Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper.

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

Furloughed Employees' Voluntary Turnover: The Role of Procedural Justice, Job Insecurity, and Job Embeddedness.

During the COVID-19 lockdown period, several employers used furloughs, that is, temporary layoffs or unpaid leave, to sustain their businesses and retain their employees. While furloughs allow employers to reduce payroll costs, they are challenging for employees and increase voluntary turnover. This study uses a two-wave model (Time 1: n = 639/Time 2: n = 379) and confirms that furloughed employees' perceived justice in furlough management and job insecurity (measured at Time 1) explain their decision to quit their employer (measured at Time 2). In addition, our results confirm that furloughed employees' job embeddedness (measured at Time 1) has a positive mediator effect on the relationship between their perceived procedural justice in furlough management (measured at Time 1) and their turnover decision (Time 2). We discuss the contribution of this study to the fields of knowledge and practice related to turnover and furlough management to reduce their financial, human, and social costs.

The Impact of the Early COVID-19 Pandemic on Registered Nurses' Intent to Stay in Nursing.

The COVID-19 pandemic has been difficult for registered nurses. Media reports, most of them anecdotal, have reported upticks in nurse resignations, and plans to resign and/or leave nursing due to COVID-19. This article reports findings from an online anonymous 95-item survey completed by about 1,600 nurses from a New York City metropolitan area health system's (HS) four hospitals and ambulatory care centers about their COVID-19 experience in the spring of 2020, their intent to stay at the HS, and their intent to stay working as a nurse. Conducted early in the pandemic, this survey addresses a major gap in the literature, as there was no timely evaluation of nurses' intent to leave during the "Great Attrition" wave or to stay during the "Great Attraction" trend. Among those nurses completing the survey, 85.7% reported that they planned to work as a nurse one year later and 77.9% reported that they planned to work at the HS one year later. Those nurses who obtained a master's or doctoral degree as their first professional degree in nursing, or had a high level of mastery, were less likely to report an intent to stay at the HS. Those with no children, those who thought the HS was more supportive, and those who thought that registered nurse-medical doctor relations were higher were more likely to intend to stay at the HS. Those nurses who reported worse communication with their nurse manager were less likely to report an intent to stay in nursing. Those who reported lower stress, who were unmarried and had no children were more likely to intend to work as nurses. Our findings on nurses' intent to leave their organization and their intent to leave nursing are much lower than reports in the popular press. Our data were collected early in the pandemic and it may not reflect the accumulated stress nurses experienced from witnessing the death of so many patients.

Turnover, COVID-19, and Reasons for Leaving and Staying Within Governmental Public Health.

BACKGROUND AND OBJECTIVES: Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay. DESIGN: Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models. RESULTS: In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% considered leaving in 2017. The factors associated with intentions to leave included job dissatisfaction, with adjusted odds ratio (AOR) of 3.8 (95% CI, 3.52-4.22) for individuals who were very dissatisfied or dissatisfied. Odds of intending to leave were significantly high for employees with pay dissatisfaction (AOR = 1.83; 95% CI, 1.59-2.11), those younger than 36 years (AOR = 1.58; 95% CI, 1.44-1.73) or 65+ years of age (AOR = 2.80; 95% CI, 2.36-3.33), those with a graduate degree (AOR = 1.14; 95% CI, 1.03-1.26), those hired for COVID-19 response (AOR = 1.74; 95% CI, 1.49-2.03), and for the BIPOC (Black, Indigenous, and people of color) (vs White) staff (AOR = 1.07; 95% CI, 1.01-1.15). The leading reasons for employees' intention to stay included benefits such as retirement, job stability, flexibility (eg, flex hours/telework), and satisfaction with one's supervisor. CONCLUSIONS: Given the cost of employee recruitment, training, and retention of competent employees, government public health agencies need to address factors such as job satisfaction, job skill development, and other predictors of employee retention and turnover. IMPLICATIONS: Public health agencies may consider activities for improving retention by prioritizing improvements in the work environment, job and pay satisfaction, and understanding the needs of subgroups of employees such as those in younger and older age groups, those with cultural differences, and those with skills that are highly sought-after by other industries.

Determining the effect of selected mental factors on turnover intention through two modulators - stress and resilience over COVID-19 period.

