Nursing Management, Год журнала: 2025, Номер 56(1), С. 24 - 30

Опубликована: Янв. 1, 2025

FigureThe COVID-19 pandemic has had a devastating effect on the nursing workforce. Although research conducted during last 2 to 3 decades clearly quantified that factors such as an unsupportive practice environment and high patient-to-nurse ratios were associated with nurses' intentions leave, exodus of nurses was unprecedented. According study published in Health Affairs, national supply RNs decreased by 100,000 1 year height pandemic.1 New data show that, reality, these same nurses, rather than leaving profession, shifted different employers.2 Another report said US hospitals experienced 23% total turnover rate 2022 among their RN employees.3 The authors concluded rates have taken financial toll hospital budgets, recruitment costs for one averaging $52,000, resulting per approximately $6.6 million $10.5 year. A unique phenomenon potentially influencing intent leave context is posttraumatic stress disorder (PTSD). systematic review meta-analysis pandemic-related PTSD frontline revealed widespread PTSD, urging both organizational-level change psychological interventions enable recovery.4 protective factor may mitigate supportive work environment. In more 21,000 physicians working at 60 Magnet® throughout pandemic, 63% reported chaotic environments.5 Hospital organizational features, environment, are postulated affect nurse job outcomes, positively negatively.6 includes greater autonomy, increased control, availability resources, improved nurse-physician relationships better patient outcomes alike. Conversely, makes vulnerable negative outcomes. Rather relying solely wellness resilience programming improve mental health addressing achieve systemwide improvement takes onus off manage own workplace health.5,7,8 purpose this article determine whether presence symptoms decreases odds era. METHODS cross-sectional survey using list all active licenses issued Jersey Division Consumer who home address email so could contact them electronically. Rutgers University Institutional Review Board reviewed granted expedited approval. About 79% licensed addresses supplied email. invitation sent from first author's university embedded letterhead 100,463 met criteria. used modified Tailored Design Method methodology outlined Dillman, which entails specific components letter sending three follow-up invitations.9 included electronic link Qualtrics prefaced informed consent. presented additional inclusion criteria, acute care being currently employed care. There no way calculate response criteria because denominator available Overall, 1,817 opened invitation. Of those, 1,049 recipients passed consent screening questions. total, 824 answered key items: within next 12 months, impact symptoms, conditions. This subset considered analytic sample, responses subjected analyses. Intent nurse's declaration intention current operationalized single item, as, "Do you intend your months? (Yes/No)."10,11 Impact event theoretically defined appraisal individual's distress regarding significant life experience.12 recent study, Event Scale (IES-6) validated independently tool PTSD.13,14 Cronbach alpha .80 demonstrated reliability, or internal consistency, IES-6.15 Criterion validity evident correlation IES-6 original IES-R, subscale correlations ranging .78 .94.15 Respondents asked each item past 7 days, respect years. An example is, "I aware I still lot feelings about it, but didn't deal them." five Likert-type ranged 0 (not all) 4 (extremely). Based recommended scoring, mean score computed IES-6, hypothetical range 4. Mean scores impact-of-event measure routinely dichotomized tested cut points.13,14,16 Dichotomization COVID score, established point 1.75 when reflects average answer "moderately."13,14 Work environment/working conditions conditions, set attributes support professional, clinical practice, including decentralized authority, managers, interdisciplinary collaboration, open effective communication methods, sufficient continuity.17 took measurement approach Aiken colleagues simplified operationally question: "How would hospital? (Excellent, Good, Fair, Poor)."18,19 Demographic control variables Nurse demographic characteristics gender, marital status, race, ethnicity, educational title, unit, employment shift, years role, age. staffing variable, given its theoretical relevance. To evaluate unit type staffing, we ran sensitivity model found insignificant. measured number patients cared shift worked.20,21 Data analysis sample described means, standard deviations, percentage distributions. Bivariate tests explore associations between characteristics, chi-square nominal variables. Only demographics subsequent regression models. Cross-tabulations examine bivariate associations. extent missing be minimal (for example, less 5%) except ratio, 6.7%. 