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Attractive institutions

In NEXT, it was observed that nursing turnover was not uniform across hospitals. In the Belgian sample, figures varied from 0.6% to 13.1% during the NEXT investigation period. We compared low-turnover hospitals, defined as attractive, and high-turnover hospitals, defined as conventional. To interpret variations in turnover, we explored the antecedents of commitment, job satisfaction and retention, i.e. managerial practices and work environment attributes, which are relevant characteristics to examine.

To define attractive and conventional institutions, we proceeded as follows : between September 2002 and September 2003, the number of nurses who had been present at Q0 and who had then voluntarily left the institution were recorded in the 16 hospitals recorded. An annual turnover rate could thus be computed. The institutions were then classified into four quartiles according to their turnover rate: (1) 0.6% to 3.1% (attractive hospitals); (2) 3.7% to 5.0%; (3) 6.3% to 7.4% and (4) 11.8% to 13.1% (conventional hospitals). We contrasted structural and organisational features of hospitals belonging to first and fourth quartiles.

Significant differences were obtained for the following dimensions (p<0.05). In attractive institutions, nurses reported a higher satisfaction regarding the value of their work, in terms of better fit between work content and their professional nursing ideal, better fit between nurses, personal and professional values and the philosophy of care advocated by the nursing department, and patient centeredness. Attractive institutions had a higher score with regard to nurse autonomy defined as independent clinical decision-making in the best interest of the patient. Relationships between staff nurses and the hierarchical levels (from the head nurse to the chief nurse executive) were perceived as better in attractive institutions. In attractive institutions, nurses felt their workload to be more acceptable than in conventional institutions. Nurses reported that they were less frequently confronted with emotional demands and difficult and troublesome physician relationships. The burnout level was lower than in conventional hospitals. Finally, nurses in attractive institutions reported fewer work-family conflicts, due to a good balance between work demands at hospital (foreseeable and flexible work schedules) and personal life.

As a whole, these features are typical of common variance sources:
- Transformational leadership, associated with strong supervisor support, individual consideration, and impetus for improved nursing practice;
- A high degree of organizational support associated with feelings of recognition and reward;
- Fairness and justice in human resources management practices, resulting in feelings of meaningful and valued work;
- Open and timely communication allied with some degree of formalization;
- Good relationships between colleagues, between physicians and nurses, resulting in a good overall organizational climate, favouring trust and respect, and leading to a higher commitment.

Dissemination of such NEXT results and further research should help hospital managers to identify the managerial practices and work environment attributes that lead to both a high level of quality of care and a good nursing staff attraction and retention. Acting on these attributes and creating a workplace that fosters retention might prevent the lower productivity caused by high turnover rates and help institutions in their human resources management. We can consider that such results and relevant management theory can lead our team into the development of a European model of attractive healthcare organizations.

Informations connexes

Reported by

UNIVERSITE CATHOLIQUE DE LOUVAIN
Clos Chapelle-aux-Champs 30 Box 3037
1200 BRUXELLES
Belgium