A Model of Factors Influencing Intention to Leave Nursing in Thailand
Keywords:
Burnout, Employment opportunity, Intention to leave, Job satisfaction, Nurse practice environment, Nurses, Nursing shortage, Professional commitment, Work-family conflictAbstract
Nurses constitute the largest workforce for achieving organizational goals in health care services. Nurses’ intention to leave their profession is one of the foremost challenges globally for nursing leaders and the health settings. This study aimed to develop and test a model of factors influencing nurses’ intention to leave nursing in Thailand at a time when there is an attrition crisis. From nine government hospitals in all regions of Thailand, 405 registered nurses were recruited by multi-stage sampling. Participants completed a questionnaire comprising eight sections: Demographic data, Job satisfaction, Burnout, Professional commitment, Nurse practice environment, Work-family conflict, Employment opportunity, and Intention to leave nursing. Path analysis was utilized to test the model.
Findings revealed that the modified model fitted the empirical data and explained 45% of the variance in intention to leave. Burnout was the strongest factor influencing intention to leave, both directly and indirectly through job satisfaction and professional commitment. Work-family conflict and nurse practice environment influenced intention to leave, indirectly through burnout, job satisfaction, and professional commitment. Work-family conflict also directly influenced intention to leave, but the nurse practice environment had no direct effect. Job satisfaction only indirectly influenced intention to leave through professional commitment whereas employment opportunity directly influenced this. Thus, to try to retain nurses within the profession, nurse and health care policymakers can design various strategies to reduce burnout; assist nurses to find a balance between work and family domains; and enhance their satisfaction and commitment to the profession to prevent them from leaving.
References
World Health Organization (2020) State of the world’s nursing. WHO, Geneva, Switzerland. 2020 [cited 2021 Mar 5]. Available from: https://www.who.int/ publications/ i/item/nursing report-2020.
Noree T, Thanomwat Y, Phanthunane P, Gongkulawat K. Research project to synthesize alternatives and a policy proposal for planning the country’s health workforce needs over the next decade. Health Systems Research Institute (HSRI) [Internet]. 2017 [cited 2020 Mar 19]. Available from: http://hdl.handle.net/11228/4749 (in Thai)
Sirisub P, Suwannapong N, Tipayamongkholgul M, Howteerakul N, Noree T. Intention to extend working life among Thai registered nurses in Ministry of Public Health: a national survey. Nurs Res Pract. 2019; doi: https://doi. org/10.1155/2019/7919404
de Oliveira DR, Griep RH, Portela LF, Rotenberg L. Intention to leave profession, psychosocial environment, and self-rated health among registered nurses from large hospitals in Brazil: a cross-sectional study. BMC Health Serv Res. 2017; 17:21. doi: https://doi.org/10.1186/ s12913-016-1949-6.
Moloney W, Boxall P, Parsons M, Cheung G. Factors predicting registered nurses’ intentions to leave their organization and profession: a job demands‐resources framework. J Adv Nurs. 2018; 74(4): 864-75. doi: https://doi.org/10.1111/ jan.13497
Yurumezoglu HA, Kocaman G. Predictors of nurses’ intentions to leave the organization and the profession in Turkey. J Nurs Manag. 2015; 24(2), 1-9. doi:10.1111/jonm.12305.
Flinkman M, Isopahkala-Bouret U, Salanterä S. Young registered nurses’ intention to leave the profession and professional turnover in early career: a qualitative case study. ISRN Nurs. 2013; 916061. doi:10.1155/2013/ 916061.
Sawaengdee K. Working life table and projection of registered nurses workforce supply in Thailand over the next 15 years (2008-2022). National Institute of Development Administration; 2009 [cited 2020 Jan 5]. Available from: http://libdcms.nida.ac.th/ thesis6/2009/b162505.pdf
Sawaengdee K, Tangcharoensathien V, Theerawit T, Thungjaroenkul P, Thinkhamrop W, Prathumkam P, et al. Thai nurse cohort study: cohort profiles and key findings. BMC Nurs. 2016; 15:10. doi.org/10.1186/s12912- 016-0131-0.
Homsuwan W. Factors associated with intention to leave of nurses in Rajavithi Hospital Bangkok, Thailand. J Health Res. 2017; 31(Suppl.1): S91-7. doi:10.14456/jhr.2017.71.
Nantsupawat A, Kunaviktikul W, Nantsupawat R, Wichaikhum O-A, Thienthong H, Poghosyan L. Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. Int Nurs Rev. 2017; 64(1): 91-8 doi: https://doi.org/10.1111 /inr.12342.
de Oliveira DR, Griep, RH, Portela LF, Rotenberg L. Intention to leave profession, psychosocial environment, and self-rated health among registered nurses from large hospitals in Brazil: a cross-sectional study. BMC Health Serv Res. 2017; 17: 21. doi: https://doi.org/10.1186/ s12913-016-1949-6.
World Health Organization. Burn-out an “occupational phenomenon”: international classification of diseases [Internet]. 2019 [cited 2020 Jan 5]. Available from: https:// www.who.int/news/item/28-05-2019-burn-o ut-an occupational-pheno menon-international-classification of-diseases
Scanlan JN, Still M. Relationships between burnout, turnover intention, job satisfaction, job demands and job resources for mental health personnel in an Australian mental health service. BMC Health Serv Res. 2019; 19: 62. https://doi.org/10.1186/s12913-018-3841-z
Chang H-Y, Shyu Y-IL, Wong M-K, Chu T-L, Lo Y-Y, Teng C-I. How does burnout impact the three components of nursing professional commitment? Scand J Caring Sci. 2017; 31(4): 1003-11. doi: 10.1111/scs.12425.
