A Study On Clinical Nurses’ Intention To Stay And Its Influencing Factors In 3-A-grade General Hospitals In Shanghai Under The Two-Child Policy

BackgroundThe shortage of nurses has become an important issue restricting the development of global nursing.The nurses of third-grade class-A hospital(referred to as"3-A")general hospitals are under high work intensity and pressure,and their intention to leave and turnover rate have been at a relatively high level.Under the universal two-child policy,the female-dominated group of nurses is bound to face more family responsibilities brought by childbearing.The work-family conflict arising from limited resources will intensify during this period and may cause work-family imbalance.How can the hospital"reduce conflicts and maintain balance"to retain and stabilize these nurses?This problem has always been the critically difficulty point of nursing human resource management.ObjectivesThis project adopted a mixed research method to analyze the experience and feelings of female nurses in 3-A general hospitals on balancing work-family relationships under the universal two-child policy and to look for the key factors influencing their intention to stay.In addition,it aimed to investigate the role of work pressure,social support,role salience to their intention to stay,so as to provide a new intervention point for management to improve nurses’intention to stay,and enrich the application research of work-family related theories.Contents and MethodsMainly divided into two research phases:(1)By using qualitative research,semi-structured interviews were conducted with nurses who had two children in 3-A general hospitals(n=10)in Shanghai in order to understand their views on the work-family relationship,and their practices and experiences in balancing the relationship.(2)A cross-sectional survey was conducted with clinical nurses(n=376)in 3-A general hospitals in Shanghai with tools such as the nurses’Work Stressor Scale,Work-Family Balance Scale,Intention to Stay Scale,Social Support Rating Scale,and Role Salience Scale.The relationship and strength of each factor with the intention to stay and the adjustment effect of related variables were examined by using statistical methods such as multiple linear regression analysis,structural equation modeling,mediation and moderating effect analysis,etc.Results(1)Three major themes were drawn from the interview data:nurses can feel not only the promotion of work to family,but also the conflict between work and family;the increase in demand for personal roles from work or family intensifies nurses’work-family conflicts;to maintain a balanced work-family relationship,both self-adjustment and external support are needed.Family members are the maintainers of important boundaries in the family field,and family support is vital to maintaining the work-family balance of a two-child nurse.(2)The mean overall working pressure of nurses scored 2.17±0.60,which is at the moderate level.The intention-to-stay scored 3.42±0.67,which is also at the moderate level.For the work-family balance relationship,work interference with family has the highest score.In the dimension of role salience,the score of mother’s role salience is the highest.The social support score is 40.28±6.75 on average,which is problematic but not serious.(3)The results of multiple linear regression of nurses’intention to stay showed that 5variables,including work pressure(β=-0.175,P<0.001),work invasion family(β=-0.129,P<0.05),social support(β=0.150,P<0.01),nursing age(β=0.177,P<0.01),monthly income A1(β=0.112,P<0.05),monthly income A2(β=0.155,P<0.01)entered the regression equation,R~2=0.236.(4)The structural equation model shows that work stress has a significant positive predictive effect on work interference with family and family interference with work(β=0.559,P<0.001;β=0.476,P<0.001),and work stress has a significant negative predictive effect on intention to stay(β=-0.171,P<0.001).Social support has a significant positive predictive effect on intention to stay(β=0.223,P<0.001).Work interference with family has a significant negative predictive effect on intention to stay(β=-0.159,P<0.001);Work stress can indirectly and negatively affect the intention to stay through the work interference with family,part of the mediating effect is-0.116,and the ratio of mediating effect to the total effect is 40.00%(-0.114/-0.285).(5)The results of cluster analysis showed that the nurses were job-oriented accounted for the largest number,accounting for 37.50%;the second was a combination of both work and family,accounting for 24.47%.In hospital A,nurses who balances work and family have a moderating effect on the relationship between work interference with family and intention to stay(β=-0.603,P<0.05).ConclusionsThe oclnisnical married and childbearing nurses’intention to stay in the 3-A general hospitals is at a medium level,and their intention to stay is mainly affected by working age,income,work stress,work interference with family and social support.Nurses are most likely to feel that work interference with family,and have the lowest perception of work promoting the family.Work interference with family as an intermediary variable,affects the impact of work stress on nurses’intention to stay.Role salience only plays a partly moderating role in the nurses who balances both work and family.Tips:the management can cut in from the perspective of reducing work-family conflicts and improving family-work facilitation.On the one hand,it effectively improves the professional benefits of nurses,and on the other hand,it strengthens the social support of nurses,especially the welfare of nurses and their families,and perform targeted interventions according to nurses’role preferences to improve the intention of clinical nurses to stay in the 3-A general hospitals.