement of the remaining technicians who spent time training new hires in how to complete tasks, mentoring them, and incorporating them into the team. Creating a positive onboarding experience will decrease expenses accrued and minimize wasted resources and staff time dedicated to a technician who will not be around in 6 months to 1 year. At M Health Fairview, a Minneapolis, MN-based health system, technician retention has been improved through a standardized approach to onboarding and orientation, including creation of the new staff role of technician success and onboarding coordinator (TSOC). CONCLUSION: A standard approach to onboarding pharmacy technicians and integrating them into the pharmacy department has proven to be essential to technician retention at M Health Fairview. To get started, it is important to find the right person for the TSOC role to coordinate successful onboarding of newly hired pharmacy technicians. That person should be an individual with passion to engage and inspire newly hired technicians, with several years of experience, and with the ability to cascade knowledge.

The Role of Continuing Professional Training or Development in Maintaining Current Employment: A Systematic Review.

The impact of continuing job education and professional development on early exit from the labor market is unclear. This systematic review examined how continuing job education or professional development influences the retention of current employment. We searched the PubMed and Embase databases from their start dates to January 2023. Two reviewers screened the full texts of relevant reports and assessed the methodological quality of the included studies using the adapted Effective Public Health Practice Project quality assessment. We qualitatively synthesized the results of the included studies. We screened 7338 publications and included 27 studies consisting of four cohort and 23 cross-sectional studies in the review. The participants of the selected studies were mostly from the health sector (24 studies). There were 19 studies on staying or leaving a current job, six on employee turnover intention, two on job change, one on return to work, one on early retirement, and one on employment. Continuing employee development or training opportunities were associated with increased intention to stay in a current job, decreased intention to leave a current job, decreased employee turnover intention, job change, or early retirement and with faster return to work. One of the two studies that examined the role of age showed that continuing employee development is a more important factor for retaining current employment among younger than older employees. A few studies found that job satisfaction and commitment fully mediated the relationship between employee development and employee intention to leave current employment. This study suggests that participating in professional training/development is related to a lower risk of leaving current employment.

Recent Paramedic Graduates' Chronic Stress Adds Intentions to Leave the Profession: A Pilot Study Utilizing a Web-Based Survey.

Paramedics have mentally and physically demanding jobs, and chronic stress is not uncommon. Recently graduated paramedics, in particular, have been identified as needing support in their early careers. This pilot study examined chronic stress experienced by recent graduate paramedics and their intentions to leave the paramedic profession. Finnish paramedics encompass qualifications to work in various nursing sectors. This pilot study was a cross-sectional survey study among Finnish paramedics who graduated less than 3 years ago and who were currently working in prehospital EMS (n = 152). They evaluated chronic organizational and operational stressors on the Emergency Medical Services Chronic Stress Questionnaire with 20 statements. Two structured questions related to the intention to leave the paramedic profession. Three summary scales were formed. The differences in stress by the intention to leave were reported descriptively and the differences were tested with Mann-Whitney U test. The influence of potential predictors of the intention to leave prehospital EMS work or the nursing sector completely were explored with a forward stepwise logistic regression model. Those who intended to leave prehospital EMS work (25%, n = 35/152) or to leave the nursing sector completely (33%, n = 50/152) experienced higher levels of stress than those without such intentions. Stress related to organizational inequity and leadership challenges was the strongest and stress related to social, health, and personal impacts was the second strongest predictor of the intention to leave. Reducing chronic stress might be important in terms of paramedic retention. Several further study needs are addressed.

Determinants of Job Satisfaction among Nurses from Chilean Hospitals / Determinantes de satisfacción laboral entre enfermeras de hospitales chilenos / Determinantes da satisfação profissional entre enfermeiros de hospitais chilenos