Wang Y, Chang Y, Fu J, Wang L. Work-family conflict and burnout among Chinese female nurses: the mediating effect of psychological capital. BMC Public Health. 2012; 12(1): 915. doi: https://doi.org/10.1186/1471-2458-12-915
Gonnelli C, Raffagnino R. Work-family conflict in nursing: an integrative review of its antecedents and outcomes. IAFOR J Phys Beh Sci. 2017; 3(1): 61-84. doi: https:// doi.org/ 10.22492/ijpbs.3.1.05
Yamaguchi Y, Inoue T, Harada H, Oike M. Job control, work-family balance and nurses’ intention to leave their profession and organization: a comparative cross-sectional survey. Int J Nurs Stud. 2016 Dec; 64:52-62. doi: 10.1016/j.ijnurstu. 2016.09.003.
Khamisa N, Oldenburg B, Peltzer K, Ilic D. Work related stress, burnout, job satisfaction and general health of nurses. Int J Environ Res Public Health. 2015; 12(1): 652-66. doi:10.3390/ijerph120100652.
Ekici D, Cerit K, Mert T. Factors that influence nurses’ work-family conflict, job satisfaction, and intention to leave in a private hospital in Turkey. Hosp Pract Res. 2017; 2(4): 102-8. doi:10.15171/hpr.2017.25.
Wang L, Tao H, Ellenbecker CH, Liu X. Job satisfaction, occupational commitment, and intent to stay among Chinese nurses: a cross‐sectional questionnaire survey. J Adv Nurs. 2012; 68(3): 539-49. doi:https://doi.org/10.1111/ j.1365-2648.2011.05755.x
Chang H-Y, Lee I-C, Chu T-L, Liu Y-C, Liao Y-N, Teng C-I. The role of professional commitment in improving nurses’ professional capabilities and reducing their intention to leave: two‐wave surveys. J Adv Nurs. 2019; 75(9): 1889-1901. doi: https://doi.org/ 10.1111/jan.13969
Unruh LY, Zhang NJ. Newly licensed registered nurse job turnover and turnover intent. J Nurses Prof Dev. 2014; 30(5): 220-30. doi:10.1097/NND.0000000000000079.
Li J. What makes nurses intend to leave their profession? International comparison. (Doctoral Dissertation). 2012 [cited 2020 Feb 10]. Available from: http://nbnresolving. de/urn/resolver.pl?urn=urn%3Anbn%3Ade%3Ahbz% 3A468-20120416-112230-6
Krejcie RV, & Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970: 30, 607-10. Available from: https://home.kku.ac.th /sompong/guest_ speaker/KrejcieandMorgan_article.pdf
Brislin RW. Back-translation for cross-cultural research. J Cross-Cult Psychol. 1970; 1(3): 185-216. doi:10. 1177/135910457000100301.
van der Heijden BIJM, Dam K, Hasselhorn H-M. Occupational turnover: understanding nurse intent to leave the nursing profession. 2007 [cited 2020 Jan 10]. Available from: www.next-study.net
Stamps PL. Nurses and work satisfaction: an index for measurement. Chicago: Health Administration Press; 1997.
Lin CJ, Wang HC, Li TC, Huang LC. Reliability and validity of nurses’ job satisfaction scale and nurses’ professional commitment. Mid Taiwan J Med. 2007 Jun; 12(2): 65-75.
Borritz M, Rugulies R, Bjorner JB, Villadsen E, Mikkelsen OA, Kristensen TS. Burnout among employees in human service work: design and baseline findings of the PUMA study. Scand J Public Health. 2006; 34(1): 49-58. doi:10.1080/ 14034940510032275.
Netemeyer RG, Boles JS, McMurrian R. Development and validation of work-family conflict and family-work conflict scales. J Appl Psychol. 1996; 81: 400-10. doi:10. 1037/0021-9010.81.4.400.
Lake ET. Development of the practice environment scale of the nursing work index. Res Nurs Health. 2002; 25(3): 176-88. doi:10.1002/nur.10032.
Hämmig, O. Explaining burnout and the intention to leave the profession among health professionals – a cross-sectional study in a hospital setting in Switzerland. BMC Health Serv Res. 2018; 18: 785. doi: https://doi.org/10.1186/s12913- 018-3556-1
Satoh M, Watanabe I, Asakura K. Occupational commitment and job satisfaction mediate effort–reward imbalance and the intention to continue nursing. Jpn J Nurs Sci. 2017; 14: 49-60. doi:10.1111/jjns.12135.
Wang H, Li Y. Role overload and Chinese nurses’ satisfaction with work-family balance: the role of negative emotions and core self-evaluations. Curr Psychol. 2019; doi: https://doi.org/10.1007/s12144-019-00494-5
Albalawi AS, Naugton S, Elayan MB, Sleim MT. Perceived organizational support, alternative job opportunity, organizational commitment, job satisfaction and turnover intention: a moderated-mediated model. Organizacija. 2019; 52(4): 310-24. doi:10.2478/orga-2019-0019.
Jones K. The benefits of Magnet status for nurses, patients, and organizations. Nursing Times [Internet]. 2017; 113(11), 28-31. [cited 2020 Feb 10]. Available from: https://www.nursingtimes.net
Downloads
Published
How to Cite
Issue
Section
License
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
.png)
