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Assessing the landscape for oncology nursing of the future, the biggest problem that faces the specialty is that of workforce shortages. On the practice side, nursing turnover, resignations, and early retirements have contrib.

Aim: To examine the relative influence of fear of COVID-19 on nurses' psychological distress, work satisfaction and intent to leave their organisation and the profession., Background: The emergence of COVID-19 has significantly impacted the psychological and mental well-being of frontline health care workers, including nurses. To date, no studies have been conducted examining how this fear of COVID-19 contributes to health, well-being and work outcomes in frontline nurses., Methods: This is a cross-sectional research design involving 261 frontline nurses in the Philippines. Five standardized scales were used for data collection., Results: Overall, the composite score of the fear of COVID-19 scale was 19.92. Job role and attendance of COVID-19-related training predicted fear of COVID-19. An increased level of fear of COVID-19 was associated with decreased job satisfaction, increased psychological distress and increased organisational and professional turnover intentions., Conclusions: Frontline nurses who reported not having attended COVID-19-related training and those who held part-time job roles reported increased fears of COVID-19. Addressing the fear of COVID-19 may result in improved job outcomes in frontline nurses, such as increased job satisfaction, decreased stress levels and lower intent to leave the organisation and the profession., Implications for Nursing Management: Organisational measures are vital to support the mental health of nurses and address their fear of COVID-19 through peer and social support, psychological and mental support services (e.g. counselling or psychotherapy), provision of training related to COVID-19 and accurate and regular information updates., (© 2020 John Wiley & Sons Ltd.)

Purpose: This study aimed to identify the degree of non-nursing tasks and nursing care left undone in integrated nursing care wards, and examine their relationships with nurses' burnout, job satisfaction, turnover intentions, and medical errors., Methods: A cross-sectional questionnaire survey was conducted. Data were collected using self-report questionnaires from 346 nurses working in 20 wards of seven small and medium-sized general hospitals, and analyzed using multiple regression and multiple logistic regression analysis with the SPSS WIN 25.0 program., Results: The mean score for non-nursing tasks was 7.32±1.71, and that for nursing care left undone was 4.42 ± 3.67. An increase in non-nursing tasks (β = .12, p = .021) and nursing care left undone (β = .18, p < .001) led to an increase in nurses' burnout (F = 6.26, p < .001). As nursing care left undone (β = .13, p = .018) increased, their turnover intentions also (F = 3.96, p < .001) increased, and more medical errors occurred (odds ratio 1.08, 95% confidence interval 1.02~1.15)., Conclusion: Non-nursing tasks and nursing care left undone are positively associated with nurses' burnout, turnover intentions, and the occurrence of medical errors. Therefore, it is important to reduce non-nursing tasks and nursing care left undone in order to deliver high quality nursing care and in turn increase patient safety., Competing Interests: The authors declared no conflict of interest., (© 2021 Korean Society of Nursing Science.)

Objective: The objective of this study was to determine whether an innovative program including psychoeducation grounded in positive psychology and awareness of cognitive biases, along with access to a dedicated relaxation environment, would lower burnout for nurses., Background: Promoting well-being of nurses is an essential goal of healthcare leaders because of the negative effects of burnout out on nurses' health and patient outcomes., Methods: A prospective cohort analysis was conducted to examine whether exposure to the OASIS (Opportunity to Achieve Staff Inspiration and Strength) education content and using the OASIS rooms were associated with improvements in quality of life or turnover intention among nurses., Results: Nurses who reported receiving 3 to 6 education sessions and who used the OASIS room reported lower levels of burnout, on average, than nurses who did not receive any education sessions., Conclusion: The OASIS program has the potential to be an effective, easy-to-deliver education program that can integrate well-being into the workday of nursing professionals.

We conducted a cross-sectional survey to assess the anxiety, distress, and turnover intention (likelihood to leave their current job) of healthcare workers in Peru during the COVID-19 pandemic. Our results reported that 21.7% healthcare workers in Peru experienced severe anxiety, whereas 26.1% of them experienced severe mental distress. A higher level of education related with a lower level of anxiety. Younger workers had a higher level of turnover intention than their older colleagues did. Healthcare workers in the private sector had a higher turnover intention than those in the public sector. Most importantly, people who were geographically far from Lima, the epicenter in Peru, during the outbreak experienced less anxiety and mental distress, corroborating the ripple effect and disconfirming the typhoon eye theory. However, the direction of these relationships can change depending on the type of institutions (public versus private) and the type of employees' contract (full time versus part time). Our research helps provide insights for clinical professionals in identifying the vulnerable groups to mental disorders in Peru. This is the first study to assess anxiety, mental distress, and turnover intention in healthcare workers in Peru during the COVID-19 pandemic.

The shortage of experienced nurses is a concern in health organizations. This study investigated the leadership styles of nurse managers' impact on turnover intention among nurses in hospitals. A descriptive correlational research design was used. Samples of 250 nurses working in five hospitals were selected to complete self-administered questionnaire. Findings show that participatory and transformational leadership styles are predominantly practiced. Correlation analysis revealed that participative and transformational leadership styles decreases turnover intention while autocratic and laissez-faire leadership styles increases turnover intention. Therefore, leadership styles of nurse managers are determinants of nurses' turnover intentions.

