Servicio de Información Comunitario sobre Investigación y Desarrollo - CORDIS


NEXT NURSES EXIT STU Informe resumido

Project ID: QLK6-CT-2001-00475
Financiado con arreglo a: FP5-LIFE QUALITY
País: Belgium

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

In Belgium, there were 174,010 nurses and midwives in 2000, for 10 millions people. About 60% of them were working in hospitals, 25% in long-term care, the remaining 15% in home care services. The main professional categories were registered nurses and certificate nurses, i.e. 74% of the active work force. Despite these figures, health care settings have difficulties to employ qualified registered nurses and are sometimes obliged to recruit less qualified personnel. This problem is mainly due to the low activity rates in both male and female nurses. Recruitment difficulties are exacerbated by part-time nurses (45% in hospitals), pregnancy, maternity leaves and the breast-feeding period, and government initiatives to reduce working hours prior to retirement. Another problem related to the nurses employment and career is the turnover rate, ranging from 0.6% to 22.6% during the one-year follow up of the

Belgian sample.
Sample. 37 institutions were involved in the survey (hospitals, nursing homes and home care settings). 4257 of 6947 nurses approached (61.3%) returned the Q0. The response rate was 65% (range 20.7% to 100%). Q12 was sent to 5953 stayers, while during the follow up, 597 leavers received Qex. 257 leavers sent back the filled-in questionnaire. Results. In Q0, 9.3% of 3973 respondents who answered the "intent-to-leave" (ITL) question thought of giving up nursing completely monthly or more often. Those thinking of this "several times per month or more" were compared to those considering it less often or never.

Age was clearly associated with ITL in a curvilinear way. ITL was at a maximum in 30-to-34 years nurses. ITL was less prevalent in younger nurses and nurses over 50.
In the analysis, job dissatisfaction was considered as the single most important factor affecting nurse turnover and premature departure from the profession. Women job satisfaction was found to be significantly higher (m=6.9; n=3142), compared with men (m=6.6; n=324; p<0.005). Satisfaction with use of abilities was lower for men (m=5.4 versus m=5.8; p<0.001), which can reflect unease with the traditional image of nurses or a clash between what men do as nurses and what they think they should do to progress in their career. Job satisfaction appeared to vary with work setting: it was higher in home care (m=7.2) than in nursing homes and in hospitals (m=6.6) (p<0.0001).

This could be explained by the characteristics of home care (higher autonomy, rewarding relation with chronic patients). Job satisfaction increased with hierarchical level: head nurses were the most satisfied nurses (m=7.1), and staff nurses the least satisfied (m=6.8). This can be attributed to more decision latitude, a valued position within nursing hierarchy, and more professional and social recognition. Satisfaction was lower among specialized nurses (m=6.7) than among registered nurses (m=6.9; p<0.001). As suggested by Price and Mueller (1981), a higher level of training may lead to dissatisfaction if organisational constraints hinder the use or the development of knowledge and abilities, while these nurses have higher expectations towards management. Job satisfaction and professional commitment were negatively correlated with ITL, (r = -.38 and r = -.33) as well as work ability (r = -.35). The ratio between the prevalence of nurses with poor work ability index (WAI) and high ITL and with good WAI and high ITL was 2.79 (CI 95%: 2.56-3.05). The relationship between WAI and burnout was negative (r = -.55). The correlation between burnout and ITL was r = .36. Job satisfaction itself was highly correlated with all other variables, the association was higher with burnout (r = -.45) than with WAI (r = .42) or with professional commitment (r = .20). All these associations were significant at p<.001.

Among the sample of leavers, 80% had a new job when they voluntarily left their previous job and 13% were searching for a new job. 87% who prematurely left their job obtained a new job in the nursing sector, with hopingly better work conditions but with an identical hierarchical position. Those 13% who left nursing care remained in the social or health sector.

In the Belgian hospitals NEXT sample, nursing turnover varied from 0.6% to 13.1%. We compared low-turnover hospitals, defined as attractive, and high-turnover hospitals, defined as conventional. Findings show that factors related to the workplace are predictors of nurses ITL. Many of these variables are under the control of institution. In the future, the fit between nurses supply and increasing demand in various settings will be more difficult to ensure. Consequently, institutions need to address several basic issues to keep competent, motivated and happy nurses.

Management must listen to nurses concerns and provide flexible scheduling, adequate staffing levels, and appropriate rewards and recognition. Managers have also to create dynamic teams in which nurses have autonomy and accountability.


Sabine STORDEUR, (researcher)
Tel.: +32-2-7643956
Fax: +32-2-7643435
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