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

Duración de la gestión ministerial y logros en salud en el Perú

Los periodos breves en la gestión de un ministerio de salud pueden poner en riesgo la implementación y la efectividad de políticas de Estado por cambios en la orientación de la gestión, por un proceso natural de aprendizaje, o por otros factores. El propósito de este artículo fue determinar y comparar la duración de la gestión ministerial en salud en Perú, describir sus características y discutir su relación con los logros en salud pública. Entre 1935 y 2021, la media de duración de la gestión fue de 13,7 meses y la mediana fue de 11 meses, siendo la más extensa de 67 meses, de Constantino Carvallo, y la más breve de un día, de Javier Correa. La duración de la gestión ministerial en el Perú tiene un amplio rango de variación (1día hasta 67 meses), es menor comparada con la de otros países, y está disminuyendo desde el 2016. Si bien, una duración mayor a la encontrada no sería suficiente para garantizar los logros en salud, podría contribuir en el sostenimiento de las acciones de salud y tener un efecto positivo en las políticas de largo plazo.

Short administration periods of a health ministry can jeopardize the implementation and effectiveness of state policies due to changes in management orientation, altering the natural learning process, or other factors. The aim of this article was to determine and compare the tenure length of the ministry of health in Peru, describe its characteristics and discuss its relationship with public health achievements. Between 1935 and 2021, the average tenure was of 13,7 months and the median was 11 months, the longest was found to be 67 months, by Constantino Carvallo, and the shortest was one day, by Javier Correa. The length of ministerial tenure in Peru has a wide range of variation (1 day up to 67 months), it is shorter compared to that of other countries and is decreasing since 2016. Although longer tenures would not be sufficient to guarantee health achievements, it might contribute to the sustainability of health-related actions and have a positive effect on long-term policies.

Dotaciones, skillmix e indicadores laborales de enfermería en Hospitales Públicos chilenos

Background: International evidence shows that there are organizational factors and nurse job outcomes that may negatively affect healthcare quality. Aim: To measure and analyze associations between nurse organizational factors, such as staffing ratios and skill mix, and job outcomes in public hospitals in Chile. Material and Methods: An observational, cross-sectional study of 1,855 registered nurses working in medical-surgical units in 37 public hospitals was conducted. Data collection followed the RN4CAST research protocol. Inferential analyses used logistic regression models. Results: The survey was answered by 1,395 registered nurses in 34 hospitals. The average staffing ratio was 14 patients-per-nurse, and the average skill mix was 31% registered nurses. Of all nurses, 35% reported burnout, 22% were dissatisfied, and 33% intended to leave. Being burned out increased by 9 and 6% the odds of being dissatisfied and the intent to leave, respectively (Odds ratio (OR) 1.09, p < 0.01 and 1.06, p < 0.01). Being dissatisfied increased by five times the odds of intent to leave (OR 5.19, p < 0.01). Conclusions: Staffing levels, burnout, and intent to leave warrant healthcare and governmental authorities' attention. All these factors may be threatening healthcare quality and safety.

Rotatividade da equipe de enfermagem em hospital privado / Turnover of nursing staff in private hospital

Os recursos humanos de enfermagem têm assumido relevância no cenário de saúde, tanto em termos quantitativos como qualitativos e têm sido associados positivamente a uma assistência qualificada e segura. A rotatividade da equipe de enfermagem representa um desafio para os gestores das instituições de saúde, frente ao impacto gerado tanto na assistência como nos custos. Este estudo teve por objetivo analisar a rotatividade dos trabalhadores de enfermagem em uma instituição hospitalar. Estudo descritivo, retrospectivo, quantitativo, realizado em um hospital de atendimento para alta complexidade do interior do Estado de São Paulo, pertencente a uma operadora de medicina de grupo e acreditado em nível de excelência pela Organização Nacional de Acreditação (ONA). A população foi constituída por todos os trabalhadores de enfermagem (enfermeiro, técnico e auxiliar de enfermagem) que no período de 1° janeiro de 2013 a 31 dezembro de 2017 apresentaram vínculo formal de emprego nas unidades selecionadas para a investigação e que neste período desligaram-se da instituição por diferentes razões. Os dados foram coletados de relatórios fornecidos pelo Centro de Recursos Humanos da instituição, constituindo-se em variáveis de interesse a idade, o sexo, a categoria profissional, a data de admissão e de desligamento e a unidade de trabalho. As medidas de rotatividade utilizadas foram as taxas de admissão e desligamento e a mediana de tempo de serviço dos demitentes. No período do estudo, 499 trabalhadores de enfermagem desligaram-se, sendo 141 (28,3%) enfermeiros, 82 (16,4%) técnicos de enfermagem e 276 (55,3%) auxiliares de enfermagem. O ano de 2013 foi o que apresentou o maior percentual (22,4%). Em relação ao sexo, para o conjunto das três categorias de trabalhadores, houve predomínio das mulheres (73,4%). A idade média do grupo foi de 32,7 anos e a mediana de 31 anos. Dentre os enfermeiros demitentes, 64 (45,4%) deixaram a instituição no primeiro ano trabalhado. Entre o período da admissão até 5 anos na instituição, essa quantidade chegou a 124 (88%) profissionais. Na categoria dos técnicos de enfermagem, 28 (34%) saíram no primeiro ano e 57 (69,5%) em até 5 anos. Em relação aos auxiliares de enfermagem, 92 (33,3%) profissionais permaneceram menos de um ano e 225 (81,5%) até 5 anos. Na média dos anos, a taxa de admissão (TA) (19,6%) superou a taxa de desligamento (TD) (18,7%). Os enfermeiros demitentes permaneceram em atividade nesse hospital no mínimo 16 e no máximo, 23 meses; os técnicos de enfermagem, no mínimo 17 e no máximo 28 meses; e os auxiliares de enfermagem, no mínimo 16 e no máximo 23 meses. As unidades de internações médicas, seguidas pelas cirúrgicas foram os locais de onde saíram a maior parte dos enfermeiros e auxiliares de enfermagem e o Centro de Terapia Intensiva, a área que mais perdeu técnicos de enfermagem. A permanência dos trabalhadores nas instituições pode ter relação direta com a qualidade dos ambientes de prática, satisfação e bem-estar. A análise da rotatividade fornece subsídios aos gerentes de enfermagem, com possibilidade de intervenções de curto prazo para solução de não conformidades identificadas nas instituições de saúde

