Back in the late 1990s when there was still a shortage for Nurses in the United States, nurse recruitment and retention were identified as probable solutions for this occupational crisis. The alarming consequences on patient safety and health outcomes due to this scarcity posed as a distressing concern not only to the U.S. but globally as well. At the same time, other factors such as nurse workload, staffing, turnover and organizational characteristics were cited as major influences to the quality of patient care, health outcomes, nurses' well-being and dedication to the workplace.

The goal of this study attempts to report and analyze the relationship of new nurse turnover intent with individual characteristics, work environment variables and organizational factors and compare new nurse turnover with actual turnover in the 18 months of employment following completion of a residency.

The research was conducted from July 1999 to 2006 with 889 new pediatric nurse respondents who underwent the same process of residency. Various instruments on psychometrics were utilized to survey the responses. These published tools assessed the following factors of each nurse respondent:


a. Individual Characteristics
(Age, Educational Level, Prior Work Experience, Choice of Work Unit, Skills and Nursing Competency, Conflict / Stress [Reality Shock] and Coping Strategies)

b. Work Environment
(Control over practice ~ Autonomy and Decision-Making and Opportunities for advancement and promotion ~ Empowerment and Job Satisfaction)

c. Organizational Factors
(Workplace ties and relationships ~ Group Cohesion, Leader Empowerment and Organizational Commitment)


The investigation also compared new nurse turnover with actual turnover:


1. Turnover Intention
This is a global measure of an individual’s intention to leave the hospital and is a single-item scale which asks ‘Do you plan to leave this facility within the next year?’

2. Actual Turnover
Turnover was defined as voluntary termination of employment at the hospital.




After the abovementioned were tested and studied, the results indicated the following conclusions:

• New nurses who have less experience academically and clinically were more likely to leave their job. Whilst, older nurses who have fixed career goals than younger ones resign when their goals are not met.

• Seeking Social Support as a coping mechanism increased the chances of being in the TI (Turnover Intention) group: “Kramer (1974) recognized that support was important for new nurses to endure the stresses of a first job.”

• Nurses who have great self-esteem / self-confidence instilled upon them also influences a huge part in TI since new graduate nurses who perceive themselves as competent professionals decreases the intention of leaving their respective institutions. “Because building confidence in competency is key to hospital success in providing quality care (McClure et al. 1983).”

• Professional Status is perceived to be of utmost importance by nurses than the salaries and other fringe benefits nurses receive from work. “Dissatisfaction with promotion had more impact on intent to leave than pay (Shields and Ward 2001).”

• Enjoyment and fulfillment in one’s job also contributed to TI. “Jackson (2005) examined what constitutes a good day for new nurses and identified the themes of doing ‘something well’, ‘feeling that you’ve achieved something’ and ‘getting the work performed’.”

• Personal feelings about colleagues in the workplace are as essential as seeking social support and enjoyment in one’s profession. “Bowles and Candela (2005) determined that support from other staff and the nursing team was second in importance to patient care as reasons for leaving their position.”

• Hospital institutions that give high importance to staff teamwork are more likely to have dedicated employees. “Cho et al. (2006) reported that emotional exhaustion influenced organizational commitment negatively and that empowerment contributed positively to work life, which in turn decreased perceptions of emotional exhaustion.”



Job satisfaction is the most important factor that everyone, not just nurses, should consider in finding that perfect job. If one is indeed happy and satisfied, he will never recognize the workload that he has because he wouldn’t even realize that he’s working in the first place. The study is very relevant to the current issues involving turnover rates and the nursing community in the Philippines. It has become a long-term problem especially the time when the “mushrooming” of nursing schools came about and almost everyone can become a registered nurse. The times have changed indeed as shown by the turnover rates and turnover intent of nurses based on the prospective data presented. In the long run, the turnover rate and intent increases as a lot of nurses are becoming dissatisfied with their current positions and opt for something that they really wanted to do. By providing the nurses a list of specializations, they can easily choose what is best for them and they can even join trainings in order for them to have a firsthand experience of that particular job. Nurses who have an astounding background and experience have the right to choose what is best for them because they have the experience and knowledge to back them up and that has prepared them to perform at a much greater scale than those who are fresh graduate nurses only. However, new graduates shouldn’t be underestimated as well, as not all of them have the same level of skills and knowledge that were learned in nursing school. Some are fast learners while others are not. The fast learners can easily be trained to be at par with those who are experienced nurses.