Background: Practitioner turnover in behavioral health settings is high and hinders the implementation of new interventions., Objective: This study examined practitioner and organizational characteristics that contribute to high staff turnover in community behavioral health settings., Participants and Setting: Clinicians in nine community-based agencies participated. Included agencies treated a high volume of families referred from child welfare., Methods: This study was part of a larger trial testing the effectiveness of a Cognitive Behavior Therapy for family conflict. Authors assessed predictors of turnover quantitatively and qualitatively. Quantitative data was collected prospectively (n = 169) on practitioner and organizational-level variables (e.g., demographics, professional practice, job satisfaction, emotional exhaustion, organizational commitment). Semi-structured interviews with practitioners who left their agencies (n = 40) provided qualitative data retrospectively., Results: Forth-five percent of practitioners left their agencies over three years. Two predictors of final survival status (lower age and lower job satisfaction) were associated with leaving the agency at the p < .05 level; however, they accounted for very little variance. Qualitative themes highlighted the importance of job characteristics, compensation, productivity requirements, advancement opportunities, and co-worker relationships as influential in the decision to leave., Conclusions: This study highlights the value of a mixed-method approach given that themes emerged from the qualitative interviews that were not accounted for in the quantitative results. Additional research is needed to better understand workforce turnover so that strategies can be developed to stabilize the behavioral health workforce., Competing Interests: Declaration of Competing Interest Amy Herschell, Jonathan Hart, Laurel Brabson and James Gavin have no conflicts of interest to report. David Kolko currently receives funding through grants from the National Institute of Mental Health (R01 MH095750-01), Substance Abuse and Mental Health Services Administration (U79 SM080056-01; U79 SM080000-01), National Institute on Drug Abuse (U01 DA040213-02), and National Institute of Neurological Disorders and Stroke (P/I #XDK0216EPI)., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aims: To improve predictability and accuracy of hiring using historical staffing data, quality improvement and workforce engagement., Background: Twenty-three per cent of newly licensed nurses leave their first job within one year, costing employers $52,100 per nurse replacement. Tools for anticipatory hiring strategies are not available in the literature., Methods: We used retrospective, secondary data analysis to develop a Prospective Staffing Model and conduct a five-year longitudinal evaluation of the implementation of the model in a convenience sample at a quaternary academic Cardiothoracic Intensive Care Unit. We used a team-based, quality improvement approach to restructure recruitment and hiring strategies, standardize new graduate nurse orientation and implement AACN Healthy Work Environment standards., Results: Over the five-year prospective evaluation period (2014-2018), 388 nurses were hired and included in the evaluation cohort. Retention increased (n = 286 days) and turnover decreased (17.6%) between 2014 and 2018. Improvements in workforce stability were sustained at five years., Conclusions: Use of a Prospective Staffing Model is associated with improved nurse retention and decreased turnover, and may improve workforce stability., Implications for Nursing Management: Results suggest that an innovative tool can mitigate the deleterious effects of turnover, adding to current knowledge and providing a method for anticipatory assessment of local turnover., (© 2019 John Wiley & Sons Ltd.)

Aims: To understand the working experiences and career trajectories of male nurses in China., Background: Compared with developed countries, men were far more under-represented in the nursing profession in China. Little is known about the working experiences of Chinese male nurses and the contextual factors that contribute to their low participation rate in the nursing profession., Methods: In-depth interviews with twenty-five male nurses and two hospital administrators were conducted. All interviews were analysed using thematic analysis., Results: Chinese male nurses had better career prospects and promotion chances compared with female nurses. The extremely low participation rate of men in nursing was related to the prejudice among the general public as well as the low professional status and salary. Two unique contextual factors influenced the career trajectories of male nurses in China: (1) the major assignment mechanism in the college entrance examination and (2) the implementation of the two-child policy., Conclusion: Although Chinese male nurses enjoyed many advantages compared with female nurses, they also encountered many difficulties related to working in a female-dominated profession., Implications for Nursing Management: Appropriate measures should be taken to shift public attitudes towards male nurses, improve the professionalization of nursing and promote gender diversity and equity., (© 2020 John Wiley & Sons Ltd.)

The purpose of this pilot study was to evaluate the impact of mindfulness education of new graduate nurse residents' awareness and use of mindfulness strategies. This pre-post education design study was approved by the university institutional review board. Mindfulness has been shown to improve focus on patient care and reduce job stress and nurse turnover. Improved awareness and use of mindfulness strategies have the potential to improve patient outcomes and reduce the cost of nurse turnover.

Objective: To examine characteristics associated with tenure length of State Health Officials (SHOs) and examine reasons and consequences for SHO turnover., Design: Surveys of current and former SHOs linked with secondary data from the United Health Foundation., Setting: Original survey responses from SHOs in the United States., Participants: Respondents included SHOs who served between 1973 and 2017., Main Outcome Measures: Tenure length and consequences of SHO turnover., Results: Average completed tenure among SHOs was 5.3 years (median = 4) and was shorter in recent time periods compared with decades prior. Older age at appointment (β = -0.109, P = .005) and those holding a management degree (β = -1.835, P = .017) and/or a law degree (β = -3.553, P < .001) were each associated with shorter SHO tenures. State Health Officials from states in the top quartile for health rankings had significantly longer average tenures (β = 1.717, P = .036). Many former SHOs believed that their tenure was too short and reported that their departure had either a significant or very large effect on their agency's ability to fulfill its mission., Conclusions: State Health Official tenures have become shorter over time and continue to be shorter than industry chief executive officers and best practice recommendations from organizational researchers. States have an opportunity to consider and address how factors within their control influence the stability of the SHO position.

Background: The health and social care sector (HCS) is currently facing multiple challenges across Europe: against the background of ageing societies, more people are in need of care. Simultaneously, several countries report a lack of skilled personnel. Due to its structural characteristics, including a high share of part-time workers, an ageing workforce, and challenging working conditions, the HCS requires measures and strategies to deal with these challenges., Methods: This qualitative study analyses if and how organisations in three countries (Germany, Finland, and the UK) report similar challenges and how they support longer working careers in the HCS. Therefore, we conducted multiple case studies in care organisations. Altogether 54 semi-structured interviews with employees and representatives of management were carried out and analysed thematically., Results: Analysis of the interviews revealed that there are similar challenges reported across the countries. Multiple organisational measures and strategies to improve the work ability and working life participation of (ageing) workers were identified. We identified similar challenges across our cases but different strategies in responding to them. With respect to the organisational measures, our results showed that the studied organisations did not implement any age-specific management strategies but realised different reactive and proactive human relation measures aiming at maintaining and improving employees' work ability (i.e., health, competence and motivation) and longer working careers., Conclusions: Organisations within the HCS tend to focus on the recruitment of younger workers and/or migrant workers to address the current lack of skilled personnel. The idea of explicitly focusing on ageing workers and the concept of age management as a possible solution seems to lack awareness and/or popularity among organisations in the sector. The concept of age management offers a broad range of measures, which could be beneficial for both, employees and employers/organisations. Employees could benefit from a better occupational well-being and more meaningful careers, while employers could benefit from more committed employees with enhanced productivity, work ability and possibly a longer career.