Nursing staff have assumed relevance in the health scenario, both in quantitative and qualitative terms and have been positively associated with the results that are desired related to qualified and safe care. The nursing personnel turnover represents a major challenge for managers of health institutions, given the impact on both care and costs. This study aimed to analyze the nursing personnel turnover in a hospital institution. This is a descriptive, retrospective and quantitative study, carried out in a hospital of high complexity, located in the interior of the state of São Paulo, which belongs to a group medicine operator and is accredited as excellence level by the National Accreditation Organization (ONA). The population consisted of all nursing staff (nurse, technician and nursing assistant) who had formal employment in the units selected for the research and that from January 1, 2013 to December 31, 2017 left the institution for different reasons. Data were collected from reports provided by the Human Resources Center of the institution, constituting variables of interest the age, gender, professional category, date of admission and dismissal and unit of work. The turnover measures used were admission and dismissal rates and median of length of service of the resigning professionals. In the period of study, 499 nursing workers resigned, being 141 (28.3%) nurses, 82 (16.4%) nursing technicians and 276 (55.3%) nursing assistants. 2013 was the year that showed the highest percentage (22.4%). Regarding gender, for all three categories of workers, there was a predominance of women (73.4%). The average age of the group was 32.7 years and a median of 31 years. Among the resigning nurses, 64 (45.4%) left the institution in the first year worked. From the admission up to 5 years in the institution, this value reached 124 (88%) professionals. In the category of nursing technicians, 28 (34%) left work in the first year and 57 (69.5%) within 5 years. Regarding nursing assistants, 92 (33.3%) professionals remained less than one year and 225 (81.5%) within 5 years. In the average of the years, the admission rate (AR) (19.6%) was higher than the dismissal rate (DR) (18.7%). The resigning nurses remained active at this hospital for a minimum of 16 months and a maximum of 23 months; the nursing technicians, for a minimum of 17 months and maximum of 28 months; and the nursing assistants, for a minimum of 16 months and maximum of 23 months. The medical inpatient units, followed by the surgical units were the places from which most nurses and nursing assistants left; and in the Center for Intensive Therapy, most were nursing technicians. The permanence of workers in institutions can be directly related to the quality of the practice environments, satisfaction and well-being. The turnover analysis provides support to nursing managers, with the possibility of short-term interventions to solve nonconformities identified in health institutions

Rotación y desempeño laboral de los profesionales de enfermería en un instituto especializado / Job Rotation and work performance of nurse practitioners at a specialized healthcare center / Rotação e performance no trabalho dos profissionais de enfermagem em um instituto especializado

