The nursing shortage in China is more serious than in most developed countries, but the loss of nurses through their voluntarily leaving nursing practice has not attracted much attention in Chinese society. The aim of this study is to add to the understanding of nurses leaving nursing practice in China by exploring the process from recruitment to final exit. The qualitative research method draws on a grounded theory approach, especially the constant comparative method of analysis. The indepth interviews were conducted with 19 nurses who have left clinical care. The selection of the study participants was guided by the principle of theoretical sampling. Two core conceptual categories emerged from leavers’ account of their leaving: “Mismatching Expectations: Individual vs. Organizational” and “Individual Perception of Power”. By illuminating the interrelationship between these two core categories, four nursing behaviour patterns are identified: (1) Voluntary leaving (2) Active staying (3) Adaptive staying (4) Passive staying. These behaviour patterns provide an explanation about why and how nursing wastage occurs. The analysis suggests: (1) the higher the degree of mismatch that the nurses recognised between individual and organizational expectations of nursing and the greater the extent of imbalance of power the individual nurses perceived, the more likely it is that the nurses intend to leave the powerless status of being a clinical nurse within the organization; (2) the more difficult it becomes for the nurses to achieve their individual expectations by exercising nursing autonomy in their nursing career, the more likely it is that they actually empower themselves to leave nursing practice. The study suggests that nursing wastage could be avoided if the individual and organizational expectations of nursing were more aligned, and the individual nurses were able to exercise nursing autonomy in their professional practice and career. Although the findings are limited in studying the current nursing workforce situation in China, the theoretical perspective may contribute to the international debate on nursing employment towards effective nursing workforce management and retention strategies.

Estimates indicate that by 2010 RN demand will exceed supply by over 400,000 full-time equivalents and by 2020 the RN shortage will increase to over 1 million. Turnover is a major contributor to the nursing shortage and job dissatisfaction is a well-established cause of nursing turnover. Understanding RN job satisfaction is an objective that is critical to keeping experienced nurses working in nursing and minimizing RN turnover. Many facets of RN job satisfaction have been examined in previous studies; however, much of the variance in job satisfaction remains unexplained. The purpose of this study was to explore job strain, body mass index, and background information variables (age, education, ethnicity, number of years in nursing, and perceived general health) as possible predictors of job satisfaction among hospital staff nurses. Resilience was examined for its mediating and moderating effects on the relationships between job strain and job satisfaction and body mass index and job satisfaction. The research design was cross-sectional and correlational. Surveys were mailed to RNs across the state of Texas. Reliable instruments were used to measure hospital staff RN job satisfaction, job strain, and resilience. Body mass index was calculated based on self-reported height and weight. From a sampling frame of full-time, hospital staff RNs purchased from the Texas Board of Nursing, a random sample of 556 RNs was obtained. The response rate was 27.6% (n = 147). Results showed that 25.2% of the RNs sampled reported high job strain. Job strain was significantly related to body mass index, and high job strain was significantly negatively related to job satisfaction. High job strain explained 24.7% of the variance in job satisfaction. None of the background information variables were significantly related to job satisfaction. Resilience had a moderating effect on the relationship between job strain and job satisfaction. Resilience did not mediate or moderate the relationship between body mass index and job satisfaction. Future research should focus on creating a nurse-specific instrument that measures job strain in hospital staff RNs. Intervention studies that investigate the effects of resilience training on the job satisfaction of hospital staff RNs should also be conducted. / text

Experienced nurses depart the workforce in significant numbers; therefore, it is critical to understand how those departures affect patient care and safety. The focus of this systematic review included appraisal of recent research to provide an understanding of strategies used in acute care settings to retain experienced nurses. Guided by Benner's model of skill acquisition, the purpose of this systematic review was to identify factors that influence the decision of nurses with experience to leave or remain working in acute care work settings. The 19 articles selected for this review were limited to those pertaining to experienced registered nurses who have worked in the acute care setting for 2 years and longer. The review excluded articles pertaining to registered nurses with fewer than 2 years of experience, who were considered at the novice or proficient level of nursing. The results of this literature review showed that management conflicts, lack of support, work environments, work schedules, and disproportionate staffing levels were among the factors leading to morale distress and burnout in experienced nurses. These findings have the potential to contribute to positive social change by guiding administrative efforts to retain experienced nurses and improve mentoring of newer nurses and, ultimately, improve patient outcomes.

An evidence-based leadership (EBL) framework is an intervention designed to facilitate organizational changes such as the reduction of nursing turnover and the improvement of nursing job enjoyment. This project provides an overview of the effect of nursing turnover on an organization, presents the components of the EBL framework, and provides an evaluation of the influence of EBL on nursing turnover and job enjoyment. The EBL framework provided a method for reducing variance in leadership skill and behavior by outlining specific methods necessary to reduce inconsistency. The project objective was to determine if the implementation of an EBL framework for 820 nursing staff in 10 clinical units at a tertiary medical center improved turnover and job satisfaction, as evidenced by turnover data from the unit-specific dashboards and the National Database of Nursing Quality Indicators (NDNQI) job enjoyment scores. All data were collected retrospectively, pre-implementation to post-implementation of the EBL framework, to determine whether significant improvement occurred in turnover percentages and job enjoyment scores. Results of a t test indicated no statistically significant improvement in turnover percentages or job enjoyment scores 7 months after the implementation of the EBL framework. The nonsignificant results could be attributed to several factors including senior leadership turnover, lack of specific accountability measures for failure to implement the EBL framework (insert comma here) and the restricted time frame of the evaluation period. Despite these nonsignificant results, the evaluation provides a baseline for future longitudinal studies to determine if an EBL framework can influence nursing turnover and job enjoyment after having been in place longer than the 7 months post implementation used for this evaluation.