Service Communautaire d'Information sur la Recherche et le Développement - CORDIS

Germany: Premature departure from nursing and 'intention to leave nursing'

Introduction:
In Germany, the need for nurses has changed during the NEXT investigation. Until 2002, there was a lack of qualified nurses. Thereafter, additional financial constraints (mainly because of a DRG based reimbursement system) have resulted in the substantial reduction of hospital staff, mainly nursing staff. At the same time, national unemployment has increased considerably, making it more difficult for nurses to find alternative occupations. This is reflected by NEXT figures: In the basic assessment 2002/3 18.4% of all participants in Germany intended to leave the profession (which is high in relation to most other participating countries), one year later this figure decreased to 17.7%. At the same time the proportion of participants fearing to become unemployed increased from 9.4% to 20.2%. Consequently, the number of participants having left the profession was lower than could have been expected in the beginning of the study. Instead, the target of attention shifted towards those who would like to leave their job and cannot do so. This group of people is likely to increase substantially in Germany.

Results:
In the German Basic assessment (2002/3) 6,484 caring staff working in 75 health care institutions (hospitals, nursing homes and home care services) were approached and 3,565 returned the questionnaires (response rate 55%), one year later 6,115 people were approached of which 2,538 carers responded (41.5%). Between the two assessments, 529 carers have left their institution (Leavers) and received a leavers questionnaire, 213 people responded (40.3%).

- Results of the leavers assessment.
Of the 213 leavers, only 31 nurses have left the profession and continued working in another profession; 27 nurses stopped working, e.g. for family reasons; 17 nurses retired; 111 have left the institution and continued to work in health care.
The differentiated analysis shows that in Germany the main reason for leaving nursing (and continuing in other area) was dissatisfaction with the working conditions. This was followed by dissatisfaction with the social work environment, a perceived lack of challenge in work demands, and, finally, financial reasons. In contrast, those changing to another health care institution did so rather because of financial reasons, while the work content played a much lesser role.

- Results of the analysis of the nurses intention to leave the profession, ITL.
In Germany, the proportion of nurses intending leaving the profession was comparably high (18.4% in the basic assessment = ranking third after UK and Italy). There, risk factors for intending to leave the nursing profession were age (young nurses, maximum 25-30 years of age), - higher nursing qualification, - working in hospitals, - low professional seniority (max in 2nd professional year), - low health and low work ability.

By means of multiple logistic regression analysis, a substantial proportion of the variance of ITL could be explained (29%, selection: registered nurses in hospitals).

The main factors leading to the nurses wish to the leave nursing were:
- Lack of professional alternatives (10.4%, lack of professional promotion prospects, dissatisfaction with work prospects),
- Health reasons (9.6%, esp. psychological health),
- Work organisational factors (8,9%, low possibilities for development, low influence at work, too many tasks not belonging to nursing, receiving conflicting orders, time pressure),
- Private conditions (8.0%, work home conflict, living alone, being single parent, number of weekly working hours),
- Work Content (6.1%, high quantitative demands, confrontation with troublesome patients, physical risk factors),
- Social work environment (4.7%, and relation to nursing administration or physicians, low quality of leadership. Less influential were
- Individual opportunities (2.7%, afraid to get job / to become unable to work) and
- Objective opportunities (1.8%, open caring jobs in region, recent job offer from outside health care).

Dissemination and use potential:
The analysis of ITL (in Germany) shows that ITL may be a highly relevant indicator for health care on general level (national and international) but possibly to the same degree when comparing health care institutions. With respect to the national level, we have delivered new detailed knowledge concerning the underlying factors for the nurses wish to leave the profession. This knowledge shall be included in the (necessary) long term planning of the nursing work force in Germany. The results have been and will be presented to the stakeholders, which show a deep interest. Furthermore, our results show that ITL has the potential to identify attractive institutions, which then may be characterised by other institutional factors (see results above).

The results from the German assessment have received great national attention. Dissemination has been very active and will continue on all levels.

Informations connexes

Contact

Hans-Martin HASSELHORN
Tél.: +49-202-4392112
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