The fast population ageing has generated and will continue to generate large social, economic and health challenges in the 21th century in Australia, and many other developed and developing countries. Population ageing is projected to lead to workforce shortages, welfare dependency, fiscal unsustainability, and a higher burden of chronic diseases on health care system. Promoting health and sustainable work capacity among mature age and older workers hence becomes the most important and critical way to address all these challenges. This paper used the pooled data from the longitudinal Household, Incomes and Labour Dynamics in Australia (HILDA) survey 2002-2011 data to investigate common and different factors predicting voluntary or involuntary workforce transitions among workers aged 45 to 64. Long term health conditions and preference to work less hours increased while having a working partner and proportion of paid years decreased both voluntary and involuntary work force transitions. Besides these four common factors, the voluntary and involuntary workforce transitions had very different underlying mechanisms. Our findings suggest that government policies aimed at promoting workforce participation at later life should be directed specifically to life-long health promotion and continuous employment as well as different factors driving voluntary and involuntary workforce transitions, such as life-long training, healthy lifestyles, work flexibility, ageing friendly workplace, and job security.

Background: The departures of chief academic administrators of nursing programs within a short tenure are likely to affect the operation of their institutions significantly., Purpose: To help nursing schools improve recruitment and retention of chief academic administrators., Methods: We obtained deans' records from the membership database of the American Association of Colleges of Nursing (AACN) for 11 starting cohorts between 2001 and 2011 and matched the data with dean data collected in the AACN Annual Survey to retrieve additional information on individual and institutional characteristics. Bivariate and multivariate analyses were used to examine the association between a characteristic and short tenures (less than 5 years)., Findings: We found that 41% of deanships have short tenures, and the figure increased from earlier cohorts to later cohorts in general. We did not find that first-time deans were more likely to experience a short tenure. However, we found in bivariate analyses that deans in newly created nursing programs have a higher likelihood of leaving deanships in less than 5 years. We also found in bivariate and multivariate analyses that an individual characteristic, age 60 or older, and three institutional attributes, deans with a title as Chair, Director, or Department Head, deans in nursing schools without a tenure system, and deans in baccalaureate or associate degree granting institutions are more likely to have a short tenure. In brief, our findings show that deans in smaller nursing programs are more likely than deans in larger nursing programs to experience a short tenure DISCUSSION: Our findings that deans in smaller programs and newly created programs are more likely to experience early attrition provide useful information to the nursing education community so more focused efforts can be made to improve the retention of chief academic administrators in nursing programs., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aim: This study aims to identify the role that spiritual climate has in reducing burnout and intentions to leave amongst clinical nurses., Background: Both shortages and the high turnover of nurses are challenging problems worldwide. Enhancing the spiritual climate amongst nurses can enhance teamwork, organisational commitment and job satisfaction and can play a role in reducing burnout and turnover intention., Methods: A total of 207 clinical nurses working at a tertiary university hospital were included in this cross-sectional, single-site study. Independent-samples t test and ANOVA, Pearson correlation analysis and hierarchical regression analysis were used to explore the relationships amongst related factors., Results: Most clinical departments showed a moderate spiritual climate (60.24 ± 0.82) with high job burnout (33.62 ± 0.28) and turnover intention (2.37 ± 0.57). A good spiritual climate was correlated with high job satisfaction (r = 0.412, p < 0.01), low burnout and turnover intention (r = -0.423, p < 0.01 and r = -0.292, p < 0.01, respectively). Spiritual climate could also indirectly influence nurses' job burnout and turnover intention (R 2  = 10.31%)., Conclusions: Different departments have different spiritual climates. The findings from this study indicate that spiritual climate may impact nursing burnout and turnover., Implications for Nursing Management: Using a spiritual climate scale provides health care decision-makers with clear information about staff spirituality well-being. Interventions to improve spiritual climate can benefit teamwork in clinical departments., (© 2019 John Wiley & Sons Ltd.)

Child welfare workforce turnover has been well studied, although there is limited understanding of factors related to the timing of departure. This study examines predictors of early job departure among newly hired child welfare workers. Data come from the first two waves of a longitudinal study. The sample for this analysis included 1,257 respondents. Hierarchical logistical regression was used to investigate worker characteristics and organizational influences on early departure. Early leavers, or those who left within the first six months, were 14.8 percent (n = 186) of the sample. Regression results indicated that two worker characteristics-years of previous work experience and major of college degree-predicted early departure. Two measures of organizational influences during the transition from training to casework were significant predictors of early departure: (1) caseload size the first week after training and (2) role ambiguity. These findings suggest that organizational attention to the orientation and socialization of newly hired child welfare professionals are likely to be instrumental to preventing early turnover., (© 2019 National Association of Social Workers.)

High levels of emotional exhaustion are frequently reported among clinicians working in community mental health settings. This study draws on social exchange theory and examines the relationships between emotional exhaustion and mental health provider work attitudes and turnover, and the moderating effect of functional psychological climates. Data were analyzed using multilevel structural equation modeling in a sample of 311 mental health providers from 49 community mental health programs. Results revealed that emotional exhaustion was negatively related to work attitudes, and the relationship was moderated by functional climates characterized by high levels of cooperation, growth and advancement opportunities, and role clarity. Specifically, the relationship between emotional exhaustion and work attitudes was attenuated for providers working in programs with a more functional psychological climate. Lower work attitudes significantly predicted higher clinician turnover. Results are discussed as they relate to improving climates and enhancing mental health provider and organizational well-being.