Resumen Introducción La rotación de personal constituye una parte importante de la gestión de recursos humanos y, por ende, debe considerar sus efectos directos o indirectos sobre el desempeño laboral. Objetivo Determinar la relación entre rotación y desempeño laboral de los profesionales de enfermería en un instituto especializado en oftalmología. Materiales y Métodos Estudio correlacional, prospectivo, de corte transversal. Se aplicó muestreo no probabilístico por conveniencia, haciendo un total de 29 enfermeras participantes del estudio. Para medir la variable rotación se elaboró un instrumento de 24 preguntas, dividido en cuatro dimensiones, con un índice de confiabilidad de 0.72. Asimismo, para la evaluación de desempeño, se utilizó un instrumento de 21 preguntas, dividido en 6 dimensiones, con un índice de confiablidad de 0.86. Resultados 93.1% fueron mujeres; 34.5% con edad entre 41 y 50 años; 62.0% con estado civil casadas, 75.9% con condición laboral nombradas. Resultados generales de rotación: 58.6% indiferente, 20.7% adecuada y 20.7% no adecuada. Resultado final del desempeño laboral: 55.2% moderado, 27.6% bajo y 17.2% alto. El resultado de correlación según Pearson (p-valor= 0.511). Discusión La rotación sucede cuando falta personal en determinado servicio, sin considerar el entorno familiar del trabajador, no contempla incentivo económico y es percibida por las enfermeras como generador de crecimiento profesional. La evaluación del desempeño laboral estriba en la subjetividad de los evaluadores. Conclusiones No se encontró relación significativa entre rotación y desempeño laboral.

Abstract Introduction Staff rotation is considered an important part of Human Resources management. Therefore, its direct or indirect impact should be considered on work performance. Objective To determine the relationship between job rotation and work performance of nurse practitioners at a specialized ophthalmologist healthcare center. Materials and Methods A prospective cross-sectional correlational study was conducted in which a non-probability convenience sampling was applied with a total of 29 nurse practitioners participating in the study. To measure the rotation variable, a 24-question instrument divided into four dimensions was designed with a reliability coefficient of .72. In addition, a 21-question instrument divided into six sections was used in the performance evaluation with a reliability coefficient of .86. Results 93.1 were women from which 34.5% were between 41 and 50 years old, 62.0% were married and 75.9% had a permanent position. General rotation results: indifferent 58.6%, appropriate 20.7% and inappropriate 20.7%. Final work performance results: moderate 55.2%, low 27.6%, and high 17.2%. Pearson's correlation coefficient (p-value= 0.511). Discussion Job rotation takes place when there is a lack of staff for a specific service, but it does not consider the worker's family settings nor include any economic compensation. However, it is considered a professional growth factor by nurse practitioners. Work performance appraisal lies on the subjectivity of evaluators. Conclusions it was not found any significant relationship between rotation and work performance.

Resumo Introdução A rotação de pessoal é uma parte importante da gestão dos recursos humanos e, por conseguinte, deve considerar seus efeitos diretos ou indiretos sobre a performance no trabalho. Objetivo Determinar a relação entre rotação e desempenho no trabalho dos profissionais de enfermagem em um instituto especializado em oftalmologia. Materiais e Métodos Estudo correlacional, prospectivo, de corte transversal. Aplicou-se uma amostragem não probabilística por conveniência, perfazendo um total de 29 enfermeiras participantes do estudo. Para medir a rotação variável foi elaborado um instrumento de 24 perguntas, dividido em quatro dimensões, com um índice de confiabilidade de 0,72. Mesmo assim, para a avaliação de performance, foi utilizado um instrumento de 21 perguntas, dividido em 6 dimensões, com um índice de confiabilidade de 0,86. Resultados 93,1% foram mulheres; 34,5% com idade entre 41 e 50 anos; 62,0% com estado civil casadas, 75,9% com as aludidas condições de trabalho. Resultados gerais de rotação: 58,6% indiferente, 20,7% adequada e 20,7% não adequada. Resultado final da performance no trabalho: 55,2% moderado, 27,6% baixo e 17,2% alto. O resultado é apurado utilizando a correlação de Pearson (p-valor= 0,511). Discussão A rotação acontece quando falta pessoal para um determinado serviço, sem levar em conta o entorno familiar do trabalhador, não contempla incentivos económicos e é percebida pelas enfermeiras como gerador de crescimento profissional. A avaliação da performance no trabalho está baseada na subjetividade dos avaliadores. Conclusões Não foi encontrada nenhuma relação significativa entre rotação e performance no trabalho.

Programa Médicos pelo Brasil: inovação ou continuidade? / Doctors throughout Brazil Program: innovation or continuity?Apesar / Programa Médicos en todo Brasil: ¿innovación o continuidad?

Apesar do lançamento do Programa Médicos pelo Brasil (PMB) alardear a ideia de inovação, este artigo evidencia o processo de continuidade do programa atual em relação ao Programa Mais Médicos (PMM). O PMB se estrutura nos acertos do PMM para montar o seu arcabouço de funcionamento e tenta superar problemas existentes no programa anterior. A principal proposta do PMB é a carreira médica para atuação na Atenção Primária à Saúde (APS), sem, no entanto, apresentar outros elementos importantes para a fixação profissional. Desta forma, apresenta-se como uma política mais frágil que seu antecessor, com foco apenas no provimento de médicos, correndo o risco de não atingir os objetivos a que se propôs enquanto política pública. Além disso, através da proposta de criação da Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o programa abre margem para a privatização dos serviços de APS e do Sistema Único de Saúde como um todo

Despite the launch of the Doctors throughout Brazil Program (PMB) bring the idea of innovation, this article highlights the continuity of the current program in relation to the More Doctors Program (PMM). The PMB structures itself in the PMM's settings to assemble its operating framework and attempts to overcome existing problems in the previous program. The main proposal of the PMB is the medical career to work in Primary Health Care (PHC), without, however, presenting other important elements for professional fixation. Thus, it presents itself as a more fragile policy than its predecessor, focusing only on the provision of doctors, at the risk of not achieving the objectives it has set itself as a public policy. In addition, through the proposal to create the Agency for the Development of Primary Health Care (Adaps), the program leaves room for the privatization of PHC services and the Unified Health System as a whole.