INTRODUCTION: Turnover intention among nurses has risen in an alarming rate since the onset of the pandemic. There are various underlying factors to turnover intention. The present study aims to determine the effect of a number of mental factors on nurses' professional-turnover intention through two modulators of stress and resilience over COVID-19 period. METHODS: The current cross-sectional study was conducted at three hospitals in Khuzestan Province, southern Iran, during the winter of 2021. To collect the data, given the restrictions in place during COVID-19 period, the web link of electronic self-reported questionnaires (including general health, mental workload, work-family conflict, resilience, job stress, corona fear, and turnover intention) were sent to 350 nurses through e-mail and other social media (WhatsApp and Telegram). Accordingly, they were asked to complete the questionnaire during rest periods within two weeks. Totally, 300 people (85% participation) filled out the questionnaires. Finally, a model was constructed in the Amos software. RESULTS: The results showed that the four independent parameters of decreasing general health, increasing mental workload, increasing WFCs and fear of COVID-19 can indirectly increase nurses' turnover intention by increasing job stress. Among these variables, the highest indirect effect coefficient on turnover intention was related to the general health parameter (-0.141). The results also demonstrated a negative correlation between job stress and resilience, with lower resilience raising job stress and, consequently, increasing intention to quit the job. CONCLUSION: Mental factors affecting turnover intension were identified in this study through path analysis. Therefore, it is recommended that the required resilience-enhancing measures to be taken by hospitals and nursing administrations to reduce psychological pressures caused by mentioned variables with the aim of minimizing job-related stress and fostering nurse retention.

Rethinking Traditional Emergency Department Care Models in a Post-Coronavirus Disease-2019 World.

As the nursing shortage in United States emergency departments has drastically worsened since the coronavirus disease-2019 (COVID-19) pandemic, emergency departments have experienced increased rates of inpatient onboarding, higher rates of patients leaving without being seen, and declining patient satisfaction scores. This paper reviews the impacts of the coronavirus disease-2019 pandemic on the current nursing shortage and considers how various medical personnel (emergency nurse-extenders) can ameliorate operational challenges by redesigning emergency department systems. During the height of the coronavirus disease-2019 pandemic, the psychological effects of increased demand for emergency nurses coupled with the fear of coronavirus infection exacerbated nursing turnover rates. Health care workers who can be trained to augment the existing emergency department workforce include paramedics, Emergency Medical Technicians, emergency department technicians, ancillary staff, scribes, and motivated health sciences students. Utilizing non-nurse providers to fulfill tasks traditionally assigned to emergency nurses can improve emergency department flow and care delivery in a post-coronavirus disease-2019 world.

Exploring the Effect of Emotional Labor on Turnover Intention and the Moderating Role of Perceived Organizational Support: Evidence from Korean Firefighters.

Synthesizing the conservation of resource theory, proximal withdrawal state theory, and job demands-resources theory, the present study examined the relationships between two dimensions of emotional labor (i.e., surface and deep acting) and turnover intention, as well as the moderating role of perceived organizational support in these relationships, such as the context of Korean firefighters. Using survey data drawn from fire organizations in Gyeonggi-do, the largest province of South Korea, we found that both surface and deep acting are positively related to firefighter turnover intentions. Further analysis indicates that the perceived organizational support of firefighters, vital for public health and safety, attenuates the positive relationship between surface acting and turnover intention but has no significant moderating effect on the relationship between deep acting and turnover intention. Our results suggest that perceived organizational support acts through essential psychological resources to recover the loss of emotional resources and contributes to the retention of firefighter personnel who primarily perform challenging and stressful work, including firefighting and offering emergency medical services. Thus, this study examines a crucial tool to ensure firefighters' public mental health.

The Race to Retain Healthcare Workers: A Systematic Review on Factors that Impact Retention of Nurses and Physicians in Hospitals.

The shortage of healthcare workers is a growing problem across the globe. Nurses and physicians, in particular, are vulnerable as a result of the COVID-19 pandemic. Understanding why they might leave is imperative for improving retention. This systematic review explores both the prevalence of nurses and physicians who are intent on leaving their position at hospitals in European countries and the main determinants influencing job retention among nurses and physicians of their respective position in a hospital setting in both European and non-European countries. A comprehensive search was fulfilled within 3 electronic databases on June 3rd 2021. In total 345 articles met the inclusion criteria. The determinants were categorized into 6 themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants for job retention were job satisfaction, career development and work-life balance. European and non-European countries showed similarities and differences in determinants influencing retention. Identifying these factors supports the development of multifactorial interventions, which can aid the formulation of medical strategies and help to maximize retention.