To measure, at the national scope, the satisfaction of Chilean nurses working in hospitals, and establish personal and institutional determinants associated with satisfaction. Methods. Cross-sectional multicenter study, carried out in 40 public and private high-complexity hospitals in Chile. A self-administered survey was conducted with 1,632 clinical nurses from medical-surgical units. The variables of interest studied were: job satisfaction, personal determinants (sex, age, and postgraduate training), institutional organizational determinants (assignments and work environment, measured through the Practice Environment Scale of the Nursing Work Index), and institutional structural determinants. Data analysis applied hierarchical logistic regression models, with three blocks of determinants, following nested models design. Results. The study showed that 21% of the nurses is very satisfied with their job. Training opportunities and professional growth are Vol. 41 No 3, September ­ December 2023ISSNp: 0120-5307 • ISSNe: 2216-0280 Invest Educ Enferm. 2023; 41(3): e04Determinants of Job Satisfaction amongNurses from Chilean Hospitalsspecific work aspects with which there is a lower percentage of nurses satisfied (10% and 11.2%, respectively). Among the personal factors, male sex and age are associated positively with satisfaction (p<0.05). Among the institutional organizational factors, a good work environment was associated with greater satisfaction (p<0.001); the number of patients per nurse was associated marginally with satisfaction (p<0.05). The structural factors of hospitals were not associated with satisfaction. Conclusion. A low proportion of nurses working in the high-complexity hospitals studied are satisfied with their job. Planning of strategies must be prioritized, leading to improving the retention of nurses, reducing the number of patients per nurse, and promoting good work environments in hospitals

Realizar una medición de alcance nacional de la satisfacción de las enfermeras chilenas que trabajan en hospitales para establecer qué determinantes personales e institucionales están asociados a ella. Métodos. Estudio multicéntrico de corte transversal, realizado en 40 hospitales públicos y privados de alta complejidad en Chile. 1632 enfermeras clínicas de unidades médico-quirúrgicas diligenciaron una encuesta. Las variables de interés estudiadas fueron: satisfacción laboral, determinantes personales (sexo, edad y formación de postítulo), determinantes institucionales-organizacionales (dotaciones y ambiente laboral, medidos mediante el Practice Environment Scale of the Nursing Work Index) y determinantes institucionales estructurales. Para el análisis de los datos se aplicaron modelos de regresión logística jerárquica, con tres bloques de determinantes, con el diseño de modelos anidados. Resultados. El 21% de las enfermeras estaba muy satisfecha con su trabajo. Las oportunidades de formación y de crecimiento profesional son los aspectos específicos del trabajo con los que hay menor porcentaje de enfermeras satisfechas (10% y 11.2%, respectivamente). Entre los factores personales, el sexo masculino y la edad se asocian positivamente a la satisfacción (p<0.05). Entre los factores institucionales organizacionales, un ambiente laboral bueno se asoció a mayor satisfacción (p<0.001); el número de pacientes por enfermera se asoció marginalmente a la satisfacción (p<0.05). Los factores estructurales de los hospitales no se relacionaron a la satisfacción. Conclusión. Una baja proporción de enfermeras Invest Educ Enferm. 2023; 41(3): e04Marta Simonetti • Leyla Sáezque trabaja en los hospitales de alta complejidad estudiados están satisfechas con su trabajo. Debe priorizarse la planificación de estrategias conducentes a mejorar la retención de las enfermeras, reducir el número de pacientes por enfermera y fomentar los buenos ambientes de trabajo en los hospitales.

Realizar uma medição nacional da satisfação dos enfermeiros chilenos que trabalham em hospitais e estabelecer quais determinantes pessoais e institucionais estão associados à satisfação. Métodos. Estudo transversal multicêntrico, realizado em 40 hospitais públicos e privados de alta complexidade no Chile. 1632 enfermeiros clínicos de unidades médico-cirúrgicas responderam à pesquisa. As variáveis de interesse estudadas foram: satisfação no trabalho, determinantes pessoais (sexo, idade e formação de pós-graduação), determinantes institucionais organizacionais (pessoal e ambiente de trabalho, mensurados por meio da Escala de Ambiente de Prática do Índice de Trabalho em Enfermagem) e determinantes institucionais estruturais. Para análise dos dados foram aplicados modelos de regressão logística hierárquica, com três blocos de determinantes, seguindo desenho de modelos aninhados. Resultados. 21% dos enfermeiros estavam muito satisfeitos com o seu trabalho. As oportunidades de formação e crescimento profissional são os aspectos específicos da função com os quais existe menor percentagem de enfermeiros satisfeitos (10% e 11.2%, respectivamente). Entre os fatores pessoais, o sexo masculino e a idade estão positivamente associados à satisfação (p<0.05). Dentre os fatores institucionais organizacionais, um bom ambiente de trabalho esteve associado à maior satisfação (p<0.001); O número de pacientes por enfermeiro esteve marginalmente associado à satisfação (p<0.05). Os fatores estruturais hospitalares não estiveram relacionados à satisfação. Conclusão. Uma baixa proporção de enfermeiros que atuam nos hospitais de alta complexidade estudados estão satisfeitos com seu trabalho. Deve ser dada prioridade ao planeamento de estratégias para melhorar a retenção de enfermeiros, reduzir o número de pacientes por enfermeiro e promover bons ambientes de trabalho nos hospitais

An Exploratory Study of Psychological Distress, Professional Quality of Life, Effort-Reward Imbalance, and Turnover Intention of Hospital Nurses during the COVID-19 Pandemic.

