Factors related to intention to stay in the current workplace among long-term care nurses: A nationwide survey

https://doi.org/10.1016/j.ijnurstu.2018.01.008Get rights and content

Abstract

Background

Keeping long-term care nurses employed is necessary to sustain the current and future demand for high-quality long-term care services. Understanding the factors relating to intention to stay among long-term care nurses is limited by the scarcity of studies in long-term care settings, lack of investigation of multiple factors, and the weakness of existing explanatory models.

Objective

To identify the factors associated with long-term care nurses’ intention to stay in their current workplace.

Design

A cross-sectional questionnaire survey.

Setting

Two hundred and fifty-seven hospitals with long-term care wards across Japan.

Participants

A total of 3128 staff nurses and 257 nurse managers from the long-term care wards of the participating hospitals.

Method

The questionnaire assessed nurses’ intention to continue working in the current workplace as well as potential related factors, including individual factors (demographic data, reason for choosing current workplace, burnout, work engagement, somatic symptom burden) and unit factors (unit size, nurse-manager-related data, patients’ medical acuity, average number of overtime hours, recreational activities, social support, perceived quality of care process, educational opportunities, feeling of loneliness, and ability to request days off). Multilevel logistic regression analysis was used to determine which variables best explained nurses’ intention to stay in their workplace.

Results

Only 40.1% of the respondents reported wanting to continue working at their current workplace. The regression analysis revealed that long-term care nurses’ intention to stay was positively associated with nurses’ age (odds ratio [95% confidence interval]: 1.02 [1.01–1.03]), work engagement (1.24 [1.14–1.35]), getting appropriate support from nurse managers (2.78 [1.60–4.82]), perceived quality of care process (1.04 [1.01–1.06]), educational opportunities (1.06 [1.0–1.13]), and various specific reasons for choosing their workplace (e.g., a good workplace atmosphere, being interested in gerontological nursing, and a high salary). By contrast, intention to stay was negatively associated with emotional exhaustion (0.93 [0.91–0.95]) and depersonalization (0.91 [0.89–0.93]). Intention to stay was associated with neither nurses’ qualifications nor patient medical acuity.

Conclusion

Reason for choosing the workplace, work engagement, getting support from the nurse manager, and perceived quality of care process are significant predictors of long-term care nurses’ intention to stay in the workplace. Promoting such nurses’ work engagement, provision of high-quality care, and access to educational opportunities might augment long-term care nurses’ intention to stay.

Section snippets

What is already known about the topic?

  • Nurse turnover is costly and associated with negative nursing and patient outcomes.

  • Voluntary nurse turnover is influenced by a myriad of inter-related individual and organizational factors, and might be moderated by the cultural and national context.

  • Research on long-term care nurses’ intention to stay is scarce and so far insufficient for explaining stay or turnover intention in this population.

What this paper adds

  • Long-term care nurses’ intention to stay in their workplace varies significantly by hospital, and is significantly influenced by both individual variables (e.g., age and reason for choosing workplace) and unit context variables (e.g., quality of care process and educational opportunities).

  • The relationship between individual variables and intention to stay does not vary significantly across units; therefore, it is not moderated by the unit context variables.

  • There are statistically significant

Design, sampling, and participants

This is a secondary analysis of a cross-sectional questionnaire survey of long-term care hospital nurses. First, 2000 hospitals with long-term care wards were selected randomly using a table of random numbers from the national hospital database (which contains a total of 3767 hospitals with long-term care wards). Second, we sent a letter to the nursing directors of those hospitals explaining the study aim and asking whether they wished to participate in the survey. The nursing directors of 268

Study participants (Table 2)

Out of the 268 hospitals, 263 returned questionnaires (response rate = 98.13%). A total of 3279 questionnaires were from nursing staff (response rate = 83.0%) and 257 were from nurse managers (response rate = 95.9%). The number of returned questionnaires from nursing managers is less than the number of participating hospitals because 6 hospitals did not return nursing manager questionnaires; thus, we excluded the staff nurse questionnaires (n = 61) from these hospitals due to the missing

Discussion

Worldwide, rather few studies have examined intention to stay in long-term care nurses. In Japan, while there has been research on turnover (Ohue et al., 2011; Tei-Tominaga and Miki, 2010; Yamaguchi et al., 2016), the current study is among the first, to our knowledge, to investigate intention to stay among nurses in long-term care hospitals across Japan. Despite the low response rate among hospitals in agreeing to participate in the study, the distribution of the participating hospitals across

Conclusion

In this cross-sectional survey, we demonstrated that a broad range of individual and contextual factors significantly contribute to long-term care nurses’ intention to stay in their workplace. Nurses’ reason for choosing their workplace, burnout, work engagement, and quality of care process were significant factors related to intention to stay. Providing appropriate support from the nurse managers and giving nurses further educational opportunities might help to keep long-term care nurses

Funding

None.

Conflict of interest

None.

Ethical approval

Research Ethics Committee, Graduate School of medicine, The University of Tokyo, Japan (No. 10925).

Acknowledgement

We would like to give special thanks to Prof. Claudia K.Y. Lai for her contribution and encouragement.

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