Aunque el lanzamiento del Programa Médicos en todo Brasil (PMB) promocionó la idea de innovación, este artículo destaca la continuidad del programa actual en relación con el Programa Más Médicos (PMM). El PMB se basa en los aciertos del PMM para construir su marco operativo e intenta superar los problemas existentes en el programa anterior. La propuesta principal del PMB es la carrera médica para trabajar en la Atención Primaria a la Salud (APS), sin presentar, sin embargo, otros elementos importantes para la fijación profesional. Por lo tanto, se presenta como una política más frágil que su predecesor, centrándose solo en la provisión de médicos, a riesgo de no lograr los objetivos que se ha fijado como política pública. Además, a través de la propuesta para la creación de la Agencia para el Desarrollo de la Atención Primaria a la Salud (Adaps), el programa deja margen para la privatización de los servicios de APS y el Sistema Único de Salud en su conjunto.

Factors related to voluntary external turnover of nursing professionals / Factores relacionados con la rotatividad externa voluntaria de profesionales enfermeros / Fatores relacionados à rotatividade externa voluntária de profissionais de enfermagem

ABSTRACT Objective: To analyze the factors related to the turnover of nursing professionals of a public teaching hospital. Method: Descriptive, exploratory, retrospective study with quantitative analysis conducted with workers from a public teaching hospital. The analysis used a data collection instrument from the service, applied at the time of the voluntary resignation of the professional. Results: 223 nursing professionals participated in the study. The factors that led to voluntary turnover were the employment bond, age and the association of both. The majority of professionals were young adults, in a high productivity phase, which increases willingness to seek challenges in the labor market and professional improvements. Conclusion: Turnover is multifactorial and influenced by economic, social and political aspects. Reducing inequalities in working conditions, which generate dissatisfaction, such as different employment bonds for professionals who have the same function and perform the same activities, is fundamental to reduce turnover.

RESUMEN Objetivo: Analizar los factores relacionados con la rotatividad de profesionales enfermeros de un hospital universitario público. Método: Estudio de carácter descriptivo, exploratorio, retrospectivo, con análisis cuantitativo, realizado con trabajadores de un hospital universitario público. Fue utilizado un instrumento de recolección de datos propio del servicio, aplicado en el momento del proceso de dimisión voluntaria del profesional. Resultado: Participaron en el estudio 223 profesionales de enfermería. Los factores que predispusieron a la rotatividad por dimisión voluntaria fueron el vínculo laboral, la edad y la asociación de ambos. La mayoría de los profesionales eran adultos jóvenes, en la fase de alta productividad, lo que favorece la búsqueda por desafíos en el mercado laboral y mejorías profesionales. Conclusión: La rotatividad es multifactorial e influenciada por los aspectos económicos, sociales y políticos. Minimizar las desigualdades en las condiciones laborales que generan insatisfacción, como vínculos laborales distintos para profesionales que ejercen el mismo puesto y llevan a cabo las mismas actividades, es fundamental para el decrecimiento de la rotatividad.

RESUMO Objetivo: Analisar os fatores relacionados à rotatividade dos profissionais de enfermagem de um hospital universitário público. Método: Estudo de caráter descritivo, exploratório, retrospectivo, com análise quantitativa, realizado com trabalhadores de um hospital universitário público. Foi utilizado um instrumento de coleta de dados próprio do serviço, aplicado no momento do processo de demissão voluntária do profissional. Resultado: Participaram do estudo 223 profissionais de enfermagem. Os fatores que predispuseram à rotatividade por demissão voluntária foram o vínculo trabalhista, a idade e a associação de ambos. A maioria dos profissionais era adulto jovem, na fase de alta produtividade, que favorece a disposição para a busca de desafios no mercado de trabalho e melhorias profissionais. Conclusão: A rotatividade é multifatorial e influenciada pelos aspectos econômicos, sociais e políticos. Minimizar as desigualdades nas condições de trabalho que geram insatisfação, como vínculos de trabalho diferentes para profissionais que exercem a mesma função e realizam as mesmas atividades, é fundamental para o decréscimo da rotatividade.