Every job entails a different level of responsibility and accountability. For patients with a higher level of care, the responsibility and expectation on the nurse is much greater than of those assigned in the general units. Self-esteem is also a factor in determining job satisfaction and hence, turnover rate. Competence and confidence in the workplace is an integral part of becoming a well-rounded and holistic nurse. By believing in oneself, one can perform better in the workplace and interact better with one’s colleagues and most especially, the patients. If one is satisfied and fulfilled with his job, he will have no complaints at all.

Therefore, everyone can become a registered nurse, but not all nurses can become compassionate nurses who love their job not because of the money, but because it is a vocation of compassion and care. There may be a lot of reasons why one chooses his profession, may it be personal or influential, but the bottom line is --- he still chose that for a reason. It depends on the nurse if he will take for granted what is best of him and end up in self-pity for the rest of his life or choose to hone his knowledge and skills to its maximum potential and become the Professional Nurse that he is both in his well-being, interpersonal relationships and clinical performance.





GUIDE QUESTIONS:

1.) Is the Philippines experiencing the same problems presented in the journal?
2.) What is the relevance of frequent turnover of nurse employees in the Philippine hospital setting?
3.) How are Filipino nurses affected by this particular crisis and how are they coping with it?
4.) Do you think that the regulatory bodies and other labor-related institutions / organizations for nurses in the Philippines are making appropriate measures to solve the problem of increasing turnover rate? Cite some examples. What are your personal recommendations?




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REFERENCES:

1. Kramer, M. (1974). Reality Shock: Why Nurses Leave Nursing. Mosby, St. Louis.

2. McClure, M.M.; Poulin, M.; Sovie, M. & Wandelt, M. (1983). Magnet Hospitals: Attraction and Retention of Professional Nurses. American Nurses Association, Kansas City, MO.

3. Shields, M.A. & Ward, M. (2001). Improving Nurse Retention in the National Health Service in England: The Impact of Job Satisfaction on Intentions to Quit. Journal of Health Economics 20, pp. 677-701.

4. Jackson, C. (2005). The Experience of a Good Day: A Phenomenological Study to Explain a Good Day as Experienced by a Newly Qualified RN. International Journal of Nursing Studies 42, pp. 85-95.

5. Bowles, C. & Candela, L. (2005). First Job Experiences of Recent RN Graduates: Improving the Work Environment. Nevada RN Formation 14(2), pp. 16-19.

6. Cho, J.; Laschinger, H.K.S. & Wong, C. (2006) Workplace Empowerment, Work Engagement and Organizational Commitment of New Graduate Nurses. Canadian Journal of Nursing Leadership 19 (3), pp. 43-60.

Turnover Intention is a global measure of an individual’s intention to leave the hospital and is a single-item scale which asks ‘Do you plan to leave this facility within the next year?’

Actual Turnover is defined as voluntary termination of employment at the hospital.

Nursing shortage refers to a situation where the demand for nurses is greater than the supply, as is currently the case in the United States and several other developed nations. According to a U.S. government study, by the year 2020, there could be a nationwide shortage of up to one million nurses.

A study revealed that the frustration among nurses focused on incompatible expectations from nurses due to regulation of cost, lack of chance to provide ample nursing care, and disillusioned workforce or loss of confidence in, and dissatisfaction with, the healthcare system. Limitations to comprehensive care were recognized because nurses are overloaded with the amount of assigned patients, substantial paper works, and short staffing due to cost cutting among hospitals.

In the Philippines however, the reason why so many Filipino nurses leave to their work is not only because of the stress at work or the shortage of staff but also of the low salary that they receive here and high offers abroad. Many Filipinos were very competent and hardworking especially in their respective field of choice. But some hospitals in the country pay their nurses as low as Php 7,000 a month which is very unproductive for the nurses to go on to their everyday life. Government hospitals and a number of big hospitals may pay higher wages however; there is still an enormous difference to what nurses earn abroad. Salary of Filipino nurses may be low in the Philippines, but the fact nowadays is that not all nurses can work abroad right after the board exams. He/she still needs to work in the local circuit to gain valuable experience. Therefore, Filipino nurses still have to work on for few months of local earnings. If only hospitals give nurses the right wages for their work as a professional, Filipino nurses wouldn’t look forward to working to other countries.