The Epidemiology and Costs of Disease Intervention Specialist Retention.

BACKGROUND: The COVID-19 pandemic changed the environment in which disease intervention specialists (DISs) operate, as their skills were in demand beyond sexually transmitted disease (STD) control programs. Workforce conditions generally have changed in the last 2 years, imposing additional challenges. Retaining STD DIS has become more difficult in the changed environment. MATERIALS AND METHODS: We conducted a landscape scan and obtained data from literature and personal observations to characterize current DIS workforce issues. We used published employment data to characterize current labor market conditions and described how cost-effectiveness analysis could be used to assess potential DIS retention interventions. An example illustrating cost-effectiveness concepts was developed. RESULTS: Many STD control programs faced difficulties in retaining STD DIS, because competing positions often could be done without field work. Economic and crime issues posed additional challenges. General workforce turnover has increased 33% since 2016. Turnover varies by age, sex, and education. Cost-effectiveness analysis can be used to assess DIS retention interventions, but data on costs and outcomes are needed on an ongoing basis. Changes in the workforce environment could impact both retention and the effectiveness of retention interventions. CONCLUSIONS: Workforce changes have impacted employee retention. Increased federal funding makes expansion of the DIS workforce possible, but the labor market environment will continue to pose challenges to recruitment and retention.

Should I stay or should I go? Why nurses are leaving community nursing in the UK.

Worsening working conditions for nursing workforce has seen a massive exodus of staff, particularly in community nursing in the UK. AIM: The study aim was to map working conditions as well as identify differentiating characteristics of community nurses that intend to leave their profession. DESIGN: Eligibility criteria were community nurses working in all 4 UK countries. All data was collected by means of a cross-sectional survey via the largest closed, private community nursing online-forum. Logistic regression was carried out to ascertain the effects of the variables on the intention to leave. RESULTS: The total number of respondents was 533. Findings showed that one in two of all community nurses (≈46%) are reporting job dissatisfaction. Length of unpaid overtime per shift (odds increase by 30% for each hour of overtime), manager support, proportion of permanent staff, team size, shift length, travel mileage, worsened conditions in the last year and overall self-rated working conditions were differentiating factors between those that intended to leave the job. The proportion of permanent staff on the team and perceived lack of support from management best predicted the likelihood of leave rates. Our findings imply that low nurse retention will fuel an even higher exodus because job dissatisfaction is highest on teams with lowest permanent staff ratios. Poor management that is inept at supporting frontline staff means that the fundamental retention issues are exacerbated and will not stop the unprecedented crisis that is predicted to lead to a collapse of care provision in community settings. Nurses play a central role and are 'key' to delivering the much- desired patient-centred care' therefore their well-being and job satisfaction should become a priority for policymakers.

Voluntary Separations and COVID-19: A Snapshot of Turnover Intention in the Federal Workforce in the First Year of the Pandemic.

Voluntary separations can exact heavy tolls on organizations that affect their efficiency or effectiveness. This historical retrospective investigates how the COVID-19 pandemic may have influenced federal employees' intention to leave for reasons other than retirement. We examined the 2020 Federal Employee Viewpoint Survey (FEVS) with a particular focus on agencies likely heavily impacted by the pandemic, including the Departments of Agriculture (USDA), Health and Human Services (HHS), Homeland Security (DHS) and the US Environmental Protection Agency (EPA). We used inferential statistics and a logistic model to identify correlations for intent to leave, considering changes related to the pandemic. Intentions to leave notably increased after the pandemic for most respondents, and overall intentions to leave were lower for USDA, HHS, and EPA staff than for all federal employees. Reasons included perceived unavailability of protections from COVID-19 exposure, disruptions to work by the pandemic, and increased work demands due to the pandemic.

Mediating effect of work stress in the relationship between fear of COVID-19 and nurses' organizational and professional turnover intentions.