55 values, another 20 due exceeding nurse. Logistic analyze independent (PTSD symptoms), dependent leave. Four models estimated multivariate logistic regression. Model simple (unadjusted) model. controlled marriage- job-related added ratio. Nurses values multiple excluded assure convergence. Statistics Stata 17 software.22 RESULTS As Table 1, majority female (88%), married (61%), diverse (72% White 28% non-White), non-Hispanic (92%), held bachelor's degree (52%), age 47.3 (SD 12.2). 78% title direct nursing, 27% worked medical-surgical full-time, 72% 12-hour 43% equal 5 experience role. 4.9 3.1). TABLE 1: - participants (N = 824) Characteristics % Gender (n 819) Male 10.1 Female 88.4 Other 1.5 Marital status 815) Nonmarried 39.4 Married 60.6 Race 813) Non-White 27.9 72.1 Ethnicity Non-Hispanic 92.1 Hispanic 7.9 Educational 817) Associate 12.6 Bachelor's 52.2 Graduate 36.2 Job 820) Clinical 77.6 Nursing management 10.7 Advanced 4.8 7.0 Unit 818) Outpatient 18.3 Critical 20.3 Medical-surgical 27.0 Labor delivery/postpartum women's 8.6 25.8 Employment Less full-time 21.5 Full-time 77.7 0.9 Shift 8 hours 11.1 71.6 17.3 Years role 42.7 Between 6 35.4 Greater 21.9 Age SD 12.2 Note: Total percentages variable not 100% rounding. Chi-square significance determined statistically significantly (χ2(1) 11.3, P .001), (χ2(4) 11.1, .025), length (χ2(2) 6.3, .044), 19.5, < .001) (see 2). Thus, only estimating variable. 2: categorical Independent No Yes χ2 4.4 .112 68.7 31.3 57.2 42.8 11.3 .001 51.1 48.9 63.0 37.0 3.0 .084 53.7 46.3 58.6 41.4 811) 2.1 .147 59.3 40.7 50.0 1.6 .441 58.3 41.8 60.5 39.5 55.7 44.3 6.8 .079 56.5 43.6 61.4 38.6 60.0 41.0 73.7 26.3 .025 57.3 54.8 45.2 52.0 48.0 64.3 35.7 66.3 33.7 1.1 .563 60.8 39.2 58.0 42.0 57.1 6.3 .044 65.9 34.1 64.8 35.2 19.5 49.6 50.4 64.7 35.3 65.4 34.6 Half (50%) study's exceeded cut-point, indicating positive symptoms. 0.50 0.50). 42% intended job. Most viewed fair poor (58%). association symptom 43.1, 3). 286 nonthreshold 60% jobs. Among 219 did threshold-level Moreover, test 75.3, .001). 260 rated jobs good/excellent, 75% contrast, 263 poor/fair, 55% 3: Cross-tabulation 69.4 30.6 Yes, 46.8 53.2 Poor/fair 45.4 54.6 Good/excellent 75.6 24.4 Multivariate analyses marriage upon 4). symptoms) job, χ2(1) 43.6, .001. 2.6 times intending compared without (OR 2.58, 95% CI 1.94, 3.43, (Model 1). Models 2, 3, covariates, characteristics. χ2(12) When controlling 2.56, 1.90, 3.44, 4: Effects ratio 818)∗ Unadjusted Adjusted LL UL Predictor (Ref. 2.58 1.94 3.43 2.56 1.90 3.44 2.19 1.61 2.98 2.11 1.55 2.88 Good/excellent) 3.34 2.41 4.61 3.23 2.33 4.47 Patient-to-nurse 1.07 1.01 1.13 following type, length, time Subsequently, χ2(13) 131.8, 2.2 2.19, 1.61, 2.98, environments 3.3 those good excellent 3.34, 2.41, 4.61, Combining effects having poor/fair 7.30, 4.76, 11.20, covariates. significant, χ2(15) 136.9, 4, 2.11, 1.55, 2.88, almost likely 3.23, 2.33, 4.47, For every increase 7% 1.07, 95%, 1.01, 1.13, .03). Within (P .025). also .004). addition, covariate .016, .041 .044, respectively), .003, .001, respectively). Being reduces 31% 0.689, 0.509, 0.934) and, experience, reduced 40% 0.596, 0.426, 0.834). DISCUSSION We motivated pandemic. combined plus Our intrapandemic small hypothesized. improving complementary strategy addition offering healthcare services months. findings line comparable era studies intent-to-leave 36%, 44%, 22%.2,23,24 our 50%. Prior onset 8% 21% nurses.25 US, 33%, ICU 22.2%.24,26 pooled 25 COVID-era 0.4% 37.4%.4 However, state highest death any nation, might possibly account higher 50% study.27 Furthermore, 53% Fifty-eight percent (58%) keeping 2021 cites stressful West (68.6%) Southeast (59.5%).28 staff collegial physicians.29 seminal literature corroborate modifiable components, reducing increasing personal over environment.2 Hence, quantifiable decreasing experiencing patient-ratio variable's significant. workload patients. 4:1 along other factors, thought assist retention outcomes.30 Cross-sectional design prevents determination causal relationships. Response bias always potential. potential participate been different. respondents, there 20,000 practicing hospitals.31,32 Perhaps suffering complete therefore, results representative respond, don't know if respondents hospitals. Additionally, little known left workforce prior survey. captured located Jersey, fraction nation. Replicating level yield valuable information retaining IMPLICATIONS FOR NURSE LEADERS substitute nurse, leaders able tangibly reduce Practice Environment Index (PES-NWI) offers dimensions, provide framework improvement.17 Leaders can compare benchmark then focus domain poorest scores. designed implemented, manager development collaboration. IMPACT ON INTENT TO LEAVE Important include small, suggests environments, threshold scores, Without changes programs policy, will most result new wave costly resignations.

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