This exploratory study aimed to identify factors that may influence nurses' turnover intentions during the COVID-19 pandemic. The data were collected during January 2023 from 250 nurses and analyzed using descriptive statistics, t-test, ANOVA, Scheffe, Pearson's correlation, and multiple regression analysis. Among the sociodemographic and clinical characteristics, nursing care and working with personal protective equipment significantly impacted the turnover intention. Among the independent variables, compassion satisfaction, burnout, effort-reward ratio, and psychological distress were significant, with an explanatory power of 43.3%. Among the subjects, 86.4% (216 people) showed a moderate or high burnout level because of the COVID-19 pandemic, and burnout seemed to have a significant impact on turnover intention. Therefore, to lower the turnover intention of nurses, burnout should be prevented, and managers should create an environment where nurses can receive a balanced reward for their efforts.

Work-schedule management in psychiatric hospitals and its associations with nurses' emotional exhaustion and intention to leave: A cross-sectional multicenter study.

BACKGROUND: Managing nurses' work schedules in hospitals is challenging because employer needs, like shift changes at short notice and overtime, may conflict with nurses' desires for a predictable and stable schedule. Nurses should have a certain degree of control over their work schedules, and their supervisors should support their needs in scheduling. How perceived control over work schedules, perceived support from supervisors in scheduling, shift changes at short notice, and overtime affect nurses' emotional exhaustion and intentions to leave has not been studied. OBJECTIVES: The aims are (1) to describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses in psychiatric hospitals; (2) to assess the variation of these four factors between units at psychiatric hospitals; and (3) to investigate the association between these factors with nurses' emotional exhaustion and intentions to leave. DESIGN: Cross-sectional survey study. SETTING(S): Swiss psychiatric hospitals with 24-hour services. PARTICIPANTS: Registered nurses (N = 994) from 114 adult-inpatient units. METHODS: To describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses, we calculated frequencies, percentages, means, and standard deviations of their responses to the survey. To assess the variation between units, we computed intraclass correlations for the four factors. We constructed random-effects models accounting for the clustering of nurses in units for emotional exhaustion and intentions to leave separately. RESULTS: Perception of work-schedule control was 3.32 (SD 1.39, range 0-5); perception of supervisor work-schedule support was 3.28 (SD 1.14, range 0-4). On average, 9 % of the nurses had to take over a shift at short notice at least three times per month, and 40 % worked at least 15 minute overtime on their most recent shift. Intraclass correlation for all four factors was higher than 0.05. Emotional exhaustion was significantly associated with supervisor support and overtime, and leaving intentions were significantly associated with perceived control, supervisor support and overtime. CONCLUSION: Perceived control, perceived supervisor support, shift changes at short notice, and overtime are promising factors for interventions to prevent nurses' emotional exhaustion and allay their intentions to leave. Unit managers should provide nurses with increased predictability and influence on their work schedules. This could reduce early career endings and early retirement and counteract nurse shortages.

Retaining Healthcare Workers: A Systematic Review of Strategies for Sustaining Power in the Workplace.

The shortage of healthcare workers is a growing concern. The COVID-19 pandemic and retirement wave have accelerated turnover rates. This systematic review aimed to identify and analyse the existing interventions for job retention of healthcare workers, in terms of nurses and physicians, in a hospital setting. A comprehensive search was conducted within three electronic databases, guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) and synthesis without meta-analysis (SWiM) guidelines, this resulted in 55 records that met the inclusion criteria. The intervention outcomes are categorized into substantial themes: onboarding, transition program to a different unit, stress coping, social support, extra staffing, coping with the demands of patient care, work relationships, development opportunities and department resources, job environment, work organization, recruitment approach, and technological innovations. Considering the literature, onboarding programs and mentoring for nurses and physicians are recommended. Additionally, other interventions described in this review could positively affect the retention of nurses and physicians. When selecting an intervention for implementation, managers and human resources should consider the intervention that matches the determinant of intention to leave of their healthcare workers and the hospital's mission, vision, and values. Sharing the success stories of implemented interventions may benefit healthcare organizations.