Turnover of nursing workers in an adult emergency unit / Rotatividad de los trabajadores de enfermería en una unidad de emergencia adulto / Rotatividade dos trabalhadores de enfermagem em uma unidade de emergência adulto

ABSTRACT Objective: to calculate the overall turnover rate of nursing workers from the adult emergency unit of a general teaching hospital in the period between January 2005 and December 2013. Method: quantitative, exploratory, descriptive, retrospective study; data collection performed on documents/work schedules of the unit. Turnover rate calculated considering monthly entry/exit of workers at the unit's work schedules. Results: 171 professionals worked in the emergency unit in this period; 101 left the unit (57 migrated to other areas and 44 left the institution). Time of service presented trend of nine years and median of two years and four months. Global turnover above 3% in four months in 2006; October/2008; April to September/2009; four months in 2010; July/2011; and May/2013. Conclusion: considering the effects of staff turnover for nursing care, it is recommended to adopt indicators for management/control of this condition.

RESUMEN Objetivo: calcular la tasa de rotatividad global de los trabajadores de enfermería de la emergencia adulto de un hospital general universitario, en el período entre enero de 2005 y diciembre de 2013. Método: estudio cuantitativo, exploratorio, descriptivo, retrospectivo; recolección de datos realizada en documentos/escalas de trabajo de la unidad. Tasa de rotación calculada considerando entrada/salida mensual de trabajadores en las escalas de trabajo de la unidad. Resultados: 171 trabajadores actuaron en la emergencia en este período; 101 se desligaron de la unidad (57 migrar a otras áreas y 44 dejaron la institución). El tiempo de servicio presentó la moda de nueve años y mediana de dos años y cuatro meses. Rotatividad global superior al 3%, en cuatro meses de 2006; octubre/2008; abril a septiembre / 2009; cuatro meses de 2010; julio/2011; y mayo / 2013. Conclusión: considerando los efectos de la rotatividad de personal para la asistencia de enfermería, se recomienda la adopción de indicadores para gestión/control de esta condición.

RESUMO Objetivo: calcular a taxa de rotatividade global dos trabalhadores de enfermagem da emergência adulto de um hospital geral universitário, no período entre janeiro de 2005 e dezembro de 2013. Método: estudo quantitativo, exploratório, descritivo, retrospectivo; coleta de dados realizada em documentos/escalas de trabalho da unidade. Taxa de rotatividade calculada considerando entrada/saída mensal de trabalhadores nas escalas de trabalho da unidade. Resultados: 171 trabalhadores atuaram na emergência neste período; 101 desligaram-se da unidade (57 migraram para outras áreas e 44 deixaram a instituição). Tempo de serviço apresentou moda de nove anos e mediana de dois anos e quatro meses. Rotatividade global superior a 3%, em quatro meses de 2006; outubro/2008; abril a setembro/2009; quatro meses de 2010; julho/2011; e maio/2013. Conclusão: considerando os efeitos da rotatividade de pessoal para a assistência de enfermagem, recomenda-se a adoção de indicadores para gerenciamento/controle desta condição.

A Study of Desired Work Conditions of Nurses in Small-Medium Hospitals / 간호행정학회지

PURPOSE: This study was done to analyze the problems and desired work conditions of nursing organizations in small-medium hospitals. METHODS: Delphi Technique was used. In the first stage, the work conditions of nurses in small-medium hospitals were identified through a literature review. In the second stage, through 3 consultations with 20 nurse advisory groups, feedback was received on the desired work conditions for nurses in small-medium hospitals. In the third stage, 415 nurses and nurse managers were selected to examine the content validity and importance of the desired work conditions identified in the second stage. RESULTS: Sixty-four items were developed along eight domains of desired work conditions for nurses in small-medium hospitals. The survey on the desired work conditions revealed the following in order of importance: ‘wages’, ‘personnel’, ‘job’, ‘work hours’, ‘welfare’, ‘education’, ‘culture’, and and ‘other incentives’. CONCLUSION: The results of this study suggest that small-medium hospitals need to recognize the desired work conditions desired by nurses and accordingly change policies through the efforts of hospitals and professional groups.

The Influence of Grit on Turnover Intention of University Hospital Nurses: The Mediating Effect of Job Involvement

PURPOSE: This study aimed to confirm the mediating effect of job involvement in the relationship between grit and turnover intention among nurses working at university hospitals. METHODS: Participants included 437 nurses from university hospitals located in C city, Gyeongnam. Data were collected from January 8 to 19, 2018, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Scheffe's test, Pearson's correlation coefficient, and multiple regression, with the SPSS/22.0 program. A mediation analysis was performed according to the Baron and Kenny, and bootstrapping methods. RESULTS: There were significant relationships between grit and job involvement (r=.40, p<.001), grit and turnover intention (r=−.29, p<.001), and turnover intention and job involvement (r=−.52, p<.001). Job involvement showed partial mediating effects in the relationship between grit and turnover intention. CONCLUSION: Grit increased job involvement and lowered turnover intention. Therefore, to reduce nurses' turnover intention, it is necessary to develop a program and strategies to increase their grit.

