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AimThis paper reports a theoretical understanding of nurses leaving nursing practice by exploring the processes of decision-making by registered nurses in China on exiting clinical care.Background
The loss of nurses through their voluntarily leaving nursing practice has not attracted much attention in China. There is a lack of an effective way to u...
Context in source publication
Context 1
... report presents the findings according to the concep- tualized categories and their subcategories that emerged from the data analysis (Table 1, Figure 1), which offer suggestions about what to look for based on reality as it exists. The core category 'Mismatched Expectations: Indi- vidual vs. Organizational' emerged from the following three subcategories. ...
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methods and the results of foreign research studies have...
Citations
... However, certain limitations were identified during the assessment of specific elements. Hung and Lam (2020) and Zhu, Rodgers, and Melia (2014) scored lower in the recruitment strategies. King and McInerney (2006), Lögde et al. (2018), Chachula, Myrick, and Yonge (2015), Çamveren, Arslan Yürümezoğlu, and Kocaman (2020) and Zhu, Rodgers, and Melia (2014) were lacking in adequately considering the relationship between researchers and participants. ...
... Hung and Lam (2020) and Zhu, Rodgers, and Melia (2014) scored lower in the recruitment strategies. King and McInerney (2006), Lögde et al. (2018), Chachula, Myrick, and Yonge (2015), Çamveren, Arslan Yürümezoğlu, and Kocaman (2020) and Zhu, Rodgers, and Melia (2014) were lacking in adequately considering the relationship between researchers and participants. MacKusick and Minick (2010) and Zhu, Rodgers, and Melia (2014) scored low in exposing data collection methods. ...
... King and McInerney (2006), Lögde et al. (2018), Chachula, Myrick, and Yonge (2015), Çamveren, Arslan Yürümezoğlu, and Kocaman (2020) and Zhu, Rodgers, and Melia (2014) were lacking in adequately considering the relationship between researchers and participants. MacKusick and Minick (2010) and Zhu, Rodgers, and Melia (2014) scored low in exposing data collection methods. Although all studies generally had clear statements of research aims, findings and value of the research, there were variations in the rigour of data analysis techniques used. ...
Aim
The aim of this study is to explore the experiences of nurses who resigned from healthcare organisations or abandoned the profession and explore the reasons behind them.
Design
A systematic review of qualitative studies and meta‐summary.
Data Sources
Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase (Ovid), MEDLINE (Ovid), Social Science Citation Index (Web of Science), and Scopus.
Methods
The search was conducted up to May 2024. Primary qualitative studies focused on nurses who had resigned or left the profession were included. The meta‐summary was conducted using method: findings were extracted from the reports, edited, grouped, abstracted into key meta‐findings, and finally, their frequency effect sizes were calculated.
Results
A total of 282 findings were extracted from 12 studies, generating 49 statements of findings that were aggregated into nine key meta‐findings. Poor management practices presented a frequency effect size of 100%. Other key meta‐findings included excessive workload, teamwork hurdles, health issues related to work shifts and difficulty in maintaining work‐life balance, a lack of career growth opportunities and promotion chances, disillusionment with nursing, dissatisfaction due to salary, bullying and horizontal violence, and moral distress over ethical dilemmas.
Conclusion
The findings can help support the development of targeted strategies and the implementation of effective policies aimed at reducing nursing turnover.
Impact and Implications for the Profession
The major impact of these findings is the recognition of rising factors that negatively affect nurses' quality of life, including workload pressures and poor management strategies, which significantly lower job satisfaction. To address these challenges, the profession should prioritise tools that value nurses in their roles, implement strategies to manage workloads more effectively and advocate for policies promoting flexible scheduling. Additionally, investing in professional development and fostering a supportive work environment can help retain skilled nurses and nurture the growth of new talent.
Reporting Method
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA).
Patient or Public Contribution
No patient or public contribution.
... So far, studies that profoundly explore the complex decision-making process and circumstances underlying the turnover of health care workers are limited [7,9,15]. The qualitative studies that explored reasons for profession turnover among former nurses reported these to include a high workload, poor interpersonal relations with supervisors and colleagues, limited career opportunities, as well as the associated poor mental health [5,[17][18][19][20]. These studies, however, focused on former novice nurses or very young nurses [5,17], were restricted to inpatient care settings [18][19][20] and were carried out before the COVID-19 pandemic. ...
... The qualitative studies that explored reasons for profession turnover among former nurses reported these to include a high workload, poor interpersonal relations with supervisors and colleagues, limited career opportunities, as well as the associated poor mental health [5,[17][18][19][20]. These studies, however, focused on former novice nurses or very young nurses [5,17], were restricted to inpatient care settings [18][19][20] and were carried out before the COVID-19 pandemic. The COVID-19 pandemic had major impacts on the working life of health care professionals [21,22]. ...
