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Regional hallmarks really matter for nurses' intention to leave their profession in China: Commentary on Heinen et al.
International Journal of Nursing Studies 51 (2014) 350–351
Contents lists available at SciVerse ScienceDirect
International Journal of Nursing Studies journal homepage: www.elsevier.com/ijns
Commentary
Regional hallmarks really matter for nurses’ intention to leave their profession in China: Commentary on Heinen et al. Qian Wang a, Yu Wang b,* a b
Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, People’s Republic of China Department of Nursing, Xijing Hospital, #127 Changle Western Road, Fourth Military Medical University, Xi’an 710032, People’s Republic of China
A R T I C L E I N F O
Article history: Received 31 October 2012 Received in revised form 17 December 2012 Accepted 17 December 2012 Keywords: Nursing Survey China
We have read with great interest the salient article by Heinen et al. (2012), in which they shed a novel light on the tricky issue, i.e., contributing factors to nurses’ intention to leave in 10 European countries. By analyzing 23,159 survey feedbacks from nurses averaged at 37.5-year-old working in multitude surgical and medical units, they drew the conclusion that nurse-physician relationship, leadership and participation in hospital affairs might be the triple critical factors causative of the 9% turnover rate. We would like to applaud the authors’ great influential work on the basis of a large sample size. Moreover, we would like to have some comments with particular reference to the regional hallmarks in China. First, not only European counties, but developing countries might have been experiencing the challenging global issue of the shortage of nursing staff with the increasing requirements for nursing. Fortunately, the issue is gaining more and more attention recently. Increasing evidence indicates that multiple factors affect nurses’ intention to leave or remain employed, the chief of which are as bellow: perceptions of health and safety (Val Palumbo et al., 2010), working environment (Choi et al., 2011), job
* Corresponding author. Tel.: +86 29 84775586; fax: +86 29 84775586. E-mail address: [email protected] (Y. Wang). 0020-7489/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijnurstu.2012.12.013
satisfaction components (Coomber and Barriball, 2007), age (Flinkman et al., 2008) and social support (van der Heijden et al., 2010). The variables in the study by Heinen et al. (2012) addressed most aforementioned factors with contrary results in terms of age. Indeed, the working outcomes might be distinctly different for young and experienced registered nurses. Several studies have demonstrated that new graduate nurses or young nurses might have a relatively high rate of intention to leave. Flinkman et al. (2008) noted that 26% of young registered nurses have the thoughts of giving up nursing, whereas Rheaume et al. (2011) noted 24% rate of intent to leave in new graduate nurses. At this point, the authors acknowledged that age was an association factor. However, they found that older nurses are more likely to leave their profession. In our opinion, the difference in the results might be due to various cultural backgrounds and survey methods. Indeed, Flinkman et al. (2008) used age groups in their analysis whereas Heinen et al. (2012) noted mean age and mean age +10 years. On the other hand, Rheaume et al. (2011) specifically addressed intention to leave in young and recently graduated nurses. Anyway, the issue is enigmatic but interesting. Second, the hallmarks in European countries warrant the triple critical factors contributing to intention to leave in terms of relatively limited population and good social security. Notwithstanding that the number of registered nurses in China has increased in the past decades, there has been a massive shortage in the nursing work force in China so far. By the end of 2011, there are only 1.66 nurses in every 1000 Chinese residents. In contrast, there are nearly 5 nurses in every 1000 habitants in European countries. The overtime workload with low salaries and unsatisfied working environment might be testing each nurse’s resolutions to retain employed occasionally. Most nurses in the operating theatres in China have to work from dawn
Q. Wang, Y. Wang / International Journal of Nursing Studies 51 (2014) 350–351
to dusk due to the great number of surgical cases in terms of the population of 1.3 billion people. Nevertheless, the authors also noted that working full-time was an association factor. On the other hand, the medical profession-patient relationship may not be as harmony as that in European countries, owing to the partially or completely self-paying mechanisms in China nowadays (Wang et al., 2012). From this point of view, nurses in China might experience more stress than those in European countries. Finally, it is well established that cultural values difference might have an impact on the behaviour of people. Accordingly, nurses in China with Eastern cultural values (Chang, 2008) might have a different intention to leave in comparison with those in European countries. Despite that we addressed the issue from a nurses-inChina standpoint, we acknowledge that these are just our opinion and thoughts. At this sense, a multi-centre survey might be definitely needed to warrant the points. Taking these points together, the authors did contribute greatly to the current knowledge on the understanding of nurses’ intention to leave their profession using strong lines of evidence. We tentatively put forward that several factors be more important for nurses’ intention to leave in China. It is noteworthy that regional hallmarks really matter as well. Conflict of interest No conflict of interest is reported.