The Effects of Hospitals' Family Friendly Management on Married Female Nurses' Retention Intention: Focused on the Mediating Effects of Work-Family Interface

PURPOSE: This study examined the effect of hospitals' family-friendly management on married female nurses' retention intention. The focus was the mediating effects of the work-family interface (work-family conflict, work-family enrichment and work-family balance). METHODS: This study was a cross-sectional study. The participants were 307 nurses working at five public and five private hospitals with more than 200 beds in Seoul. Data were collected using structured questionnaires from September 10 to September 17, 2018 and analyzed with SPSS 24.0. Data were analyzed using an independent t-test, a one-way ANOVA, Pearson's correlation coefficients, and multiple regression following the Baron and Kenny method and Sobel test for mediation. RESULTS: There were significant correlations among family-friendly management, the work-family interface, and retention intention. Work-family conflict showed a partial mediating effect on the relationship between family-friendly management and retention intention. Work-family enrichment showed a partial mediating effect on the relationship between family-friendly management and retention intention. Work-family balance showed a partial mediating effect on the relationship between family-friendly management and retention intention. CONCLUSION: These findings indicate that both hospitals' family-friendly management and nurses' work-family interface are important factors associated with nurses' retention intention. Therefore, hospitals should actively implement family-friendly management for nurses and establish strategies to enhance nurses' work-family interface for effective human resource management.

The Effect of Nurse's Emotional Labor on Turnover Intention: Mediation Effect of Burnout and Moderated Mediation Effect of Authentic Leadership

PURPOSE: To investigate the effect of nurses' emotional labor on their turnover intention that was mediated by burnout and to examine the moderated mediation effect of authentic leadership. METHODS: A total of 227 nurses working at two general hospitals in Seoul were recruited from March 21 to May 6 in 2016. Emotional labor including surface acting and deep acting; burnout factors such as emotional exhaustion and personal accomplishment; and turnover intention were assessed. The data were analyzed using SPSS 22.0 and SPSS PROCESS macro. RESULTS: Surface acting significantly increased emotional exhaustion and reduced personal accomplishment. Deep acting significantly increased personal accomplishment. Emotional exhaustion significantly increased turnover intention. Conversely, personal accomplishment significantly reduced turnover intention. Surface acting had an indirect effect on turnover intention that was mediated by emotional exhaustion. Deep acting had an indirect effect on turnover intention that was mediated by personal accomplishment. Authentic leadership had a moderated mediation effect on the relationship between surface acting and turnover intention that was mediated by emotional exhaustion. CONCLUSION: The findings of this study indicate that the establishment of strong authentic leadership by head nurses would help nurses reduce their burnout and turnover intention. Conducting intervention studies would be also important to promote better work environments that would enable nurses to fortify the positive aspect of emotional labor and to reduce their burnout levels.

Rotatividade de profissionais da Estratégia Saúde da Família no município de Montes Claros, Minas Gerais, Brasil / Personnel turnover of the Family Health Strategy in Montes Claros, Minas Gerais, Brazil

Objetivo: analisar a rotatividade dos profissionais de saúde vinculados às Equipes de Saúde da Família (ESFs) de Montes Claros, MG. Sujeitos e método: trata-se de um estudo transversal de natureza quantitativa do tipo exploratório e descritivo. Os dados foram extraídos do Relatório de Profissionais Desligados no Estabelecimento do Cadastro Nacional de Estabelecimentos de Saúde (CNES), no período de fevereiro de 2001 a agosto de 2016. Resultados: foram avaliados 811 profissionais, dos gêneros feminino (n=599) e masculino (n=212), em 93 ESFs. Estiveram cadastrados 283 médicos, 264 enfermeiros, 50 técnicos de enfermagem, 75 auxiliares de enfermagem, 78 dentistas, 56 auxiliares de saúde bucal e 5 técnicos de saúde bucal. A média do tempo de permanência (TP) dos profissionais nas ESFs foi de 20 meses, sendo que o tempo mais frequente foi menor que 1 mês (6,2%), seguido pelos tempos de 1 (5,9%) e 2 (4,3%) meses; 48,82% dos profissionais (n=396) permaneceram por tempo menor que 12 meses. Os cirurgiões-dentistas foram os profissionais que tiveram maior TP dentre os profissionais de nível superior, e profissionais de nível médio apresentaram TP significativamente maior. Conclusão: pôde-se observar uma alta taxa de rotatividade profissional nas ESFs no município avaliado. (AU)