Aim: To expand knowledge about the predictive factors of nurses' intention to leave their job and consequently to turnover., Background: Nurse turnover is costly and negatively influences quality of care. Understanding the association between intention to leave and modifiable features of hospital organisation may inform strategies to reduce turnover., Methods: A cross-sectional survey of 3,667 medical and surgical nurses was conducted in Italy. Measures included intention to leave; work environment; burnout; job satisfaction; and missed care using the RN4CAST instruments. Descriptive, logistic regression analysis was used., Results: Due to job dissatisfaction, 35.5% of the nurses intended to leave their current job, and of these, 33.1%, the nursing profession. Push factors included the following: understaffing, emotional exhaustion, poor patient safety, performing non-nursing care and being male. Pull factors included the following: positive perception of quality and safety of care, and performing core nursing activities., Conclusion: The present study expands knowledge about the predictive factors of nurses' intention to leave their job and consequently to turnover, which is one of today's major issues contributing to the shortage of nurses., Implications for Nursing Management: Nurses' intention to leave their job is the consequence of a poor work environment, characterized by factors such as understaffing and performance of non-nursing activities., (© 2019 John Wiley & Sons Ltd.)

Background: The 2008 financial crisis exacerbated an already mounting workforce challenge faced by most health services in the western world, namely the recruitment and retention of qualified nurses., Aim: This paper examines two additional challenges of relevance to workforce planning in health care, an ageing nursing workforce and reliance upon migrant nurses to solve short-term workforce issues., Methods: Using Ireland as a case exemplar of these issues, this paper argues that policy makers and service providers should seek not only to address the challenge of retaining trained newly qualified and younger nurses but also focus on supporting older nurses and migrant nurses to remain within the workforce., Findings: The findings of this paper highlight the need for workforce planners, policy makers and service providers to take account of an ageing nursing workforce and reliance on foreign-trained nurses as a solution to short-term planning difficulties., Conclusion: Failure to address this need is likely to lead to significant workforce difficulties for health services into the future and undermine current efforts to increase the number and long-term retention of qualified nursing staff., Implications for Nursing Policy: Policy makers and service providers should focus on the retention of trained older nurses as an important element of workforce planning., (© 2018 International Council of Nurses.)

Background: To secure human resources for occupational medicine, it is important to analyse occupational physician retention trends and the factors associated with retention. However, little is currently known about this topic., Aims: To identify occupational physician retention trends, to identify factors associated with this retention and to discuss the policy implications of the findings., Methods: We analysed data from the biannual national physician census surveys conducted by the government of Japan from 2002 to 2014. In this study, those who chose 'working as an occupational physician' as their workplace/type of work from a pre-determined list in the survey questionnaire were considered full-time occupational physicians. We presented retention trends by calculating the annual retention rate for each set of two consecutive surveys. We then used logistic regression to identify factors associated with retention among occupational physicians., Results: The annual retention rate of full-time occupational physicians from 2012 to 2014 was estimated as 76%, which represents a 6% improvement in retention over the study period. The odds of continuing to practise as an occupational physician were higher for occupational physicians working in cities compared with those working in towns or villages., Conclusions: Improving and facilitating smooth transitions between clinical practice and occupational medicine would help to secure human resources in occupational medicine, even if the current trend of low retention continues., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Aim: To critically analyse the international literature describing the experiences of nurses working in rural hospitals., Background: Nursing shortages in rural areas is an ongoing issue. Given the significant role nurses play in the delivery of rural health care, a sufficient workforce is essential. However, maintaining this workforce is challenging. Understanding the experiences of nurses working in rural hospitals is essential to inform strategies around job satisfaction and staff retention., Evaluation: An integrative review was conducted. Six primary sources were included related to the experiences of nurses working in rural hospitals., Results: Four themes emerged, namely: (a) Professional Development; (b) Workplace stressors; (c) Teamwork; and (d) Community., Conclusion: There is a need for further research exploring the experiences of nurses working in rural hospitals and its impact on job satisfaction, turnover intention and patient safety., Implications for Nursing Management: This review highlights some key issues impacting nurses' working in rural hospitals. This understanding can be used by nurse managers to inform strategies for recruitment and retention of nurses in these areas., (© 2018 John Wiley & Sons Ltd.)

Aim: The aim of the present study was to assess the implications of Iran's recent health care reforms on nurses' experience of moral distress, their perceptions of the respect for patient rights and the relationship of these variables to job and income dissatisfaction and turnover intention., Background: Health systems around the world are reforming themselves to adapt to meeting the future needs of increasing patient care to an ever-growing population., Methods: This was a cross-sectional correlational study. The participants were 276 nurses at six large private and public hospitals in Tehran, Iran., Findings: Negative correlations were reported between turnover intention and respecting patient rights (r = -0.560, p < 0.001), satisfaction with job (r = -0.710, p < 0.001) and satisfaction with income (r = -0.226, p < 0.001). The correlation between moral distress intensity (r = 0.626, p < 0.001) and frequency (r = 0.701, p < 0.001) was positive with turnover intention., Conclusions: Moral distress was significantly correlated to poor respect for patient rights, poor job satisfaction and income satisfaction and was a major predictor of turnover intention., Implications for Nursing Management: Health system reform must take into account the concomitant increasing workload and its negative impact in order to ensure that reform does not lead to unintentional detrimental outcomes of increased moral distress, decreased satisfaction and increased turnover rates among nursing personnel., (© 2018 John Wiley & Sons Ltd.)

Aims: This study examines how career barriers and supports (i.e., perceived discrimination, lack of advancement, human capital, and social capital) impact affective, normative, and continuance aspects of professional commitment and thus nurses' professional turnover intention., Background: Professional commitment is known to influence professional turnover intention. However, little is known about how career barriers and supports contribute to professional commitment and reduce professional turnover intention., Methods: This study adopted a cross-sectional design and a survey to collect representative data in a major hospital in northern Taiwan. We used proportionate random sampling to ensure sample representativeness and obtained 524 responses., Results: Perceived discrimination and lack of advancement were negatively related to affective professional commitment. Human capital was positively related to affective, normative, and continuance professional commitment. Social capital was positively related to normative professional commitment. All aspects of professional commitment were negatively related to professional turnover intention., Conclusion: Career barriers and supports have an important influence on professional commitment. Reduced barriers and enhanced support may therefore help reduce nurses' professional turnover intentions., Implications for Nursing Management: Nursing managers could aim to lessen career barriers while increasing career support for nurses, helping strengthen nurses' professional commitment and retention., (© 2018 John Wiley & Sons Ltd.)