References:
Nurses Needed-- NOW on PBS http://www.pbs.org/now/shows/442/

http://en.wikipedia.org/wiki/Nursing_shortage

Brush, B. L., Sochalski, J., & Berger, A. M. (2004). Imported care: Recruiting foreign nurses to U.S. health care facilities. [Electronic Version]. Health Affairs, 23(3), 78-87. Retrieved October 26, 2006 from http://content.healthaffairs.org.offcampus.lib.washington.edu/cgi/content/full/23/3/78?ijkey=82040093f179b956b3b2d1769736a1c23040fad0

Trossman, S. (2002). The global reach of the nursing shortage: The ANA questions the ethics of luring foreign-educated nurses to the United States. [Electronic Version]. American Journal of Nursing, 102(3), 85 – 87. Retrieved October 11, 2006, from Ovid database

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Therefore, everyone can become a registered nurse, but not all nurses can become compassionate nurses who love their job not because of the money, but because it is a vocation of compassion and care.

“Many are called, but few are chosen." This is a very famous quotation from the Holy Bible —Matthew 22:13, 14. It is true that many have tried to become what they want to be whether as a professional boxer, artist, doctor, lawyer, nurse and many other professions. No matter how good you are, how long you have prepared, how much effort you have given if you don’t put your heart to it then it is useless.

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Hospital institutions that give high importance to staff teamwork are more likely to have dedicated employees.

The Joint Commission on the Accreditation of Healthcare Organizations is a strong proponent of teamwork. Their focus is on coordination of care and the support of healthcare professionals for each other: Teams whose members have experience working together know each other’s strengths and weaknesses, can better support each other and compensate for each other—even under extreme stress and fatigue conditions.

http://ccn.aacnjournals.org/cgi/content/full/23/3/8?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=teamwork&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Quote:

Is the Philippines experiencing the same problems presented in the journal?

Yes, among the reasons for turnover of Philippine nurses were political instability, corruption and the need for padrino / backer in order to get a job or promotion which is very traditional here in our country. If you don’t have a backer then you cannot get in. Nurses were also given long hour of shift which is very distressing. But the most common reason they give up, is economic.
United Kingdom is a destination of most Philippine nurses, one nurse can bring home P500,000 after just six months there. For those bound for the United States, there is even a signing bonus of anywhere from $2,000 to $10,000. Even recruiters/ manpower agencies are being paid for every nurse they bring to a foreign health institution.
The figures above are far from what the nurses are getting here in our country. Hospitals in the provinces, pay P2,000 a month to their staff nurses, government hospitals pay more than private hospitals. Government nurses are paid at least P9,000; in private hospitals, it could go down to P4,000 a month. Under the Nursing Law of 2002, an entry-level nurse should get about P13,300 a month. Contractual nurse without experience gets P9,930 a month; with experience, their pay goes a bit higher at P12,000.
The Department of Budget and Management said that unavailability of funds is the reason for the small wages of nurses.

http://www.pcij.org/stories/2005/nurses.html

Philippines- is known as the world's largest exporter of nurses. Filipinos frequently travel to countries such as Great Britain, Singapore, Saudi Arabia and Australia. The nurses are well-suited to work in the United States because they are educated along an American training model and in English. Some of the Filipino nurses said that they are pleased with their decision to move to other countries for higher wages than in the Philippines.

The nursing shortage is so severe that nurses don't feel threatened by the foreign nurses. Instead, they are glad that vacant positions are being filled. On the other hand, the foreign nurses may have some language and cultural hurdles to clear, so extensive orientations are very important.

Luck has no magical formula. It surely comes when readiness meets an opportunity. For the 17,000 Filipino nurses, job opportunities in and outside the United States continue to beckon. The shortage of nurses continues despite rising wages of nurses. The US Bureau of Labor Statistics projected in 2005 more than 3.1 million registered nurse jobs would be available by 2014. That would add more than 700,000 new jobs for nurses.

