Does an alignment of employment policies and individual preferences affect intention to stay in the profession? Evidence from Canadian Midwives.

BACKGROUND: This study examines whether alignment of actual and preferred employment policies, including compensation method, employment status, and work schedule, affect midwives' intention to stay in the profession. The study further investigates the moderating effect of financial-rewards satisfaction and compares midwives' policy preferences in urban/rural practices. METHODS: Cross-sectional survey data from 549 midwives across Canada were analysed through descriptive statistics, bivariate correlations, and hierarchical linear regressions. Further regression analysis separated data for urban/rural practicing midwives. RESULTS: Three-quarters of the respondents are paid through a billable-course-of-care, while only one-third prefer this model. Another one-third prefer a combination of salary and billable-course-of-care. More than three-quarters of the respondents are independent contractors, but half prefer other forms of employee status. Lastly, half prefer a part-time work schedule, while others prefer full-time. Alignment of actual and preferred employment policies significantly explains midwives' intention to stay in the profession. Intentions to stay in the profession for urban midwives is significantly affected by the alignment of actual and preferred compensation methods, but not for rural ones. Both urban and rural midwives report similar preferences for employment status and work schedule policies. Furthermore, satisfaction with financial rewards is significantly associated with their intention to stay. CONCLUSION: Policymakers can positively influence midwives' intention to stay in the profession by facilitating alignment of their actual and preferred employment policies.

Retaining nurses in their employing hospitals and in the profession: effects of job preference, unpaid overtime, importance of earnings and stress.

The purpose of this paper is to examine the effects of job preference, unpaid overtime, importance of earnings, and stress in retaining nurses in their employing hospitals and in the profession. Data come from our survey of 1396 nurses employed in three teaching hospitals in Southern Ontario, Canada. Data are analyzed first for all nurses, then separately for full-time, part-time, and casual nurses. Results show that the key to understanding the effects of these variables may be to pay attention to the work status of nurses. With regards to retaining nurses in their hospitals, working in their preferred type of job is important, particularly for part-time nurses. Working unpaid and longer than agreed hours is also a factor for increasing the likelihood of part-time nurses to leave the profession. All nurses are less inclined to leave as the importance of their earnings for the family increases, but it is particularly important for part-time nurses. Stress is an ongoing concern for retaining nurses in their hospitals and within the profession. We suggest managers and policy makers pay attention to employing nurses in jobs they prefer, decrease unpaid overtime, and consider the importance of earnings for them and their families in developing policies and programs to retain nurses. More importantly, stress levels should be lowered to retain nurses.

The impact of implementing managed competition on home care workers' turnover decisions.

This paper addresses the question: Did the implementation of managed competition in Ontario increase turnover in home care agencies? This question is addressed through a case study analysis of the impacts of tendering on the exiting home care labour force from three non-profit home care agencies during the period 1997 to 2001 in a mid-sized city in Ontario. These agencies provided 85% of the market share in 1996. Findings showed that 52% of the nurses and personal support workers (PSWs) left their agency over the five-year period. Analysis of the turnover data showed a temporal association between the implementation of managed competition and turnover. Additional support for the argument that the implementation of managed competition increased turnover is provided through analysis of a questionnaire sent to nurses and personal support workers who had left their agency during this period. Respondents indicated dissatisfaction with their pay, hours of work, benefits, heavy workload and lack of support from their supervisors/managers (all factors affected by the marketization of the home care sector) as reasons for leaving. Of those employed, only one-quarter remained in home care; most of those remaining were working in other healthcare fields such as hospitals and long-term care institutions. However, about one-third of employed PSWs were no longer working in the healthcare field.

Job stress and job dissatisfaction of home care workers in the context of health care restructuring.

Changes in the social organization of home care work due to health care restructuring have affected the job stress and job dissatisfaction of home care workers. This article reports the results of a survey of 892 employees from three nonprofit home care agencies in a medium-sized city in Ontario, Canada. Survey results are complemented by data from 16 focus groups with 99 employees. For the purposes of this study, home care workers include both office workers (managers, supervisors, coordinators, office support staff, and case managers) and visiting workers (nurses, therapists, and visiting homemakers). Focus group participants indicated that health care restructuring has resulted in organizational change, budget cuts, heavier workloads, job insecurity, loss of organizational support, loss of peer support, and loss of time to provide emotional laboring, or the "caring" aspects of home care work. Analyses of survey data show that organizational change, fear of job loss, heavy workloads, and lack of organizational and peer support lead to increased job stress and decreased levels of job satisfaction.