Nurse Working Conditions, Organizational Climate, and Intent to Leave in ICUs: An Instrumental Variable Approach

Abstract

Objective. To investigate causes of nurse intention to leave (ITL) while simultaneously considering organizational climate (OC) in intensive care units (ICUs) and identify policy implications. Data Sources/Study Setting. Data were obtained from multiple sources including nurse surveys, hospital administrative data, public use, and Medicare files. Survey responses were analyzed from 837 nurses employed in 39 adult ICUs from 23 hospitals located in 20 separate metropolitan statistical areas. Study Design. We used an instrumental variable technique to assess simultaneously the relationship between OC and ITL. We estimated ordinary least squares and reduced form regressions to determine the extent of simultaneity bias as well as the sensitivity of our results to the instrumental variable model specification. Principal Findings. Fifteen percent of the nurses indicated their ITL in the coming year. Based on the structural model, we found that nurses' ITL contributed little if anything directly to OC, but that OC and the tightness of the labor market had significant roles in determining ITL ( p values o.05). Furthermore, OC was affected by the average regionally adjusted ICU wages, hospital profitability, teaching, and Magnet status ( p values o.05). Conclusions. OC is an important determinant of ITL among ICU nurses. Because higher wages do not reduce ITL, increased pay alone without attention to OC is likely insufficient to reduce nurse turnover. Implementing interventions aimed at creating a positive OC, as found in Magnet hospitals, may be a more effective strategy.

<em>Mindfulness in Motion</em> (MIM): An Onsite Mindfulness Based Intervention (MBI) for Chronically High Stress Work Environments to Increase Resiliency and Work Engagement

“…Although individuals who initiate their own personal stress reduction strategies may be able to lessen their individual experience of stress 17 , systematic organization approaches are more effective. Workplace interventions can positively impact symptoms of stress (high blood pressure is one example) and demonstrate changes in psychological symptoms of stress 35 , and simply introducing stress reduction programming may shift the organizational climate, which has been shown to be an important factor for ICU nurses' intention to retain or leave their job 36 .…”

Job Embeddedness and Organizational Climate

“…Empirical evidence had shown a significant relationship between organizational climate and job satisfaction (Schyns, Veldhoven& Wood, 2009), employee retention (Gentry, Kuhnert, Mandore& Page, 2007), and employee's intention to leave (Stone, Mooney-Kane, Larson, Pastor, Zwanziger& Dick, 2007). These researchers have successfully found evidence that organizational climate experienced by the employees can have the powerful influence on employee's behavior.…”

Making the Move: From Bedside to Camera-Side

“…However, unless interested in a formal management or education role, or in returning to academia to attain an advanced degree, many nurses are left with little choice but to consider leaving the bedside for further opportunities. Intention to leave often precedes actual nursing turnover 27 ; nursing turnover rates are reported to range from 15% to 36% 28 per year with the loss of experience increasingly difficult to replace. 6 The tele-ICU provides a new role that leverages the ICU nurse's expert knowledge and skills while dramatically reducing the physical and emotional demands of bedside care.…”