Retaining employment in the hospital setting: A descriptive phenomenological study of Indonesian nurses' experiences.

Background: Losing competent nurses due to turnover can have adverse effects on healthcare administration, service delivery, and organizational dynamics. Frequent staff turnover can hinder optimal nursing practices, but some nurses remain committed. Therefore, understanding factors that foster sustained engagement and retention is crucial to create a retention strategy. Objective: This study aimed to explore the current experience of Indonesian nurses who retain their jobs in the hospital setting. Methods: A phenomenological design was employed in this study, with ten nurses selected using purposive sampling. Semi-structured interviews were used to gather data from a private hospital in Batam, Indonesia, between January and March 2022. A conventional content analysis was used to analyze the data. Results: The participants had an average total work experience of 10.4 years and an average age of 35.6 years, ranging from 28 to 44 years. The majority of the participants were females, held bachelor's degrees, and were married. Three main themes were developed in this study: solid teamwork, adequate compensation, and professional career development. Conclusion: Retaining experienced nurses in hospitals is influenced by antecedents such as teamwork, pay, and career growth. These findings offer nursing and hospital managers insights into developing policies and strategies to improve hospital nursing retention programs in Indonesia and beyond.

Retention of newly graduated registered nurses in the hospital setting: A systematic review.

BACKGROUND: There is a gap in the literature on identifying and describing effective interventions for the retention of newly graduated registered nurses in hospital settings. To the best of our knowledge, no systematic review has been conducted on this issue. AIM: To identify effective interventions that promote the retention of newly graduated registered nurses in the hospital setting and their components. DESIGN: A systematic review was conducted according to PRISMA 2020 Statement. METHODS: Information derived from the PubMed, CINAHL, Scopus, PsycINFO and Cochrane Library databases was reviewed, for the period January 2012-October 2022. Screening, data extraction and quality appraisal were conducted independently by two reviewers. The Joanna Briggs Institute Critical Appraisal tools were used for descriptive, quasi-experimental and cohort studies. Disagreements between the two reviewers were resolved through discussion. RESULTS: Following the critical appraisal, nine studies were included. The evidence reveals the heterogeneity of programmes developed in the hospital context to promote the retention of newly graduated registered nurses, clarifies the three competencies to be addressed (core, cross-cutting and specific), their components (programme development framework, duration, content and support components), and shows significant improvements after their implementation. CONCLUSIONS: This systematic review identifies that either nurse residency or individualised mentoring programmes, lasting 1 year, and multi-component, addressing core and specific competencies and including preceptor or mentor components seem to be the most comprehensive and effective in promoting the retention of new nurses in the hospital setting. RELEVANCE TO CLINICAL PRACTICE: The knowledge provided by this review will contribute to developing and implementing more effective and context-specific strategies directed at retaining newly graduated registered nurses and subsequently enhancing patient safety and healthcare costs. NO PATIENT OR PUBLIC CONTRIBUTION: Given the study design and focus.

Factors affecting child welfare and protection workers' intention to quit: a cross-sectional study from Norway.

INTRODUCTION: High turnover rates have been a problem for Norwegian child welfare and protection services for years. The main aim of this study was to identify which factors affect Norwegian child welfare and protection (CWP) workers intention to quit their job and whether there is a difference between experienced (< 3 years) and less experienced workers. METHODS: A cross-sectional survey was performed among 225 Norwegian child welfare and protection workers. Data were collected using a self-report questionnaire. Turnover intention was examined using a variety of job demands and resources as possible predictors. T tests were used to study mean differences in variable scores between experienced and less experienced workers and linear regression analysis was employed determining predictors of intention to quit. RESULTS: For the total sample (N = 225) the most important predictors for intention to quit were workload, burnout, engagement, and views on leadership. Higher emotional exhaustion and cynicism, and low professional efficacy predicted a higher score on the intention to quit scale. High engagement and leadership satisfaction predicted lower scores. The effect of workload was moderated, such that intention to quit among less experienced workers increased more with high workload than it did among more experienced child welfare workers. CONCLUSIONS: The conclusions are that job demands affect experienced and less experienced CWP workers differently and that when designing preventive efforts to reduce turnover this must be considered.

Effects of Nursing Work Environment, Need Satisfaction, and Depression on Turnover Intention in Korea.

