care workers: a prospective study.
AbstractThe aim of this study was to analyze the impact of the ERI model on intent to leave the current organisation (ITL organisation) and intent to leave the nursing profession (ITL profession) in a prospective way. A total of 1531 health care workers who remained in their job filled in a self-administered questionnaire at baseline and one year later. ERI was measured at baseline by a 23-item questionnaire. Multivariate logistic regression analyses were performed. Within a population with low intent to leave at baseline, we found that an imbalance between high efforts and low rewards (extrinsic hypothesis) increased the risk of high ITL organisation (OR 4.98; 95% CI 2.07-11.97) and high ITL profession (OR 1.84; 95% CI 1.03-3.30), one year later. A high level of overcommitment (intrinsic hypothesis) was not predictive for both intent to leave outcome variables, neither was the interaction between high efforts/low rewards and a high level of overcommitment (interaction hypothesis). Our results showed that an effort-reward imbalance is a significant predictor of intent to leave among health care workers. This contribution concludes with some directions aimed at boosting nurses' retention and recommendations for future research.
2
IntroductionIn the last decades, the demand for nurses has continued to increase due to a growing ageing population, an increased consumer behaviour in combination with higher patient expectations, and the rapid evolution of medical technologies (Coomber & Barriball, 2007;Simoens, Villeneuve, and Hurst, 2005). At the same time, fewer young people are entering the nursing profession which may be the result of the low social value given to nursing and the negative perceptions of nurse working conditions (Kivimaki, Vahtera, Elovainio, Virtanen, and Siegrist, 2007;Simoens et al., 2005;Stordeur et al., 2003). Moreover, health care settings are facing high turnover of nursing staff and problems in recruiting new employees (Kivimaki et al., 2007;Stordeur et al., 2003;Stordeur & D'Hoore, 2007). Organisational and professional turnover, like absence from work are, examples of work-related withdrawal behaviour (Krausz, Koslowsky, Shalom, and Elyakim, 1995). High turnover is a major problem for nursing and for health care in general. Beside substantial financial costs, turnover causes negative patient and nurse outcomes (e.g. increased waiting times, decreased patient and nurse satisfaction, adverse nurse health) (Aiken, Clarke, Sloane, Sochalski, and Silber, 2002; Hayes et al., 2006; Kivimaki et al., 2007; O'Brien-Pallas et al., 2006).Understanding why health care workers abandon their current employer and/or their job in the nursing profession is essential, in order to retain them and to prevent turnover behaviour.One of the most important and strongest predictors of actual nurse turnover was found to be intention to leave (Borda & Norman, 1997; Hayes et al., 2006; O'Brien-Pallas et al., 2006;Stordeur et al., 2007; Widerszal-Bazyl, Radkiewicz, Hasselhorn, ...