Objective: to analyze the turnover of health professionals linked to the Family Health Teams (FHT) of Montes Claros, MG, Brazil. Subjects and method: it is a cross- -sectional, quantitative, exploratory, and descriptive study. The data were extracted from the Report of Professionals Dismissed from the Establishment available at the Brazilian Registry of Health Establishments (CNES), from February 2001 to August 2016. Results: a total of 811 professionals were evaluated, both women (n=599) and men (n=212) in 93 FHT. Moreover, 283 physicians, 264 nurses, 50 nursing technicians, 75 nursing assistants, 78 dentists, 56 oral health assistants, and five oral health technicians were registered. The average length of stay (LS) of the professionals in FHT was 20 months, and most often, it was less than 1 month (6.2%), followed by 1 (5.9%) and 2 (4.3%) months. Additionally, 48.82% of the professionals (n=396) stayed for less than 12 months. Dentists were the professionals with the highest LS among higher-level professionals, while medium- level professionals presented significantly higher LS. Conclusion: a high rate of personnel turnover was observed in the FHT in the city analyzed. (AU)

Factor Influencing New Graduate Nurses' Turnover Intention according to Length of Service / 간호행정학회지

PURPOSE: The purpose of the study was to explore factors influencing turnover intention of new graduate nurses according to length of services. METHODS: From May to July, 2017, a survey was conducted among 220 nurses working in four hospitals. Inclusion criteria were new graduate nurses who had careers of less than 16 months. Data were collected on organizational socialization, support in work place, job stress, and turnover intention. RESULTS: Satisfaction with current work department, job satisfaction, organizational commitment, and job stress were significant factors influencing turnover intention of new nurses with less than six months experience. However, in case of nurses with seven to 15 months experience, only organizational commitment influenced turnover intention. CONCLUSIONS: These findings indicate that the factors influencing turnover intention are different according to the length of time the new graduate nurses have worked. To reduce the turnover intention of new nurses, it is necessary to differentiate human resource management approaches according to length of employment. The study results could be useful evidence for developing strategies to reduce turnover in new nurses.

Relationship between Career Plateau, Career Planning, Social Support, and Turnover Intention in Nurses / 간호행정학회지

PURPOSE: This study was a correlational research to examine the relationship between career plateau, career planning, social support and turnover intention experienced by nurses in the clinical nursing field. METHODS: Participants were 237 nurses working in general hospitals with 100~300 beds located in G Metropolitan City. Data were collected from September 26 to October 6, 2016, and analyzed using the SPSS/WIN 22.0 program. Descriptive statistics, independent t-test, univariate ANOVA, Scheffé test, correlation analysis, and hierarchical multiple regression analysis were conducted. RESULTS: Participants' turnover intention was positively correlated with career plateau (r=.38, p < .001), structural career plateau (r=.31, p < .001) and content plateau (r=.35, p < .001), but negatively correlated with social support (r=−.38, p < .001), supervisor support (r=−.36, p < .001), peer support (r=−.32, p < .001), and career planning (r=−.15, p=.043). Factors associated with participants' turnover intention were supervisor support (β=−.22, p=.006), structural career plateau (β=.19, p=.012), and content career plateau (β=.14, p=.047). CONCLUSION: Results suggest that structural career plateau, content career plateau, and supervisor support are related to nurses' turnover intention. To lower nurses' turnover intention, alternative ways must be developed to improve the structure of nursing organizations to address career plateau and establish an organizational culture that can be supported by supervisors.

Influence of the Awareness of Healthcare Accreditation on Job Stress and Turnover Intention in Tertiary Hospital Nurses / 산업간호학회지

PURPOSE: The aim of this study was to investigate the influence of nurses' awareness of healthcare accreditation on their job stress and turnover intention. METHODS: Across-sectional correlation study design was used. Participants consisted of 143 nurses from two tertiary hospitals in Seoul and Gyunggido, South Korea. Data were collected in October 2016 using self-report questionnaires and analyzed using descriptive statistics, t-test, an ANOVA, Pearson's correlation coefficient, and multiple regression in SPSS/WIN 21.0. RESULTS: Awareness of health care accreditation correlated negatively with job stress (r=−63, p < .001) and turn over intention (r=−.50, p < .001). Awareness of health care accreditation was the factor that most influenced job stress, explaining 38% of the variance (F=23.10, p < .001). Awareness of health care accreditation and duty pattern were the factors that most influenced intention to leave, explaining 32% of the variance (F=10.35, p < .001). CONCLUSION: These findings suggest raising nurses' awareness of certification systems to reduce their job stress and turnover intentions. It will be necessary to provide support for the aggressive work nurses do and improve their work structure, highlighting the need for both manpower and institutional support. Accordingly, providing regular education programs and appropriate compensation schemes, by raising nurses' awareness of medical institutions' certification systems, is necessary.

