Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan; Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Egypt.
Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
Int J Nurs Stud. 2018 Apr;80:118-127. doi: 10.1016/j.ijnurstu.2018.01.008. Epub 2018 Feb 3.
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.
To identify the factors associated with long-term care nurses' intention to stay in their current workplace.
A cross-sectional questionnaire survey.
Two hundred and fifty-seven hospitals with long-term care wards across Japan.
A total of 3128 staff nurses and 257 nurse managers from the long-term care wards of the participating hospitals.
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.
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.
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.
维持长期护理护士的就业是维持当前和未来高质量长期护理服务需求的必要条件。由于长期护理环境中研究的稀缺性、对多种因素的调查不足以及现有解释模型的薄弱性，对与长期护理护士留任意愿相关的因素的理解受到限制。
确定与长期护理护士留在当前工作场所意愿相关的因素。
横断面问卷调查。
日本 257 家设有长期护理病房的医院。
来自参与医院长期护理病房的 3128 名一线护士和 257 名护士长。
问卷评估了护士继续在当前工作场所工作的意愿以及潜在的相关因素，包括个人因素（人口统计学数据、选择当前工作场所的原因、倦怠、工作投入、躯体症状负担）和单位因素（单位规模、护士长相关数据、患者医疗严重程度、平均加班时间、娱乐活动、社会支持、护理过程质量感知、教育机会、孤独感和请假能力）。采用多水平逻辑回归分析确定哪些变量能最好地解释护士留在工作场所的意愿。
只有 40.1%的受访者表示希望继续在当前工作场所工作。回归分析显示，长期护理护士的留任意愿与护士的年龄（优势比[95%置信区间]：1.02[1.01-1.03]）、工作投入（1.24[1.14-1.35]）、从护士长那里获得适当的支持（2.78[1.60-4.82]）、感知的护理过程质量（1.04[1.01-1.06]）、教育机会（1.06[1.0-1.13]）和选择工作场所的各种具体原因（例如，良好的工作氛围、对老年护理的兴趣和较高的工资）呈正相关。相比之下，留任意愿与情绪衰竭（0.93[0.91-0.95]）和去人格化（0.91[0.89-0.93]）呈负相关。护士的资格和患者的医疗严重程度与留任意愿无关。
选择工作场所的原因、工作投入、获得护士长的支持以及对护理质量的感知是长期护理护士留任意愿的重要预测因素。促进护士的工作投入、提供高质量的护理和获得教育机会可能会增加长期护理护士的留任意愿。