Introduction: In Australia, on any given day, there are more than 300 advertised emergency nursing positions, and this situation can be replicated in nearly every country internationally. The nursing shortage globally is known. The importance of not only why nurses specialize in the field of emergency nursing but also why they remain in the field requires an understanding of the evidence and research into nursing recruitment and retention. Leadership within the emergency department has a strong correlation to staff retention. It is hoped that, by gaining a greater understanding of the elements that influence staff retention, we will be able to lay down a strong foundation for the future of emergency nursing., Methods: This literature review used a bibliographic search as well as the author's own experience., Results: This article presents the key factors that have impact on emergency nursing retention: workplace environment, demands on emergency nurses, resilience, and education and training., Discussion: Emergency nursing recruitment and retention is a multifaceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This literature review has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing., (Copyright © 2018 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

Review Question/objective: The objective of this systematic review update is to evaluate recent available research on the effectiveness of strategies and interventions aiming to assist the transition from student to newly qualified nurse for job satisfaction, confidence, competence, knowledge, stress, anxiety, retention, turnover and costs.

Aim: This research investigated the relationship between perceived career opportunities, affective commitment to the supervisor, and social isolation from colleagues on the one hand and nurses' well-being and turnover intentions on the other. In addition, this study explored the mediating role of affective commitment to the organisation in these relationships., Background: Previous research suggested that organisational commitment explained the effect of nurses' work environment on their turnover intentions. However, less is known about how organisational commitment may contribute to explain nurses' well-being., Method: This research used a cross-sectional design. A sample of 244 nurses completed a questionnaire survey., Results: Results indicated that affective commitment to the organisation partially mediates the relationships between perceived career opportunities, affective commitment to the supervisor, and social isolation on one hand, and turnover intentions and well-being on the other hand., Conclusion: This study showed that the way nurses assess various aspects of their work experience transposes to their emotional bond to their organisation, which in turn explains their well-being and turnover intentions., Implications for Nursing Management: This paper identifies factors that could contribute to reduce nurses' intent to quit and promote their well-being., (© 2018 John Wiley & Sons Ltd.)

Background: The shortage of critical care and specialist nurses has been an ongoing issue for many decades. Although all areas of nursing are affected, critical care areas are especially vulnerable to recruitment and retention problems. High nursing turnover in critical care areas is evident; however, research into the factors that influence nurses' intentions to leave adult critical care areas is limited., Aim: To explore factors that may influence nurses' intentions to leave adult critical care areas., Objectives: To appraise existing evidence and highlight gaps in knowledge regarding factors that may influence nurses' intentions to leave adult critical care areas., Methods: A systematic mixed-method literature review was conducted. The search strategy was developed using the List, Keep and Delete approach, a framework used to identify search terms for systematic health care reviews. The following key words were used: intentions to leave, nurses, adult and critical care. The databases searched were BNI, CINAHL, PubMed, PsycINFO, Embase and Health B Elite from 2005 to 2016. Primary data from non-critical care areas and neonatal and paediatric critical care areas were excluded. Comprehensive supplementary searching was performed. Papers were critically appraised using the NICE (2012) checklists. Data were analysed using the Braun and Clarke (2006) thematic framework., Results: A total of 15 studies, including 13 cross-sectional studies and 2 qualitative studies, were reviewed. Three main themes emerged following data analysis. These themes were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences., Conclusions: The literature review highlighted the need for further research and greater understanding of how these themes may impact critical care nurses. Nurse managers and leaders should consider these findings when developing strategies to improve nurse retention., Relevance to Practice: The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care., (© 2018 British Association of Critical Care Nurses.)

Background: Burnout and the intention to leave the profession are frequently studied outcomes in healthcare settings that have not been investigated together and across different health professions before. This study aimed to examine work-related explanatory factors or predictors of burnout and the intention to leave the profession among health professionals in general, and nurses and physicians in particular., Methods: Cross-sectional survey data of 1840 employees of six public hospitals and rehabilitation clinics recorded in 2015/16 in German-speaking Switzerland were used. Multiple logistic and stepwise linear regression analyses were performed to estimate the relative risks (odds ratios) and standardized effects (beta coefficients) of different workloads and work-related stressors on these outcomes and to study any possible mediation between them., Results: On average, one in twelve health professionals showed increased burnout symptoms and every sixth one thought frequently of leaving the profession. Temporal, physical, emotional and mental workloads and job stresses were strongly and positively associated with burnout symptoms and thoughts of leaving the profession. However, the relative risks of increased burnout symptoms and frequent thoughts of leaving the profession were highest in the case of effort-reward and work-life imbalances. In fact, these two work-related stress measures partly or even largely mediated the relationships between exposures (workloads, job stresses) and outcomes and were found to be the strongest predictors of all. Whereas a work-life imbalance most strongly predicted burnout symptoms among health professionals (β = .35), and particularly physicians (β = .48), an effort-reward imbalance most strongly predicted thoughts of leaving the profession (β = .31-36). A substantial part of the variance was explained in the fully specified regression models across both major health professions and both outcomes. However, explained variance was most pronounced for burnout symptoms of physicians (43.3%) and for frequent thoughts of leaving the profession among nurses and midwives (28.7%)., Conclusions: Reducing workload and job stress, and particularly reward frustration at work, as well as the difficulties in combining work and private lives among health professionals, may help to prevent them from developing burnout and/or leaving the profession and consequently also to reduce turnover, early retirement, career endings and understaffing in healthcare settings.