Predictive Factors of Turnover Intention among Intensive Care Unit Nurses / 임상간호연구

PURPOSE: The purpose of this study was to understand morality identity, occupational stress and authentic leadership and identify factors contributing to turnover intention among intensive care unit (ICU) nurses. METHODS: Data were collected from 230 nurses at the university hospitals in Daegu, Ulsan and Busan between February 15 and March 23, 2017. Instruments measuring turnover intention, moral identity, occupational stress, and authentic leadership were utilized. Statistical analysis included t-test, ANOVA, Pearson correlational analysis, and hierarchical regression analysis. RESULTS: A total of 207 nurses in ICU participated in this study. The power of explanation with age and dependents on turnover intention was 4.1%. With inclusion of occupational stress, moral identity, and authentic leadership factors put into the model, further 20.4% was explained. The explanatory power of the turnover intention in the final model was 23.6% (F=11.63 p<.001), and occupational stress was the key factor explaining turnover intention (β=.28, p<.001). Predictive factors contributing to turnover intention were age, occupational stress, moral identity, and authentic leadership in final model. CONCLUSION: These findings demonstrated occupational stress, moral identity and authentic leadership as critical factors contributing turnover intention of ICU nurses. It is necessary to promote nursing manager's authentic leadership, and to encourage moral identity in ICU nurses. In addition, providing intervention programs to reduce occupational stress for ICU nurses is necessary.

The Relationship among Workplace Bullying, Organizational Commitment and Turnover Intention of the Nurses Working in Public Medical Institutions / 임상간호연구

PURPOSE: The purpose of this study was to explore the relationships among workplace bullying, organizational commitment, and turnover intention of nurses. METHODS: A cross-sectional study was conducted. Data were collected using a structured questionnaire from nurses at five public hospitals (N=190). RESULTS: The experience of bullying was 31.29 points (range 16–64) on average: Work-related bullying was the highest, followed by verbal/non verbal bullying and external threats. The consequences of bullying were 30.54 points (range 13–52) on average: The physical/psychological withdrawal was the highest, followed by increasing distrust and the poor quality of patient care. The experiences of bullying had positive correlations with the consequences of bullying (r=.55, p < .001) and the turnover intention (r=.27, p < .001), and had a negative correlation with organizational commitment (r=−.28, p < .001). The consequences of bullying had a positive correlation with the turnover intention (r=.52, p < .001), and had a negative correlation with organizational commitment (r=−.49, p < .001). Organizational commitment showed a negative correlation with the turnover intention (r=.63, p < .001). CONCLUSION: The findings of this study suggests the needs of a regular monitoring system and organizational management for workplace bullying, which helps nurses to commit to their organization and to be retained in a workplace.

Subjectivity About Turnover Intention Among Male Nurses in South Korea: A Q-Methodological Study

PURPOSE: Around the world, male nurses face a variety of difficulties within clinical settings; accordingly, a large number of male nurses consider changing their occupation. In particular, male nurses in a number of Asian countries with a Confucian heritage experience difficulties. Thus, the purpose of this study was to explore individual differences in turnover intention among male nurses in one such country, South Korea, and on that basis to suggest concrete strategies for reducing turnover among male nurses in Confucian cultures. METHODS: Q methodology, which is used to analyze human subjectivity, was applied. Q statements were derived from 207 candidate statements gathered from various documents and interviews; 40 statements were finalized. A purposive sample of 41 male nurses was selected as likely to have diverse opinions on turnover intention of male nurses. The collected data were analyzed using PQMethod software. RESULTS: Four distinct types of subjectivity about turnover intention among male nurses were identified: (1) “Pursuing occupational values,” (2) “Dissatisfaction with treatment,” (3) “Seeking a relaxed and stable life,” and (4) “Conflict related to organizational culture.” CONCLUSION: This study suggests various ways of reducing turnover and increasing retention among male nurses based on the four identified perspectives, especially in Confucian heritage regions.

Influencing Factors and Consequences of Workplace Bullying among Nurses: A Structural Equation Modeling

PURPOSE: The purpose of this study was to build and test a model outlining the factors related to workplace bullying among nurses. The hypothesized model included authentic leadership and a relationship-oriented organizational culture as influencing factors, symptom experience and turnover intention as consequences, and positive psychological capital as a mediator of workplace bullying among nurses. METHODS: We obtained structured questionnaire data from 301 nurses working at hospitals in South Korea. Based on these data, the developed model was verified via a structural equation modeling analysis using SPSS and AMOS program. RESULTS: The fit indices of the hypothesized model satisfied recommended levels; χ2 = 397.58 (p < .001), normed χ2 (χ2/df) = 1.82, RMR = .05, TLI = .93, CFI = .94, RMSEA = .05. A relationship-oriented organizational culture had a direct effect on workplace bullying (β = −.48, p < .001). Furthermore, workplace bullying had a direct effect on symptom experience (β = .36, p < .001), and this relationship was mediated by positive psychological capital (β = .15, p = .003). Workplace bullying also had an indirect effect on turnover intention (β = .20, p = .007). Finally, symptom experience had a direct effect on turnover intention (β = .31, p = .002). CONCLUSIONS: These results suggest that workplace bullying among nurses may be prevented by constructing a relationship-oriented organizational culture, as long as employees have sufficient positive psychological capital. In this regard, workplace bullying among nurses should be addressed using a comprehensive strategy that considers both individual and organizational factors.