This study examined the effects of the nursing work environment, need satisfaction, and depression on turnover intention in South Korean nurses through a mediating model. This study was a descriptive cross-sectional research study and was conducted through an online questionnaire. A total of 248 nurses were recruited for this study. Data were collected in August 2022. Participants were invited to complete self-reported questionnaires that measure nursing work environment, need satisfaction, depression, turnover intention, and demographic information. The data obtained were analyzed using the dual mediation model applying the PROCESS macro (Model 6). This study analyzed the direct effects of the nursing work environment on need satisfaction, depression, and turnover intention. The nursing work environment also had indirect effects on their turnover intention via need satisfaction and depression. The mediating effect of need satisfaction, which affects the turnover intention by increasing the satisfaction of the nursing work environment, was found to be the greatest. It has been shown that the more positive a nurse's experience of the nursing work environment, the higher the nurse's need satisfaction. According to the study results, the increase in nurses' need satisfaction greatly contributes to the decrease in depression and turnover intention. Therefore, active efforts should be made to improve the nursing work environment to fulfill basic needs.

SAMU 192 workforce turnover in Brazil / Rotación de plantilla de SAMU 192 en Brasil / Rotatividade da força de trabalho do SAMU 192 no Brasil

Objective: To describe the general and outgoing turnover of SAMU 192 professionals according to states and regions, in 2019, generating a national reference rate. Method: Exploratory-descriptive study, carried out with public data collected from the tabulation tool of the National Registry System of Health Establishments for competences from January to December 2019, according to states, macro-regions and country. The general turnover rate (TRG), the exit turnover rate (TRS) and the movement index for the categories (IM) were calculated. Results: The movement of 33,738 professionals was analyzed, resulting in a TGR of 8.0% and a TRS of 6.8%, with a movement of 1:6.2 professionals and variation according to categories, sectors, regions and states. Turnover at CRU (TRG 15.5% and TRS 12.4%) was twice that observed in care (TRG 6.9% and TRS 5.9%). Physicians had high turnover in the CRU (TRS 14.7%, IM 2.9) and in care (TRS 12.7, IM 3.4). The turnover of nurses and drivers is lower. The North, Midwest and South macro-regions have worse turnover rates compared to the Southeast and Northeast. The states of São Paulo, Pernambuco and Piauí have lower rates, while Rondônia, Roraima, Santa Catarina and the Federal District stand out for high rates.

Objetivo: Describir la rotación general y saliente de los profesionales del SAMU 192 según estados y regiones, en el año 2019, generando una tasa de referencia nacional. Método: Estudio exploratorio-descriptivo, realizado con datos públicos recolectados de la herramienta de tabulación del Sistema Nacional de Registro de Establecimientos de Salud por competencias de enero a diciembre de 2019, según estados, macrorregiones y país. Se calculó la tasa de rotación general (TRG), la tasa de rotación de salida (TRS) y el índice de movimiento de las categorías (IM). Resultados: Se analizó el movimiento de 33.738 profesionales, resultando una TGR de 8,0% y una TRS de 6,8%, con un movimiento de 1:6,2 profesionales y variación según categorías, sectores, regiones y estados. La rotación en CRU (TRG 15,5% y TRS 12,4%) fue el doble de la observada en atención (TRG 6,9% y TRS 5,9%). Los médicos tenían alta rotación en la URC (TRS 14,7%, IM 2,9) y en atención (TRS 12,7, IM 3,4). La rotación de enfermeras y conductores es menor. Las macrorregiones Norte, Medio Oeste y Sur tienen peores índices de rotación en comparación con el Sudeste y el Nordeste. Los estados de São Paulo, Pernambuco y Piauí tienen tasas más bajas, mientras que Rondônia, Roraima, Santa Catarina y Distrito Federal se destacan por tasas altas.