Background: Primary care physicians generally earn less than specialists. Studies of other occupations have identified perception of pay fairness as a predictor of work- and life-related outcomes. We evaluated whether physicians' pay fairness perceptions were associated with their work satisfaction, turnover intention, and personal health., Methods: Three thousand five hundred eighty-nine physicians were surveyed. Agreement with "my total compensation is fair" was used to assess pay fairness perceptions. Total compensation was self-reported, and we used validated measures of work satisfaction, likelihood of leaving current practice, and health status. Hierarchical logistic regressions were used to assess the associations between pay fairness perceptions and work/life-related outcomes., Results: A total of 2263 physicians completed surveys. Fifty-seven percent believed their compensation was fair; there was no difference between physicians in internal medicine and non-primary care specialties (P = 0.58). Eighty-three percent were satisfied at work, 70% reported low likelihood of leaving their practice, and 77% rated their health as very good or excellent. Higher compensation levels were associated with greater work satisfaction and lower turnover intention, but most associations became statistically non-significant after adjusting for pay fairness perceptions. Perceived pay fairness was associated with greater work satisfaction (OR, 4.90; 95% CI, 3.94-6.08; P < 0.001), lower turnover intention (OR, 2.46; 95% CI, 2.01-3.01; P < 0.001), and better health (OR, 1.33; 95% CI, 1.08-1.65; P < 0.01)., Discussion: Physicians who thought their pay was fair reported greater work satisfaction, lower likelihood of leaving their practice, and better overall health. Addressing pay fairness perceptions may be important for sustaining a satisfied and healthy physician workforce, which is necessary to deliver high-quality care.

Background: Low job satisfaction is the most common cause of nurses' turnover and influences the quality of nursing service. Moreover, we have no idea regarding whether job control, as an individual factor, can play a role in the relationship., Objective: To explore the relationship between work-family conflict and job satisfaction among Chinese registered nurses and the mediating role of job control in this relationship., Methods: From August 2015 to November 2016, 487 Chinese registered nurses completed a survey. The study used work-family conflict scale, job control scale, job satisfaction scale, as well as general information. Multiple regression analysis was used to explore the independent factors of job satisfaction. Structural equation model was used to explore the mediating role of job control., Results: Work-family conflict was negatively correlated with job satisfaction (r ‑0.432, p<0.01). In addition, job control was positively related to job satisfaction (r 0.567, p<0.01). Work-family conflict and job control had significant predictive effects on job satisfaction. Job control partially mediated the relationship between work-family conflict and job satisfaction., Conclusion: Work-family conflict affected job satisfaction and job control was a mediator in this relationship among Chinese registered nurses. Job control could potentially improve nurses' job satisfaction.

Health care has been cited as a job engine for the U.S. economy. This study used the Current Population Survey to examine the sector and occupation shifts that underlie this growth trend. Health care has had a cyclical relationship with retail trade, leisure and hospitality, education, and professional services. The entering workforce has been increasingly taking on low-skilled occupations. The exiting workforce has not been necessarily retiring or going back to school, but appeared to be leaving without a job, with potentially more child care duties, and with high rates of disability and poverty levels. This study also found that the number of workers staying in health care has been slowly declining over time. As the United States moves toward team-based care, more attention should be paid to the needs of the lower skilled workers to reduce turnover and ensure delivery of quality care.

To assess perspectives of US community-based palliative care program leaders on staffing, recruitment, and training, a qualitative descriptive study was conducted. Leaders (n = 20) from academic medical centers, large integrated and community health systems, home health and hospice organizations, and the Veterans Administration were recruited. Three major categories emerged that influence community-based palliative care workforce team composition across settings: (1) staffing models and recruitment are influenced by setting and workforce experience, (2) training varies by setting, and (3) demand exceeds supply of trained workforce. Participants described a hybrid approach used in academic and community settings to complete an interdisciplinary team by leveraging social work and chaplaincy from inpatient departments and home health and hospice. Physician-led interdisciplinary teams in academic settings and teams more often led by nurse practitioners in community settings were reported. Community program leaders expressed the desire to recruit nurses with home health and hospice experience because of the ability to work independently. Training was described as more often on-the-job in community settings. Turnover related to the lack of a properly trained workforce was described as one of the biggest barriers to palliative care development.

With a sample of employed women of color (N = 276), we tested the associations of sexist and racist discrimination with poor work outcomes (job-related burnout and turnover intentions) and mental health outcomes (i.e., psychological distress). Drawing from the Theory of Work Adjustment, Organizational Support Theory, and scholarship on discrimination, we tested perceived person-organization (P-O) fit, perceived organizational support, and self-esteem as mediators of the associations of workplace discrimination with the outcomes. Based on intersectionality scholarship, womanist attitudes were tested as a moderator. Participants provided cross-sectional data via an online survey. Latent variable structural equation modeling results indicated that a second-order latent workplace discrimination variable yielded better fit to the data than modeling sexist and racist discrimination separately. Workplace discrimination was directly and indirectly (via the mediating role of self-esteem) associated with higher psychological distress. Furthermore, workplace discrimination was indirectly associated with poor work outcomes through the mediating roles of perceived P-O fit, perceived organizational support, and self-esteem. Last, moderation analyses indicated that higher womanist attitudes weakened the direct association of workplace discrimination with psychological distress. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Aim: This commentary presents a cost-benefit analysis to advocate for the use of succession planning to mitigate the problems ensuing from nurse manager turnover., Background: An estimated 75% of nurse managers will leave the workforce by 2020. Many benefits are associated with proactively identifying and developing internal candidates. Fewer than 7% of health care organisations have implemented formal leadership succession planning programmes., Evaluation: A cost-benefit analysis of a formal succession-planning programme from one hospital illustrates the benefits of the programme in their organisation and can be replicated easily., Key Issues: Assumptions of nursing manager succession planning cost-benefit analysis are identified and discussed. The succession planning exemplar demonstrates the integration of cost-benefit analysis principles., Conclusion: Comparing the costs of a formal nurse manager succession planning strategy with the status quo results in a positive cost-benefit ratio., Implications for Nursing Management: The implementation of a formal nurse manager succession planning programme effectively reduces replacement costs and time to transition into the new role. This programme provides an internal pipeline of future leaders who will be more successful than external candidates. Using an actual cost-benefit analysis equips nurse managers with valuable evidence depicting succession planning as a viable business strategy., (© 2017 John Wiley & Sons Ltd.)