Nursing is one of the most stressful and high-risk professions. It is important to identify the psychological problems experienced by nurses during the COVID-19 pandemic and examine the relationship between these problems to devise measures that can properly address them. This study examined mediating effect of work stress in the relationship between fear of COVID-19 and nurses' organizational and professional turnover intentions. Using a cross-sectional research design, this study was conducted on 486 nurses working in seven hospitals in Turkey. The mean age of the participants was 35.24 ± 6.81 and 59.9 % of them were women. The Fear of COVID-19 Scale, the General Work Stress Scale, and the Turnover Intention Scale were used to collect data. A mediation model showed that fear of COVID-19 was positively associated with work stress and organizational and professional turnover intentions. The model also revealed that work stress was positively associated with organizational and professional turnover intentions. Furthermore, the results demonstrated that fear of COVID-19 did not only have a direct effect on organizational and professional turnover intentions but also had an indirect effect on it via increased work stress. Findings improve our understanding of the role of work stress in the relationship between fear of COVID-19 and organizational and professional turnover intentions. The findings are fruitful for tailoring and implementing intervention programs to reduce the adverse psychological impacts of COVID-19 on nurses.

Impact of the COVID-19 pandemic on staff turnover at long-term care facilities: a qualitative study.

OBJECTIVE: The objective of this research was to explore the lived experiences of long-term care facilities' staff during the COVID-19 pandemic and examine if and how the pandemic played a role in their decision to leave their jobs. DESIGN: Qualitative study using thematic analysis of semistructured interviews. Interview transcripts were analysed using coding techniques based in grounded theory. PARTICIPANTS: A total of 29 staff with various roles across 21 long-term care facilities in 12 states were interviewed. RESULTS: The pandemic influenced the staff's decision to leave their jobs in five different ways, namely: (1) It significantly increased the workload; (2) Created more physical and emotional hazards for staff; (3) Constrained the facilities and their staff financially; (4) Deteriorated morale and job satisfaction among the staff and (5) Increased concerns with upper management's commitment to both general and COVID-19-specific procedures. CONCLUSIONS: Staff at long-term care facilities discussed a wide variety of reasons for their decision to quit their jobs during the pandemic. Our findings may inform efforts to reduce the rate of turnover in these facilities.

The effect of macro-control and organizational support perception on nurses and physicians intention to quit during the COVID-19 pandemic.

AIM: The aim of this study is to determine the effect of organizational support and COVID-19 macro-control perception levels on intention to quit in physicians and nurses. BACKGROUND: During the pandemic process, healthcare workers faced great health risks and workloads. Many health workers are considering quitting their job. METHOD: A cross-sectional and explanatory research. The sample of the study consisted of 300 nurses and 73 physicians. To collect data, COVID-19 perception of macro-control, perceived organizational support, and intention to quit scales were used. Structural equation modeling was used. RESULTS: COVID-19 macro-control perception and perceived organizational support have a negative effect on the intention to quit. The perceived organizational support has a partial mediating role, on the COVID-19 macro-control perception and the intention to quit. CONCLUSION: This study demonstrated that the macro measures taken against the pandemic and the organizational support received by the nurses and physicians, who are the main actors in the fight against the epidemic, negatively affected their intention to leave. IMPLICATIONS FOR NURSING PRACTICE AND CLINICAL RELEVANCE: To reduce the intention to quit health workers during the COVID-19 pandemic, scientific-based macro-control measures should be taken, and organizational support should be provided.

Reducing Staff Turnover and Clinician Burnout With a Structured Support Group During the COVID-19 Pandemic.

Retention and burnout have always been a challenge for nurse leaders, but the pandemic brought these concerns to a whole new level. And now the Great Resignation is affecting health care. So how can nurse leaders at hospitals and health care systems create a supportive environment for staff during a public health emergency? Structured support groups are a viable option for emphasizing self-care and wellness. We explain why we decided to form a structured support group for our intensive care unit nurses and illustrate the results from our clinical research team. In addition, we share feedback we received from participating nurses and offer advice on forming a structured support group in acute care settings. This strategy resulted in a change in the participant's behaviors after attending the structured emotional support group. This finding aligns with the literature, which supports strategies to protect nurses' mental well-being and to take preventive measures in critical situations. Using this as a foundation, a structured emotional support group can change nurse engagement and involvement in their process and practice, during times of crisis. Many other benefits could be realized from this strategy such as improved nursing practice and processes, improved nurse satisfaction, and improved recruitment and retention.

