Intention to leave and associated factors among psychiatric nurses in China: A nationwide cross-sectional study

https://doi.org/10.1016/j.ijnurstu.2019.03.013Get rights and content

Abstract

Background

The retention of psychiatric nurses is an important concern for healthcare administrators in China. However, Chinese psychiatric nurses’ intention to leave their jobs and the factors associated with it have been scarcely studied.

Objective

To investigate Chinese psychiatric nurses’ intention to leave their jobs, and to explore the associations between the intention to leave and individual characteristics, job-related factors and job satisfaction.

Design

A cross-sectional, anonymous survey of a nationwide sample was conducted.

Settings

Thirty-two tertiary psychiatric hospitals in 29 provincial capital cities in China.

Participants

All 9907 nurses in 32 hospitals were targeted for this survey conducted in December 2017; 8493 responded (response rate = 85.7%), and 7933 (without logic errors in the data) were included in the analysis.

Methods

A questionnaire was used to investigate the respondent’s intention to leave their job and to collect data on related factors, including individual characteristics (gender, age, marital status, educational background and self-rated health), job-related factors (professional title, working years, income, work hours, history of patient-initiated violence, perceived respect from patients, social recognition as well as physician-nurse coordination and trust) and job satisfaction. The short version of the Minnesota Satisfaction Questionnaire was used to assess job satisfaction. Chi-square tests and multilevel logistic regression analysis were used to examine associations between an intention to leave and other factors.

Results

Among 7933 respondents, 20.2% reported an intention to leave their current jobs. The multiple regression analysis showed that better self-rated health (i.e. OR = 0.373, 95%CI = 0.308-0.452 for good health, reference: poor health), working more than 20 years (OR = 0.479, 95%CI = 0.389-0.590, reference: 20 years or less), higher monthly income (i.e. OR = 0.521, 95%CI = 0.399-0.680 for 6001–8000 RMBs, reference: 4500 RMB or less), perceived patient respect (OR = 0.727, 95%CI = 0.623-0.849), physician-nurse coordination (OR = 0.549, 95%CI = 0.480-0.629) and being satisfied with one’s job (OR = 0.373, 95%CI = 0.308-0.452) were negatively associated with an intention to leave; while those who were male (OR = 1.879, 95%CI = 1.605–2.199), working more than 40 hours per week (OR = 1.584, 95%CI = 1.374–1.825) and experienced patient-initiated violence in the past 12 months (OR = 1.566, 95%CI = 1.376–1.781) had a higher odds of reporting an intention to leave.

Conclusions

Self-rated health, monthly income, work hours, patient-initiated violence, perceived patient respect, physician-nurse coordination and job satisfaction are significant factors associated with a nurse’s intention to quit their job. In order to retain nurses in Chinese tertiary psychiatric hospitals, the government and hospital administrators should consider ways to address these factors.

Section snippets

What is already known about the topic?

  • Turnover and shortage of psychiatric nurses may lead to a low quality of healthcare and adverse patient outcomes.

  • Psychiatric nurses’ intention to leave is associated with several individual characteristics and job-related factors, some of which are modifiable.

  • China faces a shortage of psychiatric nurses, and studies examining Chinese psychiatric nurses’ intention to leave are needed to guide policy change and resource allocation.

What this paper adds

  • The proportion of Chinese psychiatric nurses who intend to leave their current job is relatively high.

  • Better self-rated health, perceived respect from patients, physician-nurse coordination and job satisfaction are significantly associated with a lower likelihood of intending to leave one’s job.

  • One-third of Chinese psychiatric nurses have experienced patient-initiated violence in the past 12 months, and they have a greater likelihood of intending to leave compared with their counterparts who

Design, setting and participants

This study was part of a national cross-sectional survey conducted in December 2017 with the purpose of evaluating the performance of tertiary hospitals to ultimately improve healthcare quality and satisfaction. This survey included basic information about the participating hospitals (e.g. number of beds, nurses and discharges) and investigations among their staff and their patients. In psychiatric settings, the China’s Ministry of Health purposefully sampled 32 tertiary psychiatric hospital in

Descriptive analysis of hospitals and participants

The basic data of 32 tertiary psychiatric hospitals are shown in Table 1. The number of beds within these hospitals ranged from 169 to 2134 with a median of 810. The number of discharges in the past 12 months ranged from 859 to 33,472 with a median of 6094. The average length of stay for each discharge was 49.5 days. The number of nurses, the number of nurses per 100 occupied beds, and the nurse-physician ratio also varied, with medians of 303 (inter-quartile range (IQR) = 161), 0.10

Discussion

Using a large, nationwide sample of nurses from 32 tertiary psychiatric hospitals in China, this study examined nurses’ intention to leave their job and explored factors associated with that choice. In addition, this study provided a profile of the respondents using descriptive analysis. One strength of this study was that we not only focused on nursing staff in specialty psychiatric hospitals but also integrated several individual characteristics and job-related factors in models focused on a

Conclusions

This cross-sectional study demonstrated that gender, personal health, income, workload, items related to nurse-patient and nurse-physician relationships as well as job satisfaction were significantly associated with an intention to leave among psychiatric nurses in China. Given that psychiatric nurses in China are playing a very important role in providing psychiatric care in China and that they are already in short supply, we suggest that the government and hospital administrators pay

Funding

This research was supported by the Beijing Medical and Health Foundation, which did not play a role in the conduct of the research.

Conflict of interests

None declared.

Acknowledgements

The authors thank the Beijing Medical and Health Foundation who funded this research, and we also appreciate the efforts of the hospital administers who facilitated the survey.

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