Background: Newly licensed nurses are overwhelmed and feel stressed as they transition from student to professional nurse. Health educators are making strides in improving the work environment, yet these nurses continue to feel stressed. Little has been done to track stress-ors to see whether they have changed over time., Method: A descriptive qualitative research method was used to identify the stressors of newly licensed nurses. The first focus group interviews were conducted in 2003 with 21 nurses. In 2015, the study was replicated using another group of 22 recently graduated nurses., Results: There were fewer stressors noted in the 2015 group compared with the 2003 group. Six major stress-ors were identified in the 2003 group, and only three of these were noted in the 2015 group., Conclusion: The decline in work-related stressors could be attributed to changes in health care organizations and in state policies. Nurse educators and leaders should refine orientation and educational programs based on ongoing changes in stressors expressed by newly licensed nurses. J Contin Educ Nurs. 2018;49(3):132-140., (Copyright 2018, SLACK Incorporated.)

Introduction: The purpose of this study is to reconcile public health workforce supply and demand data to understand whether the expected influx of public health graduates can meet turnover events., Methods: Four large public health workforce data sources were analyzed to establish measures of workforce demand, voluntary separations, and workforce employees likely to retire at state and local health departments. Data were collected in 2014-2016 and analyzed in 2016 and 2017. Potential workforce supply (i.e., candidates with formal public health training) was assessed by analyzing data on public health graduates. Supply and demand data were reconciled to identify potential gaps in the public health workforce., Results: At the state and local level, ≅197,000 staff are employed in health departments. This is down more than 50,000 from 2008. In total, ≥65,000 staff will leave their organizations during fiscal years 2016-2020, with ≤100,000 staff leaving if all planned retirements occur by 2020. During 2000-2015, more than 223,000 people received a formal public health degree at some level. More than 25,000 students will receive a public health degree at some level in each year through 2020., Conclusions: Demands for public health staff could possibly be met by the influx of graduates from schools and programs of public health. However, substantial implications exist for transferal of institutional knowledge and ability to recruit and retain the best staff to sufficiently meet demand., (Copyright © 2018 American Journal of Preventive Medicine. All rights reserved.)

Aim(s): To understand nurses' experiences of injustice in the workplace and to identify the impact of injustice on well-being., Background: Little is known about how nurses view injustice or its effects on their well-being, although research indicates that such perceptions are central to workplace practices such as performance management and outcomes such as employee well-being., Method(s): A qualitative study was conducted with semi-structured interviews for nurses employed in Australian public hospitals. Data were analysed using content analysis., Results: Experiences of injustice and unfairness negatively impacted on performance and the personal health of nurses. Unfair treatment was met with reduced effort and commitment., Conclusion(s): This study provides valuable insights into how nurses perceive and experience injustice at work and supports the link between injustice and nurses' decreased well-being and effectiveness., Implications for Nursing Management: Implications for nurse managers include the need for managers to engage in regular conversations regarding systemic barriers to performance and implementing performance management as an ongoing dialogue designed for employee voice and relationship management. This process also suggests a need for leadership development in nursing management. Using such steps and strategies would significantly enhance best practice in nursing management., (© 2018 John Wiley & Sons Ltd.)

Emeritus Professor Alan Glasper, University of Southampton, discusses a new initiative by Health Education England to address staffing challenges facing the health service.

Background and Purpose: This systematic review explores relationships between advanced practice registered nurses' (APRN) job satisfaction and intent to leave. There exists a dearth of APRN providers compared with the ever-growing need for their services. Furthermore, the organizational costs associated with the APRN turnover are extremely high. It, therefore, behooves practice administrators to understand what factors most contribute to APRN job satisfaction and retention., Methods: A search of research databases CINAHL, PubMed, and PsycINFO, using keywords "Advanced Practice Registered Nurse," "job satisfaction," "intent to leave," "anticipated turnover," and "Nurse Practitioner" to yield articles included in this review., Conclusions: The strength of existing evidence for this topic is weak. Studies have found that extrinsic factors, such as administrative support and salary, significantly contribute to job dissatisfaction, whereas intrinsic factors, such as autonomy and finding work meaningful, most significantly contribute to job satisfaction. Additional research is needed to better understand the factors relating to APRN job satisfaction and dissatisfaction, and how those factors influence practitioners' intent to leave., Implications for Practice: Efforts to improve APRN job satisfaction will have positive implications for provider retention, practices, and patients. Administrators should consider the job satisfaction factors identified herein when implementing practice improvement and retention efforts.

The challenges in deaf education illustrate the requirement and importance of leadership in this specialized field. The significant and impending talent depletion unfolding as baby-boomers retire, positions leadership succession planning as a strategic issue. This mixed methods study is the first of its kind in New Zealand. The aim is to understand leadership demographics and assumptions to determine the need for strategic succession planning to identify and address leaky pipelines. The findings from 82% of the deaf education workforce through a questionnaire and interviews with seven senior leaders reveal that senior leaders do not appear aware of four key areas that dissuade and shrink the pool of potential leadership aspirants. The four areas are prioritizing family; safeguarding health; concerns about bureaucracy, paperwork, and workload; and, a reluctance to move away from teaching. Aspirant identification appears informal, as there is no formal succession plan in place, which suggests a leadership crisis is imminent in New Zealand deaf education provision. Recommendations are provided that may help address this situation in New Zealand and other first-world nations if sufficient leaders are in place to deal with the challenges facing deaf education today and in the future., (© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The CGEAN Board established a goal to support MSN administration programs to thrive and meet the need for well-prepared nurses to assume leadership roles. This column addresses how we embarked on this work through creation of a Circle of Advisors composed of national nursing leaders who came together to address specific curricular issues and more importantly to voice support for continuation of MSN administration programs.

With the growing focus on continuous professional development, demands placed on nurses to uphold nursing competence have been increasing. This study examined how nurses with different lengths of clinical experience perceived the relationship between their actual competence and the competence they felt was demanded of them, and how this relationship was related to their turnover intentions. Survey questionnaires were distributed to 1,377 nurses, of whom 765 returned usable completed forms. The results showed that across all the groups of clinical experience, nurses perceived the demanded competence levels to be higher than their actual competence levels. However, turnover intentions were not related to nurses' perceptions of demanded competence and were negatively related to perceptions of actual competence. The levels of competence demanded should not be considered as threats for nurses. Improving nurses' competence may reduce their turnover intentions.