351
References Chang, Y., 2008. The impact of Chinese cultural values on Taiwan nursing leadership styles: comparing the self-assessments of staff nurses and head nurses. Journal of Nursing Research 16 (2), 109–120. Choi, S.P., Pang, S.M., Cheung, K., Wong, T.K., 2011. Stabilizing and destabilizing forces in the nursing work environment: a qualitative study on turnover intention. International Journal of Nursing Studies 48 (10), 1290–1301. Coomber, B., Barriball, K.L., 2007. Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of the research literature. International Journal of Nursing Studies 44 (2), 297–314. Flinkman, M., Laine, M., Leino-Kilpi, H., Hasselhorn, H.M., Salantera, S., 2008. Explaining young registered Finnish nurses’ intention to leave the profession: a questionnaire survey. International Journal of Nursing Studies 45 (5), 727–739. Heinen, M.M., van Achterberg, T., Schwendimann, R., Zander, B., Matthews, A., Ko´zka, M., Ensio, A., Sjetne, I.S., Casbas, T.M., Ball, J., Schoonhoven, L., 2012. Nurses’ intention to leave their profession: a cross sectional observational study in 10 European countries. International Journal of Nursing Studies, http://dx.doi.org/10.1016/ j.ijnur-stu.2012.1009.1019. Rheaume, A., Clement, L., Lebel, N., 2011. Understanding intention to leave amongst new graduate Canadian nurses: a repeated cross sectional survey. International Journal of Nursing Studies 48 (4), 490–500. van der Heijden, B.I., Kummerling, A., van Dam, K., van der Schoot, E., Estryn-Behar, M., Hasselhorn, H.M., 2010. The impact of social support upon intention to leave among female nurses in Europe: secondary analysis of data from the NEXT survey. International Journal of Nursing Studies 47 (4), 434–445. Val Palumbo, M., Rambur, B., McIntosh, B., Naud, S., 2010. Registered nurses’ perceptions of health and safety related to their intention to leave. AAOHN Journal 58 (3), 95–103. Wang, H.Q., Liu, Z.H., Zhang, Y.Z., Luo, Z.J., 2012. Integration of current identity-based district-varied health insurance schemes in China: implications and challenges. Frontiers of Medicine 6 (1), 79–84.
Contents lists available at SciVerse ScienceDirect
International Journal of Nursing Studies journal homepage: www.elsevier.com/ijns
Commentary
Regional hallmarks really matter for nurses’ intention to leave their profession in China: Commentary on Heinen et al. Qian Wang a, Yu Wang b,* a b
Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, People’s Republic of China Department of Nursing, Xijing Hospital, #127 Changle Western Road, Fourth Military Medical University, Xi’an 710032, People’s Republic of China
A R T I C L E I N F O
Article history: Received 31 October 2012 Received in revised form 17 December 2012 Accepted 17 December 2012 Keywords: Nursing Survey China
We have read with great interest the salient article by Heinen et al. (2012), in which they shed a novel light on the tricky issue, i.e., contributing factors to nurses’ intention to leave in 10 European countries. By analyzing 23,159 survey feedbacks from nurses averaged at 37.5-year-old working in multitude surgical and medical units, they drew the conclusion that nurse-physician relationship, leadership and participation in hospital affairs might be the triple critical factors causative of the 9% turnover rate. We would like to applaud the authors’ great influential work on the basis of a large sample size. Moreover, we would like to have some comments with particular reference to the regional hallmarks in China. First, not only European counties, but developing countries might have been experiencing the challenging global issue of the shortage of nursing staff with the increasing requirements for nursing. Fortunately, the issue is gaining more and more attention recently. Increasing evidence indicates that multiple factors affect nurses’ intention to leave or remain employed, the chief of which are as bellow: perceptions of health and safety (Val Palumbo et al., 2010), working environment (Choi et al., 2011), job
* Corresponding author. Tel.: +86 29 84775586; fax: +86 29 84775586. E-mail address: [email protected] (Y. Wang). 0020-7489/$ – see front matter ß 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijnurstu.2012.12.013