... By contrast, the decision process for those reporting changes in priorities was characterized as easy and fast [35]. As part of the decision process former nurses who obtained a university/college degree often reported a discrepancy between the nursing taught in class and how it is in practice after entering the profession [5,17,20]. This experienced discrepancy right after entering the profession was not mentioned by the participating former MA. ...
Background
Worldwide growing shortages among health care staff are observed. This also holds true for medical assistants in Germany. Medical assistants mainly work in outpatient care and are the first point of contact for patients while performing clinical and administrative tasks. We sought to explore profession turnover among medical assistants, that is, in terms of the underlying decision-making process, the reasons for leaving the medical assistant profession and potential retention measures from the perspective of former medical assistants.
Methods
For this qualitative study, we conducted semi-structured telephone interviews with 20 former medical assistants between August and November 2023. Eligible for participation were medical assistants who (i) were of legal age, (ii) completed medical assistant vocational training and ii) were formerly employed as a medical assistant, but currently employed in another profession. The interviews were recorded, transcribed verbatim and content-analyzed.
Results
Former medical assistants expressed various, often interrelated reasons for leaving the profession. These were changes in priorities throughout their career (e.g., in terms of working hours and salary), a constant high workload, barriers to further training, poor career prospects, and poor interpersonal relationships particularly with supervisors, but also within the team and with patients as well as the perception of insufficient recognition by politics and society. Suggestions of former medical assistants to motivate medical assistants to stay in their profession included amongst others higher salaries, more flexible work structures, improved career prospects, and more recognition from supervisors, patients, and society.
Conclusion
Our study provides insights into the complex decision-making process underlying ultimate medical assistant profession turnover. In light of an already existing shortage of medical assistants, we suggest to further explore how the suggested interventions that aim at retention of working medical assistants can be implemented.
... In the Philippines, nurses often contend with higher nurse-to-patient ratios, typically ranging from 1:20 and potentially escalating to 1:50 (Alibudbud, 2023). In China, the calculation of nurse-to-patient ratios follows a distinct system; hospitals frequently witness a surplus of doctors in comparison to nurses, and there is a prevalent practice of privately hiring individuals lacking formal nursing training to provide patient care (Zhu, 2012;Zhu et al.,2015). In contrast to Canada's nursing practice, nurses often perceive nursing positions in the United States as being better equipped, with patient care characterized by greater integration of technological innovations and advancements in medical science and pharmaceuticals (Berg, 2022). ...
Background: The World Health Organization estimated there is a shortage of 5.9 million nurses around the world. The United States (U.S.) alone predicted a shortage of almost one million nurses by 2030, which is exacerbated by the COVID-19 pandemic. It is not surprising that healthcare institutions recruit nurses from other countries to fill in for their nursing shortage. Recruiting internationally educated nurses (IENs) is not a new strategy since the U.S. has continuously used this strategy to fill since the Second World War. The concept of transition to practice among IENs is important because of the differences in nursing education and practices between the U.S. and other countries. These differences in nursing education and practice across the world make it more imperative to understand the concept of transition to practice among IENs.
... The studies were conducted across six countries: Canada (Chachula et al., 2015), China (Zhu et al., 2014), Finland (Flinkman et al., 2013;Flinkman & Salanterä, 2015), Germany (Roth et al., 2022), Iran Alilu et al., 2017;Valizadeh et al., 2016) and The Netherlands (Kox et al., 2020). A total of 138 nurses took part in TA B L E 1 Summary of the results of JBI critical appraisal checklist of qualitative research. ...
... The nurses experienced a lack of support which contributed to the desire to exit nursing. First, a lack of support and encouragement from managers was reported Alilu et al., 2017;Flinkman & Salanterä, 2015;Valizadeh et al., 2016;Zhu et al., 2014). Nurses felt that managers did not understand how physically demanding nursing work was (Alilu et al., 2017), and that they had very unrealistic ideas about how to develop patient care (Flinkman et al., 2013). ...
... Furthermore, nurse managers did not compliment nurses on what they were good at (Flinkman et al., 2013), and nurses felt a lack of support for the retention of nurses (Zhu et al., 2014). Nurses experienced managers' behaviour as distant, bureaucratic and rushed (Flinkman & Salanterä, 2015), which led to confusion . ...
Aim
To systematically provide an overview of the qualitative evidence available on the motivations for nurses to leave the nursing profession.
Design
A qualitative systematic review using the meta‐aggregation design of the Joanna Briggs Institute.
Data Sources
Qualitative studies in English, dating from 2010 until January 2023, were obtained from CINAHL, PsycINFO and PubMed.