Aims: This study examined the relationship between the level of trust with immediate supervisor and the level of intent to stay at work among registered nurses (RNs) in Jordan and explored if there is a significant difference between RNs working in governmental- and university-affiliated teaching hospitals., Background: Financial retention strategies are not feasible in low- and middle-income countries. This study investigated if the level of trust that RNs hold toward their immediate supervisors could affect their intent to stay at work, so as to be used as a nonfinancial strategy., Methods: A descriptive correlational design was used to examine this relationship among a convenience sample of 260 hospital nurses in Jordan. Descriptive and inferential statistics were used to analyze the data., Results: When the level of trust increased, the level of intent to stay at work also increased. RNs working in governmental-affiliated teaching hospitals reported higher levels of trust and intent to stay at work than those working in university-affiliated teaching hospitals., Conclusion: The findings emphasized the positive effect of trust with immediate supervisor on the level of RNs' intent to stay., Implications for Nursing Management: Building trust between RNs and their immediate supervisors could be an important retention strategy., (© 2016 Wiley Periodicals, Inc.)

Aim: To inform countermeasures against nurses' workplace violence by reviewing the experience of violence., Background: Violence is an important issue in medical settings that influences turnover intention of nurses. However, few studies have dealt with the effects of violence experienced by nurses on professional quality of life and turnover intention., Method: A descriptive study using a structured questionnaire and data were analysed using t-test, one-way anova and hierarchical multiple regression analysis., Results: Of 358 nurses 95.5% reported that they had experienced workplace violence during the previous 1 year. Findings indicated that turnover intention was positively associated with years worked as a nurse, functional nursing delivery system, exposure types of violence with physical threats, and mild or severe burnout., Conclusions: Nurses experienced diverse workplace violence, which could decrease their professional quality of life and be a factor affecting their turnover intention., Implications for Nursing Management: Role of leadership in creating a positive work environment is needed. Prevention of workplace violence should focus on at-risk groups to reduce workplace violence. Workplace violence should be communicated regularly and feedback should be given if there is unintentional non-physical violence. In particular it is important to investigate post-violence management in nurses who have experienced violence to reduce secondary trauma., (© 2017 John Wiley & Sons Ltd.)

Background: Faculty retirement has been a growing concern for the nursing education community given the impact it may have on preparing the future nursing workforce., Purpose: To estimate faculty retirements in 2016-2015 and to assess the impact of retirements on the faculty workforce., Method: The Least-Squares Regression and the Cohort Component Methods were used to project retirements., Discussion: The study projected that total retirements in 2016-2025 would equal one third of faculty in 2015. Retirees are likely to come from current faculty aged 60 or older, and faculty aged 50-59 are likely to be their replacements. The impact of the retiring faculty on the faculty workforce will be huge given their overrepresentation in doctoral attainment, senior rank, and ability for graduate-level teaching., Conclusion: The findings suggest a sense of urgency for the nursing education community to address the impending exodus of senior faculty and to develop younger faculty for their successful succession., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The wave of retirements is beginning to hit nursing, taking a toll on our cadre of nursing leaders. Ongoing healthcare reform is adding to the stress burden and exerting an effect on nurse leader turnover. The next generation of leaders will likely come from our millennial nurses, who have different attitudes toward work than previous generations. The AONE assembled a panel of experts to create guidelines to assist nurse executives in recruiting the next generation of talent into formal leadership roles.

Background: Nursing managers have to meet expectations of patients despite economic pressures, an increasing burden of disease and nursing shortages. Shifting health care-related tasks to lower categories of staff, including non-nursing support staff, has become one solution to address this dilemma. Patient care workers are a specific group of non-nursing support staff working in South African hospitals. Although patient care workers have been used for several years and their numbers are increasing, there are controversial opinions about the role of patient care workers, ranging from praise for their contribution towards patient care to serious concerns about the impact of their role on patient safety., Objective: The study objective was to explore and describe the role of patient care workers in private hospitals., Methods: A qualitative, descriptive design was applied to explore the role of patient care workers. Purposive sampling was used to select unit managers, nurses and patient care workers from medical and surgical wards of three private hospitals. Fifteen semi-structured interviews were conducted and transcribed verbatim. The researcher applied interpretative data analysis to move from the participants' descriptions of their experiences to a synthesis of all participants' descriptions., Results: Patient care workers are involved in direct patient care and spend much time with patients, often not working under direct supervision of registered nurses despite limited training and lack of regulation. Their contribution, however, is valued by nurses., Conclusion: Patient care workers are well-integrated into the patient care team and are mostly seen as nurses. Yet, there are concerns about their evolving role despite their limited training and the lack of direct supervision. Regulating the work of patient care workers is recommended.

Aim: To investigate the views of senior nurse and human resource managers of strategies to retain hospital nurses in a metropolitan area., Background: Against a global shortage, retaining nurses is a management imperative for the quality of hospital services., Method: Semi-structured interviews, thematically analysed., Results: Metropolitan areas have many health organisations in geographical proximity, offering nurses choices in employer and employment. Senior nurse and human resource managers recognised the complexity of factors influencing nurse turnover, including those that 'pulled' nurses out of their jobs to other posts and factors that 'pushed' nurses to leave. Four themes emerged in retaining nurses: strategy and leadership, including analysis of workforce and leavers' data, remuneration, the type of nursing work and career development and the immediate work environment., Conclusions: In contexts where multiple organisations compete for nurses, addressing retention through strategic leadership is likely to be important in paying due attention and apportioning resources to effective strategies., Implications for Nursing Management: Aside from good human resource management practices for all, strategies tailored to different segments of the nursing workforce are likely to be important. This metropolitan study suggests attention should be paid to strategies that address remuneration, progressing nursing careers and the immediate work environment., (© 2016 The Authors Journal of Nursing Management Published by John Wiley & Sons Ltd.)

Aims: To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013., Background: Positive nurse practice environments have been linked to nurse retention and care quality outcomes., Methods: The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared., Results: On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period., Conclusions: The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline., Implication for Nursing Management: Managers need to apply existing evidence to improve nurse practice environments and manage instability., (© 2016 John Wiley & Sons Ltd.)