satisfaction components (Coomber and Barriball, 2007), age (Flinkman et al., 2008) and social support (van der Heijden et al., 2010). The variables in the study by Heinen et al. (2012) addressed most aforementioned factors with contrary results in terms of age. Indeed, the working outcomes might be distinctly different for young and experienced registered nurses. Several studies have demonstrated that new graduate nurses or young nurses might have a relatively high rate of intention to leave. Flinkman et al. (2008) noted that 26% of young registered nurses have the thoughts of giving up nursing, whereas Rheaume et al. (2011) noted 24% rate of intent to leave in new graduate nurses. At this point, the authors acknowledged that age was an association factor. However, they found that older nurses are more likely to leave their profession. In our opinion, the difference in the results might be due to various cultural backgrounds and survey methods. Indeed, Flinkman et al. (2008) used age groups in their analysis whereas Heinen et al. (2012) noted mean age and mean age +10 years. On the other hand, Rheaume et al. (2011) specifically addressed intention to leave in young and recently graduated nurses. Anyway, the issue is enigmatic but interesting. Second, the hallmarks in European countries warrant the triple critical factors contributing to intention to leave in terms of relatively limited population and good social security. Notwithstanding that the number of registered nurses in China has increased in the past decades, there has been a massive shortage in the nursing work force in China so far. By the end of 2011, there are only 1.66 nurses in every 1000 Chinese residents. In contrast, there are nearly 5 nurses in every 1000 habitants in European countries. The overtime workload with low salaries and unsatisfied working environment might be testing each nurse’s resolutions to retain employed occasionally. Most nurses in the operating theatres in China have to work from dawn
Q. Wang, Y. Wang / International Journal of Nursing Studies 51 (2014) 350–351
to dusk due to the great number of surgical cases in terms of the population of 1.3 billion people. Nevertheless, the authors also noted that working full-time was an association factor. On the other hand, the medical profession-patient relationship may not be as harmony as that in European countries, owing to the partially or completely self-paying mechanisms in China nowadays (Wang et al., 2012). From this point of view, nurses in China might experience more stress than those in European countries. Finally, it is well established that cultural values difference might have an impact on the behaviour of people. Accordingly, nurses in China with Eastern cultural values (Chang, 2008) might have a different intention to leave in comparison with those in European countries. Despite that we addressed the issue from a nurses-inChina standpoint, we acknowledge that these are just our opinion and thoughts. At this sense, a multi-centre survey might be definitely needed to warrant the points. Taking these points together, the authors did contribute greatly to the current knowledge on the understanding of nurses’ intention to leave their profession using strong lines of evidence. We tentatively put forward that several factors be more important for nurses’ intention to leave in China. It is noteworthy that regional hallmarks really matter as well. Conflict of interest No conflict of interest is reported.
351
References Chang, Y., 2008. The impact of Chinese cultural values on Taiwan nursing leadership styles: comparing the self-assessments of staff nurses and head nurses. Journal of Nursing Research 16 (2), 109–120. Choi, S.P., Pang, S.M., Cheung, K., Wong, T.K., 2011. Stabilizing and destabilizing forces in the nursing work environment: a qualitative study on turnover intention. International Journal of Nursing Studies 48 (10), 1290–1301. Coomber, B., Barriball, K.L., 2007. Impact of job satisfaction components on intent to leave and turnover for hospital-based nurses: a review of the research literature. International Journal of Nursing Studies 44 (2), 297–314. Flinkman, M., Laine, M., Leino-Kilpi, H., Hasselhorn, H.M., Salantera, S., 2008. Explaining young registered Finnish nurses’ intention to leave the profession: a questionnaire survey. International Journal of Nursing Studies 45 (5), 727–739. Heinen, M.M., van Achterberg, T., Schwendimann, R., Zander, B., Matthews, A., Ko´zka, M., Ensio, A., Sjetne, I.S., Casbas, T.M., Ball, J., Schoonhoven, L., 2012. Nurses’ intention to leave their profession: a cross sectional observational study in 10 European countries. International Journal of Nursing Studies, http://dx.doi.org/10.1016/ j.ijnur-stu.2012.1009.1019. Rheaume, A., Clement, L., Lebel, N., 2011. Understanding intention to leave amongst new graduate Canadian nurses: a repeated cross sectional survey. International Journal of Nursing Studies 48 (4), 490–500. van der Heijden, B.I., Kummerling, A., van Dam, K., van der Schoot, E., Estryn-Behar, M., Hasselhorn, H.M., 2010. The impact of social support upon intention to leave among female nurses in Europe: secondary analysis of data from the NEXT survey. International Journal of Nursing Studies 47 (4), 434–445. Val Palumbo, M., Rambur, B., McIntosh, B., Naud, S., 2010. Registered nurses’ perceptions of health and safety related to their intention to leave. AAOHN Journal 58 (3), 95–103. Wang, H.Q., Liu, Z.H., Zhang, Y.Z., Luo, Z.J., 2012. Integration of current identity-based district-varied health insurance schemes in China: implications and challenges. Frontiers of Medicine 6 (1), 79–84.