Review Methods
Studies were selected using predetermined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The assessment of confidence in the review findings was done according to the ConQual approach.
Results
Nine papers that investigated nurses' motivations to leave the profession were included. We developed four synthesized findings from 11 synthesized categories and 31 categories to reflect nurses' motivations to leave the profession, including (1) challenging work environment, (2) emotional distress, (3) disappointment about nursing reality, and (4) culture of hierarchy and discrimination.
Conclusion
This review provides an in‐depth and meaningful understanding of motivations for nurses to leave the profession. Among others, poor working conditions, a lack of opportunities for career development, a lack of support from managers, work‐related stress, a discrepancy between nursing education and practice and bullying behaviour were motivations to leave the profession, which calls for targeted action to retain nurses in the profession.
Impact
Findings of this study shine a light on reasons why nurses leave the profession, providing evidence to support nurse managers and policymakers to develop retention strategies to move out of current crisis into recovery of sustainable global healthcare.
Patient or Public Contribution
There was no direct patient or caregiver contribution to this study because this study originated from the process of a Master study. However, two of the authors are still involved in clinical nursing practice and provided the necessary link between research and practice.
... The participants in the study traced their dissatisfaction with nursing to the pre-college time. A qualitative study with those who quit nursing in China also found that exnurses were not fond of nursing when they were recruited by nursing schools of different educatioan levels [37]. Although some nurses in our study tried to advance their career development after they had decided to settle down, others acknowledged no passion for nursing. ...
... Although some nurses in our study tried to advance their career development after they had decided to settle down, others acknowledged no passion for nursing. They were termed as "passive staying" in Zhu's study on ex-nurses [37]. They may again become vulnerable to leaving under unfavourable conditions or better employment opportunities. ...
Background:
The nurse workforce shortage, partially caused by high work turnover, is an important factor influencing the quality of patient care. Because previous studies concerning Chinese nurse work turnover were predominantly quantitative, they lacked insight into the challenges faced by nurses as they transition from university to their career. A successful transition can result in new nurses' commitment to the career. As such, this study sought to understand how new nurses commit to the career, and focused on identifying facilitators and barriers to such commitment.
Methods:
This was a qualitative study using a grounded theory design. Through purposive sampling, clinical nurses were recruited from hospitals in Western China to participate in semi-structured interviews. The data was analyzed through coding to develop categories and themes.
Results:
Theoretical saturation was achieved after interviewing 25 participants. The data revealed the 'zigzag journey' of committing to the nursing career. The emerging core theme was "getting settled", indicating that new nurses needed to acclimate to the work reality in the nursing career. By analyzing the data provided by the participants, the researchers concluded that the journey to getting settled in nursing compassed four stages:1) "sailing out with mixed feelings", 2) "contemplating to leave", 3) "struggling to stay", and 4) "accepting the role". For most participants, nursing was described as a way to earn a living for their family, not as a career about which they felt passionate.
Conclusions:
Committing to the nursing career is a complicated long-term process. There seems to be a lack of passion for nursing among the Chinese clinical nurses participating in this study. Thus, the nurses may need continued support at different career stages to enhance their ability to remain a nurse for more than economic reasons.
... The (12,(22)(23)(24). There is also a lot of evidence in this regard in other countries (7,13,20,(25)(26)(27)(28). ...
Background: Training specialist manpower requires social justice in higher education and inequality leads to the emergence of hierarchies of power and types of dominant or dominated groups. Aim: The aim of the present study was to explain the perceptions and experiences of the heads of nursing departments of Iranian nursing schools regarding medical dominance in nursing education. Methods: The present study was a conventional content analysis. Data collection was carried out using purposeful sampling and in-depth semi-structured interviews with 24 participants. The data analysis process was performed according to Graneheim and Lundman’s qualitative content analysis (2004). Findings: Data analysis led to the emergence of the theme of "Medical dominance in nursing education" and the three main categories of “physician-centered university education", "weakened educational status", and "belittling nursing education in medical system”. Conclusion: The findings of the present study indicated that physicians enjoy special and superior position in the structure of the Ministry of Health and Medical Education of Iran. Physicians manage the entire system including medical education due to their greater power in managing the system at all micro and macro levels. Thus, other disciplines including nursing education, which are closely related to medicine, are highly ignored.
... Evidently, unclear nursing roles related to oral feeding assistance was pointed out as one of the main barriers to the effective provision of oral feeding assistance by nurses in the present study, Chinese nurses have a heavy workload without clear role boundaries as revealed in a qualitative study. 22 Hence, considering the nursing status in China, it was suggested that related nursing intervention that helps nurses understand the importance of nursing roles related to oral feeding assistance, and introduces ways to guide families or caregivers about oral feeding assistance is necessary. ...