Opportunities also abound for licensed Filipino nurses outside the United States. Tuason said Kiwis (locals in New Zealand) prefer Filipino nurses over other nationalities because of their compassion and sensitivity to their patients’ needs.

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Filipino nurses are very kind and helpful, too,

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Most Philippine-trained nurses are not very conscious about rendering work even beyond their time of duty.

The annual outflow of Filipino nurses is now three times greater than the annual production of licensed nurses, said Dr. Jaime Z. Galvez-Tan, executive director of the National Institutes of Health Philippines. Global need Tan said the shortage of nurses in the developed countries would not just be for a year or two, but for at least the next 10 to 15 years. He explains: The developed countries are experiencing a longer lifespan and the graying of their population. But their youth population is not interested in the nursing profession because of the difficult and risky work. More options are also available to them to take on other professions that offer better pay and working conditions. The solution for these countries: hire foreign nurses to do the job. Based on statements made by their respective governments, the US would need around 10,000 nurses a year, while the UK, Ireland, the Netherlands and other European countries would need another 10,000 nurses a year.

Ma Linda Buhat, president of the Association of Nursing Service Administrators of the Philippines, said the most common reasons nurses leave the country are the low salary, lack of professional opportunities, the need for adventure, sense of obligation to family, desire to seek foreign citizenship and health reasons. The Philippines will never be able to compete with the salaries offered to nurses in the developed countries. Basic monthly pay abroad ranges from $3,000 to $4,000 compared to the $169 average monthly pay in most cities here.

Dr. Teresita Barcelo, a professor at University of the Philippines College of Nursing, in a speech before a recent nursing congress, decried the governments deafening silence to curb the outflow of nurses and the lack of political will to implement the nursing law that hopes to improve the salary of nurses and their working conditions. While the profession is cognizant of its social responsibility, society also needs to address the reasons why nurses are leaving, said Annabelle R. Borromeo, vice president for patient care services at the Asian Hospital and Medical Center.

We want to take care of our people, but we also have families to feed. Sometimes, leaving may be the best way to help because by staying here, we won't have the means to help. As a society, we all need to alleviate poverty. If we can lick it, maybe wed have better choices.This poor image will continue to push young nurses to migrate to other countries. Theres a need to improve this image of nurses so they will be motivated to practice their profession here, she said. It is ironic that the Philippines, which is one of the world's major suppliers of nurses, has yet to give due recognition to those who choose to serve here.

REFERENCES:
1.www.workingimmigrants.com/2006/11/the_nursing_shortage_real_gett.html
2.www.filipinonurses2us.com/filipino_nurses_2_us/nursing/index.html
3.www.allfilipinonurses.com

Nurses now seeks for the benefits, the salary and experience that they will be having, unlike those nurses back then they stick to their career goals. it is said that Filipino nurse is kind, helpful and hospitable in any way. how true is that and to what extent?

You have stated that,

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Job satisfaction is the most important factor that everyone, not just nurses, should consider in finding that perfect job. If one is indeed happy and satisfied, he will never recognize the workload that he has because he wouldn’t even realize that he’s working in the first place.

In the study of "Factors Affecting Job Satisfaction in the Registered Nurse"
its conclusion stated that there are many factors that contribute to dissatisfaction in the work place. Many variables within each factor make achieving satisfaction for every individual a very difficult task. Recognition of frustrations, such as turnover, lack of internal empowerment, burnout, and, elimination of external sources of stress can decrease dissatisfaction in the health care setting.

Issues concerning job satisfaction, potential for burnout, as well as effect of burnout on patients, expanded knowledge and better understanding of productivity, and, sources of empowerment for RNs in the health care setting should continue to be investigated. Improved job satisfaction results in less turnover, better quality patient care, less physical and mental injuries to health care staff, and betterment of entire organization.


