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.