4. DISCUSSION
Nurses are an integral part of the healthcare industry. However, there
continue to be nurse shortages throughout the country during the
COVID-19 pandemic. Increased baby boomers’ health care exacerbates the
need for more nurses, and other allied field works need demand;
therefore, retaining and reducing nurses’ attrition is imperative. Spetz
et al.19 suggested employing more internationally
educated nurses (IEN) to offset nurse scarcity and increase nurse
supply. However, hiring IEN may not be the only panacea to the problem
because this creates a ripple effect that may contribute to more
shortages in other areas. Another approach to the problem may be to
retain the existing nurses in the field by addressing some of the
underlying factors causing attrition in the industry.
Work environments do influence nurse job change due to stress. Some
literature studies7,14,16 suggested that a healthy
work environment does play a significant role in whether a nurse will
remain on the job. Interestingly, the results from the retrospective
analysis in this study showed there might not be a strong association
between nurse work environment and nurse job change due to work stress.
Unfortunately, nurses continue to leave the profession, so the question
remains why?
Some nurses cite increased stress and a higher nurse-to-patient ratio as
the reason for abandoning the field. In a study about nurse staffing and
outcomes, Shin, Park, and Bae21 suggested that a
higher nurse-to-patient ratio harms patient care. Also, Shin et al.21 indicated in the same study a direct relationship
between rising nurse-to-patient proportion and increasing odds for nurse
discontentment. While Shin et al.21 linked
dissatisfaction to patient outcome, this study also found a strong
association to nurse workplace and nurse job change due to work stress
while controlling for job satisfaction. Subsequently, in a literature
review study in which the authors examined 59 papers, Lu et al. and
Mcvicar22,23 asserted that nurse job contentment is
among a multiplicity of factors, including organizational empowerment,
work setting, employment stress, nurse to patient ratio, social support,
demographics, and evidence-based approach were associated. Because the
results from the odds ratio supporting dissatisfaction and job change in
the study were substantially significant, the finding from this study
supports the claim that the nurse-to-patient ratio may contribute to job
dissatisfaction, including job change due to nurse work stress.
The reason for nurses who are aged between 65 to 69 have lower odds for
no employment change related to work stress when compared to nurses aged
50 to 54; the reference category may be because those nurses have a
higher level of experience, including resilience, and may be because
they can transition to different jobs easily or retire from the
profession. Equally important, senior nurses aged 65 to 69 have
developed more substantial adaptation coping mechanisms over many years
of working in a high-stress nursing environment. Perhaps, another
possible explanation may be that most senior nurses aged 65 to 69 are in
a leadership position and may have less burden of job stress. Effective
leadership may play a fundamental role in nurse
retention24,25.
Effective leadership is essential in healthcare. O’Hara et
al.24 described the need for leadership encouragement
in healthcare by suggesting that millennial job satisfaction was closely
related to leaders providing sufficient help and guidance. In contrast,
Tyndall et al.26 does not support my finding that
nurse satisfaction may help mitigate or reduce retention. Numerous
studies have argued that dissatisfied nurses hurt patient safety and
quality improvement. Therefore, job satisfaction efforts need to be
encouraged. The results study seems to suggest that job satisfaction is
an excellent predictor of nurses seeking a job change. Subsequently, the
evidence from this research may indicate that nurses have a higher odd
of changing jobs due to stress when they are more dissatisfied when
compared to moderately satisfied, the reference category.
A comparison of the findings in this research may be consistent with
that of Liu et al.27 and Leng et
al.28 that showed that work stress contributed to
burnout and mental exhaustion, including some psychiatric disorders.
These psychiatric disorders and related stress may indirectly influence
nurses’ job changes. Subsequently, Falguera et al.29found that a conducive work environment has synergistic benefits that
may promote burnout reduction and job stress, including improving
patient care quality outcomes.