Objetivo: Descrever a rotatividade geral e de saída dos profissionais do SAMU 192 segundo estados e regiões, em 2019, gerando uma taxa nacional de referência. Método: Estudo exploratório-descritivo, realizado com dados públicos coletados da ferramenta de tabulação do Sistema de Cadastro Nacional de Estabelecimentos de Saúde para as competências de janeiro a dezembro de 2019, segundo estados, macrorregiões e país. Foi calculada a taxa de rotatividade geral (TRG), a taxa de rotatividade de saída (TRS) e o índice de movimentação para as categorias (IM). Resultados: Foi analisada a movimentação de 33.738 profissionais, resultando em TGR de 8,0% e a TRS de 6,8%, com a movimentação de 1:6,2 profissionais e variação segundo categorias, setor, regiões e estados. A rotatividade na CRU (TRG 15,5% e TRS 12,4%) foi o dobro da observada na assistência (TRG 6,9% e TRS 5,9%). Médicos apresentaram rotatividade alta na CRU (TRS 14,7%, IM 2,9) e na assistência (TRS 12,7, IM 3,4). A rotatividade da enfermagem e dos condutores é menor. As macrorregiões norte, centro-oeste e sul têm piores taxas de rotatividade se comparadas ao sudeste e nordeste. Os estados de São Paulo, Pernambuco e Piauí apresentam taxas mais baixas, enquanto Rondônia, Roraima, Santa Catarina e Distrito Federal se destacam por taxas elevadas

Advanced Practice Nurses' Organization Commitment: Impact of Job Environment, Job Satisfaction, and Person-Organization Fit.

PURPOSE: The demand for advanced practice nurses (APNs) has increased globally due to a shortage of physicians and an increased demand for high-quality healthcare. Research is needed on the enhancement of advanced practice nurses' organization commitment. Organization commitment (OC) directly impacts the retention of APNs. This study aims to identify the key factors affecting the OC of advanced practice nurses. METHOD: A cross-sectional survey was conducted at the largest hospital in South Korea. A total of 189 APNs answered survey questions. A partial least squares-structural equation modeling method was employed to analyze the survey responses. RESULTS: A pay scale of APNs is positively associated with person-organization fit (POF). However, the effect of job location and computer self-efficacy on POF is not significant. Job satisfaction plays a salient direct role in supervision and POF. Job satisfaction is also a significant moderator in the relationship between supervision and POF. POF is significantly associated with both OC and supervision. Supervision has a positive effect on organization commitment. CONCLUSIONS: Pay scale, job satisfaction, supervision, and POF are significant factors affecting organization commitment. Establishing an intra-organization entity, such as APN steering committee, to ensure mutual consensus and transparent communication between administrators and APNs would enhance POF, the rating of supervision, and organization commitment.

Turnover Intention and Organizational Commitment of Primary Healthcare Nurses.

Turnover intention is a predictor of the decision to leave an organization, which, if carried out, affects the quality of care provided. There is an association between turnover intention and organizational commitment. The more committed nurses are to the unit in which they work, the more committed they become to the unit's organizational goals; thus, they tend to continue working for the organization. Aiming to assess the turnover intention and the organizational commitment of nurses in primary healthcare, we conducted a quantitative, observational, descriptive, and cross-sectional study. The Intention of Turnover Scale and the Organizational Commitment Scale were applied in a sample of 297 nurses. Data were analyzed based on descriptive statistics. About 92.8% of the nurses intend to stay at their current workplace and only 7.3% plan to leave soon, suggesting low turnover intention; 84.5% of the nurses are willing to make an effort beyond what is normal to help their organization succeed, and 88.7% feel really interested in the destiny of the organization, which shows high organizational commitment. Pearson's Coefficient revealed the existence of a significant negative correlation between the factors "Intention to leave" and "Committed to the organization" (r = -0.51, p < 0.01). These findings suggest that, when nurses are more committed to their work and to the organization, they display less intention to leave, keeping the teams committed and motivated towards the organizational goals Our findings may guide nurse managers and policy-makers to develop strategies that retain nurses in organizations, keeping them motivated and engaged, and focusing on higher organizational commitment due to the influence it may have on the turnover intention.

COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave.

General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.

High-Risk Symptom Cluster Groups for Work-Life Quality and Turnover Intention among Nurses.

This cross-sectional study aims to identify high-risk symptom cluster groups for assessing the quality of nursing work life (QNWL) and turnover intention among Korean nurses who have experienced workplace violence. Nurses were recruited for an online survey in May 2021 (n = 203). The following four symptom clusters are extracted: (a) depression-anxiety, (b) shame-somatization, (c) nightmare-loss of appetite, and (d) anger-shock. Three symptom cluster groups were identified. Group 1 had the highest score for the anger-shock symptom cluster, as well as the highest symptom scores and turnover intention. Group 2 had the highest score for the nightmare-loss of appetite symptom cluster and the lowest QNWL. Group 3 had a similar symptom cluster pattern to Group 1 but lower scores for all symptom clusters. Symptom monitoring and programs tailored to symptom cluster groups at the institutional level could be useful for managing QNWL and turnover intention.