The Impact of Job Stress, Role Ambiguity and Work-Life Imbalance on Turnover Intention during COVID-19: A Case Study of Frontline Health Workers in Saudi Arabia.

The main objective of the present study is to examine the impact of job stress, role ambiguity, work-life imbalance and burnout on employee turnover intention. Moreover, the mediating role of burnout between job stress, role ambiguity, work-life imbalance and turnover intention is also examined. The data collection for this quantitative research was conducted through the "Questionnaire" technique. The questionnaire was developed based on previously established questions available in the literature. The data were collected using simple random sampling from the healthcare workers of KSA. From the distributed questionnaire, 73.5% of the usable questionnaires were returned. This study used SPSS and PLS for the analysis of the data to highlight the most significant variables that impact the employees' turnover intentions among KSA health workers. The findings show that job burnout is clearly related to turnover intentions and is positively affected by both role stress and role ambiguity. Moreover, a statistically positive association is found between work-life imbalance and burnout among the healthcare workers in KSA. Furthermore, the mediating role of burnout is also confirmed in this study. The study also indicates that role ambiguity and role stress due to COVID-19 may create burnout among employees, which may lead to turnover intention among healthcare workers. There is a lack of research on the assessment of the impact of the novel COVID-19-related job stress, role ambiguity and work-life imbalance on the medical staff's turnover intentions in hospitals. This study fills the gap of the limited studies conducted regarding the identification of the factors that can create turnover intention among healthcare workers of KSA by providing empirical evidence from a Gulf country, Saudi Arabia. This study provides managerial implications for hospital management and health policymakers to develop a strategy to retain the employees. Furthermore, healthcare administrators need to pay close attention to front line workers' turnover intentions as these medical heroes are the vital part of our society who assist patients to receive their initial treatment during the COVID-19 pandemic.

Characteristics of Occupational Burnout among Nurses of Various Specialties and in the Time of the COVID-19 Pandemic-Review.

Occupational burnout is particularly common among nurses due to their work being associated with stress, showing understanding, compassion, and commitment, along with the simultaneous need to maintain the necessary emotional distance. The aim of this review was to assess the occurrence and characterization of burnout among nurses working within neurology, geriatric care, intensive care units and with patients infected with the novel COVID-19 virus. PRISMA guidelines were used to conduct the review. The search for literature was limited to articles meeting the inclusion criteria and published from 2017 to 2022 in PubMed, Scopus, Science Direct, Google Scholar, and Wiley. A total of 768 articles from this category have been found. Ultimately, after in-depth analysis, 20 articles were included in the study. The group of respondents ranged from 49 to 3100 participants. According to the data, the percentages of nurses suffering from burnout in the presented research ranged from 14.3% to 84.7%, with the highest value of burnout among nurses who worked in the ICU during the COVID-19 pandemic. There are certain factors among nurses that significantly affect the occurrence of burnout. These include, among others, working time, age, exposure to infection and contact with infected patients, lack of training on COVID-19 prevention, providing care to an increased number of COVID-19 patients per shift, lack of personal protective equipment, lack of support of administration, lack of pay satisfaction, intrinsic motivation and turnover intention.

Professional commitment, resilience and intent to leave the profession among nurses during the COVID-19 pandemic - a descriptive study.

AIM: The three-component model of commitment, resilience and selected nurse characteristics were tested as predictors of nurses' intent to leave the profession. BACKGROUND: In the wake of the COVID-19 pandemic, news reports suggest that a mass exodus of nursing professionals is occurring. METHOD: This nonexperimental, descriptive, correlational, predictive study used a cross-sectional approach to collect survey data from a convenience sample of 189 registered nurses (RNs) who were providing direct patient care in adult inpatient units with a high likelihood of admitting patients diagnosed with COVID-19 and met other eligibility requirements. RESULTS: Most (73.5%) plan to remain in the nursing profession and feel highly resilient. Only affective commitment demonstrated a significant relationship to the intention to leave the nursing profession. CONCLUSIONS: The study was conducted after the pandemic had been in effect for a prolonged time, and it is likely the nurses with the intent to leave the profession had already left. The findings provide a glimpse of a sample of nurses drawn from a population likely much different from only a few months prior. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies to retain nurses should include efforts to strengthen professional commitment and build resilience.