Reference:

Jennifer L. Kettle (2002)Factors Affecting Job Satisfaction in the Registered Nurse, University of North Carolina, Charlotte, NC
ttp://www.juns.nursing.arizona.edu/articles/Fall%202002/Kettle.htm

Turnover intention is the cause variable of turnover behavior. Based on accurately forecasting, organization can effectively control the occurrence of turnover. (Chenbaojie, 2004)

Amidst the nurse shortage in the country and abroad, it is not surprising for people to analyze and focus on the turnover intent of these nurses, whether old or new. It is significant for human resources to do studies like these, in order to facilitate reduction of turnover intent and increased retention among their employees at which the hospital would best benefit in means of patient safety and quality of care. It is imperative to consider both new and old nurses, as both have their own odds of having turnover intent.
The study considers individual characteristics, work environment, and organizational factors in analyzing the turnover occurrence. It informs us that satisfaction, just compensation and commitment in the job would most likely decrease the nurse’s turnover intent. For the new nurses, factors such as lower skills, competency and enjoyment would push them to leave the job, but if programmes stated on the study like an 11-week orientation with a preceptor, and a 16-week competency orientation would be available to these new graduate nurses, they would feel supported and it would aid them in their transition. Old nurses does not differ in the likelihood of having turnover intents in a way that most of these old nurses have higher educational attainment, they have vested much effort to reach such position and have fixed careers goals in which if these goals were not met, they would most likely leave the job as well. A significant reason for turnovers on both nurses is not being able to work, or assigned to the ward of their choice and expertise.
Follow-up question: Given these opportunity to analyze and options to consider, promoting retention of nurses, why is still there exist a nurse shortage, particularly in the Philippines?

REFERENCE:

Chenbaojie (2004)"A study on the factors of employee's turnover intention in private enterprises" for ZhengZhou Institute of Aeronautical Industry Management

Nursing is a dignified profession but most importantly, it is a vocation that requires absolute commitment because it encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well in all settings.

Human beings cannot be treated like machines or robots if health care is to make a positive difference in their lives. Instead, health care must become more humanizing. As professionals, nurses play an important role in making care an integral part of health care delivery. This begins by nurses’ making caring a part of the philosophy and environment in the workplace. Finally, during the day-to-day practice with the clients and families, nurses must be committed to caring and be willing to establish the relationships necessary for personal, compassionate and meaningful nursing care to be delivered.

The Turnover Intention and Nursing Shortage

The existing nursing shortage and high turnover is of great concern in many countries because of its influence upon the efficiency and effectiveness of any the health care delivery system. Recruitment and retention of nurses are persistent problems associated with job satisfaction. There have been numerous changes in the health care system, including cost-containment efforts, the increased growth of managed care, and shortages of many health professionals. It is important to assess the impact these changes are having on the quality of health care delivery and the way various health professionals view their jobs.

References

1. Burnard, P.R. (2004). Professional and Clinical Issues in Nursing 3rd Edition. Philadelphia: Elsevier Lmtd.

2. Deloughery, G.L. (2000). Issues and Trends in Nursing. Philadelphia: Mosby-Year Book Inc.

3. http://www.emeraldinsight.com/Insight/viewContentItem.do;jsessionid=0F3BE05CA13ED9FBD8EE5AC084AD298A?contentType=Article&contentId=881110

After nearly two decades of teachers, parents and therapists focusing their efforts on boosting children's self-esteem, a team of psychologists led by Florida State University Francis Eppes Professor Roy Baumeister has found no evidence that boosting self-esteem through school programs or therapeutic interventions leads to any positive outcomes.

Raising self-esteem will not by itself make young people perform better in school, obey the law, stay out of trouble, get along better with their fellows or respect the rights of others

although there is correlation between self esteem and performance, it is more likely that good performance leads to high self esteem

boosting self esteem have not shown any improvement in performance and may sometime be counter productive.

People with high self-esteem claim they are more likable, attractive and have better relationships than others, but these advantages exist mainly in their own minds, the researchers found. Objective data, such as ratings by their peers, generally fail to confirm their high opinions of themselves, and in some cases, they are actually disliked more than others.

This article is very interesting, some hospitals are spending in programs, seminars and group dynamic activities just to increase a nurse's self esteem, with the above article saying that good performance leads to increase self esteem. maybe we should concentrate more on doing activities related to improving a nurse's competency.

reference

JILL ELISH "FSU study finds self-esteem programs don't work" from http://www.fsu.com/pages/2004/03/01/self_esteem.html