Background: Patients with hemiplegia often suffer from malnutrition and security threat due to disabilities and inadequate supports. This study aims to explore nursing perceptions regarding problems, necessary nursing supports, and nursing competencies required for the provision of oral feeding assistance to hospitalized hemiplegic patients.Methods: A qualitative study was conducted in Taian City, China in 2016. A purposive sampling method was used, and data were gathered using semi-structured interviews. Totally, 5 faculty members and 10 ward nurses in China were interviewed. In relation to the nursing status regarding oral feeding assistance in the case of hemiplegic patients, background and improvement measures in nursing practice were assessed. Data were analyzed using the content analysis method.Results: Four problems in providing oral feeding assistance to hemiplegic patients were identified: 1) insufficient cognition of nursing roles, 2) insufficient consideration of psychological aspects of the patients, 3) lack of related theoretical and practical education, 4) lack of nutritional support during hospitalization. Twenty-five items of nursing competencies, the knowledge and skills required for oral feeding assistance to hospitalized hemiplegic patients were identified.Conclusions: The nursing competency identified by this study can provide evidence for reviewing the related nursing practice and continuous education in China.
... Trustworthiness in this study is a primary consideration in all phases of the research process. The details have been discussed in a previous report (Zhu et al. 2015). ...
... In this study the constant comparative analytic process as outlined by Glaser and Strauss (1967) and Glaser (1978) was used. The data were given considerable thought regarding open, selective and theoretical coding, and the process of theoretical sampling by focusing on generating ideas that fit and work (Zhu et al. 2015). ...
... This is particularly true in Chinese Grade three hospitals, which are the subject of my study. The Grade Three hospitals can select the well-educated and best qualified nursing graduates since there are plenty of candidates on the waiting list to enter these high status hospitals (Zhu et al. 2015). When supply exceeds demand, a surplus exists locally. ...
Open access the paper from
https://www.athensjournals.gr/health/2018-5-3-2-Zhu.pdf
... Competent nurses are considered rare human resources in many countries (1)(2)(3). Policymakers try to solve the issue through increasing nursing training centers and the number of new nursing workforce through employing more nurses (4,5). According to studies, just like many countries across the world, Iran is also short of nursing personnel (6,7). ...
Background: As the largest and most fundamental group targeted by programs developed to improve quality of care, nurses should be the focus of attention in the management of human resources in the field of health care. A review of literature on this subject revealed the lack of scales designed for measuring professional commitment in nurses. The present study was designed to develop a scale to measure professional commitment in clinical nurses and examine its psychometric properties.
Methods: This study will develop a professional commitment scale for clinical nurses within one qualitative and one quantitative step. The first step of the study will entail a review of the literature on the subject and interviews with clinical nurses so as to develop the categories and the items. The second step, the quantitative step, will analyze the items extracted in the qualitative step, determining the features of the topics and factor structure of the scale. The initial scale will be completed by 300 clinical nurses. The correlation among the topics, the construct validity, and reliability of the scale will also be examined in this step.
Results and Discussion: This study will develop an instrument that can measure professional commitment in clinical nurses. Given the lack of instruments for measuring professional commitment in clinical nurses, the findings of this study may be of help to nursing managers, authorities, and the health system in general.
... Higher scores indicated more serious symptoms. Overall scores were rated as severe depression (≥35), moderate depression (20-34), mild depression (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and no depression (≤8). ...
... This indicated that the predictive nursing education process significantly improved level of comfort, activities of daily living, and quality of life, as well as lifted the spirits of cancer patients. The work attitude and professional conduct of the nurses in charge plays a decisive role in care (9). Cancer patients often lose confidence in life, and their physical and mental functions are severely diminished as a consequence. ...
Background
We investigated the application of a predictive nursing education process on the degree of comfort and quality of life for cancer patients.
Methods
A total of 168-cancer patient in Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China between June 2014 and June 2016 were enrolled and admitted for surgery or radiotherapy/chemotherapy treatment. Patients were randomly divided into control and observation groups, each containing 84 cases. Patients in the control group received routine cancer care, whereas the observation group received care incorporating a predictive nursing education process. Patients were assessed after admission and prior to discharge via the Kolcaba’s comfort status scale (through a General Comfort Questionnaire (GCQ)), quality of life scale (QOL), and Barthel Index (BI) for activities of daily living (ADL). Patient mental state was also evaluated using the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD).
Results
GCQ, QOL, and BI scores of the observation group were all significantly higher than those of the control group (P <0.05). HAMA and HAMD scores were significantly lower in the observation group compared to the control group (P < 0.05).
Conclusion
The predictive nursing education process could significantly improve degree of comfort and activities of daily living for cancer patients, and thus improve mental states and quality of life.
