Doran Diane, Duffield Christine, Rizk Paul, Nahm Sang, Chu Charlene H
Author Affiliations: Professor Emerita (Dr Doran), Research Officer (Mr Rizk and Dr Nahm), and PhD Student and Research Assistant (Ms Chu), Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada; and Professor of Nursing and Health Services Management and Director of the Centre for Health Services Management (Dr Duffield), Faculty of Health, University of Technology Sydney, New South Wales, Australia.
Clin Nurse Spec. 2014 Mar-Apr;28(2):105-14. doi: 10.1097/NUR.0000000000000031.
PURPOSE/OBJECTIVES: The purpose was to describe the number, demographic characteristics, work patterns, exit rates, and work perceptions of nurses in Ontario, Canada, in 4 specialty classifications: advanced practice nurse (APN)-clinical nurse specialist (CNS), APN-other, primary healthcare nurse practitioner [RN(extended class [EC])], and registered nurse (RN) with specialty certification. The objectives were to (1) describe how many qualified nurses are available by specialty class; (2) create a demographic profile of specialist nurses; (3) determine the proportions of specialist and nonspecialist nurses who leave (a) direct patient care and (b) nursing practice annually; (4) determine whether specialist and nonspecialist nurses differ in their self-ratings of work environment, job satisfaction, and intention to remain in nursing. Employment patterns refer to nurses' employment status (eg, full-time, part-time, casual), work duration (ie, length of employment in nurses and in current role), and work transitions (ie, movement in and out of the nursing workforce, and movement out of current role).
A longitudinal analysis of the Ontario nurses' registration database from 2005 to 2010 and a survey of specialist nurses in Canada was conducted.
The setting was Canada.
The database sample consisted of 3 specialist groups, consisting of RN(EC), CNS, and APN-other, as well as 1 nonspecialist RN staff nurse group. The survey sample involved 359 nurses who were classified into groups based on self-reported job title and RN specialty-certification status.
Data sources included College of Nurses of Ontario registration database and survey data. The study measures were the Nursing Work Index, a 4-item measure of job satisfaction, and 1-item measure of intent to leave current job. Nurses registered with the College of Nurses of Ontario were tracked over the study period to identify changes in their employment status with comparisons made between nurses employed in specialist roles and those registered as general staff nurses. Analysis involved descriptive summaries, mean comparisons with independent-samples t test, and χ(2) tests for categorical data.
Exit rates from direct practice were highest for APN-other (7.6%) and CNS (6.2%) and lowest for RN(EC) (1.0%) and staff nurses (1.2%). χ(2) Tests indicated yearly exit rates of both APN-other and CNS nurse groups were significantly higher than those of staff nurses in all years evaluated (α = .025). Every specialist employment group scored significantly higher than staff nurses on measures of work environment and satisfaction outcomes.
We provided a description of specialist nurses in Ontario and examined the relationship between specialization and employment patterns of nurses to inform nurse retention strategies in the future. Employment in specialist nursing positions is significantly associated with differences in transitions or exits from nursing among the specialist and nonspecialist groups. Registered nurses (EC) displayed improved retention characteristics compared with staff nurses. Advanced practice nurse-other and APN-CNS exit rates from nursing practice in Ontario were comparable to staff nurses, but exit rates from direct clinical practice roles were higher than those of staff nurses.
Targeted strategies are required to retain CNS and APN-other in direct clinical practice roles.
目的/目标：目的是描述加拿大安大略省4种专业分类护士的数量、人口统计学特征、工作模式、离职率及工作认知：高级实践护士（APN）-临床护理专家（CNS）、APN-其他、初级保健执业护士[注册护士（扩展类别[EC]）]以及具有专业认证的注册护士（RN）。目标是：（1）按专业类别描述有多少合格护士；（2）创建专科护士的人口统计学概况；（3）确定每年离开（a）直接患者护理岗位和（b）护理工作的专科和非专科护士比例；（4）确定专科和非专科护士在工作环境自评、工作满意度及留职意愿方面是否存在差异。就业模式指护士的就业状态（如全职、兼职、临时）、工作时长（即在护士岗位及当前职位的工作年限）以及工作转换情况（即进出护理行业，以及离开当前职位）。
对2005年至2010年安大略省护士注册数据库进行纵向分析，并对加拿大专科护士进行调查。
背景为加拿大。
数据库样本包括3个专科组，即注册护士（EC）、临床护理专家和APN-其他，以及1个非专科注册护士普通护士组。调查样本包括359名护士，根据自我报告的职位和注册护士专业认证状态进行分组。
数据来源包括安大略省护士学院注册数据库和调查数据。研究指标包括护理工作指数、一项4项工作满意度指标以及一项离职意愿指标。在研究期间对在安大略省护士学院注册的护士进行跟踪，以确定其就业状态的变化，并对担任专科职位的护士和注册为普通护士的人员进行比较。分析包括描述性总结、独立样本t检验的均值比较以及分类数据的χ²检验。
APN-其他（7.6%）和临床护理专家（6.2%）直接实践的离职率最高，注册护士（EC）（1.0%）和普通护士（1.2%）最低。χ²检验表明，在所有评估年份中，APN-其他和临床护理专家护士组的年离职率均显著高于普通护士（α = 0.025）。在工作环境和满意度指标方面，每个专科就业组的得分均显著高于普通护士。
我们描述了安大略省的专科护士情况，并研究了护士专业化与就业模式之间的关系，为未来的护士留用策略提供参考。专科护理岗位的就业与专科和非专科群体在护理行业的转换或离职差异显著相关。与普通护士相比，注册护士（EC）表现出更好的留用特征。安大略省高级实践护士-其他和APN-临床护理专家从护理实践中的离职率与普通护士相当，但直接临床实践岗位的离职率高于普通护士。
需要制定针对性策略，以留住临床护理专家和APN-其他在直接临床实践岗位。
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