Forschungs- & Entwicklungsinformationsdienst der Gemeinschaft - CORDIS

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

In 2001, there were 120,000 employees working in the nursing professions in Finland. The availability of nurses has, so far, generally been good, but recruitment problems have arisen in some regions, and particularly regarding substitutes. The "image" of the field as a rewarding sector of work has declined, and it is becoming increasingly unclear whether the field will be sufficiently attractive in the future to recruit enough well-trained staff.

In Finland, 65 organizations were involved in the NEXT survey. 3970 nurses answered the basic questionnaire (response rate 77%), and the follow-up questionnaire was returned by 2941 respondents (66 %). Of 722 nurses who left their institution, 402 responded to the leavers' questionnaire (56 %), and 309 returned the leavers' follow-up questionnaire. Results: In the first questionnaire, 20 % of the respondents considered leaving the organization and 15 % leaving the profession. Intent to leave was most common among the young, the temporarily hired, those who had stayed less than a year in the institution, and those perceiving their economic situation to be strained as well as those who had experience of burnout. In addition, thoughts about leaving the organisation were more common among the better trained nurses, and thoughts about leaving the profession among male nurses and nurses with reduced work ability. Weak organizational commitment reported in the basic questionnaire was strongly associated with the follow-up intention to leave the organization (OR 3.41, p<.001, adjusted for many individual and organisational factors), as was also weak professional commitment with the intent to leave the profession (OR 4.44, p<.001).

Several work-related factors correlated with decreased commitment. The association was strongest with the feeling that own work is not meaningful or important, dissatisfaction with the way one's own abilities were put to use, dissatisfaction with the opportunities to give patients the care they needed, small possibilities for development, low level of influence, experience of bad atmosphere at work, low quality of leadership and poor promotion prospects. Of the respondents who returned the leavers' questionnaire, 40 % left of their own free will, while 16 % left because their contract was not renewed by the employer. Nearly one fifth left temporarily because of maternity leave and 12 % retired; these respondents are not considered as leavers. Weak organizational and professional commitment as well as the intent to leave was strongly associated with voluntary leaving (p<.001). Those who left were younger and their working contract was more often limited than those who stayed (Chi², p<.001). Age, working contract and commitment independently predicted leaving the institution. The present situation of the leavers was investigated about a year after they had left the institution. Of them, 40 % had returned to the same institution, 48 % worked in another institution, and 12 % were not in work at that moment. Only a few nurses had given up their profession, so it was not possible to compare their situation with that of the others. Nurses who changed institution were younger than those who returned to the institution that they had left (mean age 37.6 and 43.0 years, respectively) (p<.01). Regardless of age, those who had changed institution reported less experience of burnout (p<.05), higher work ability scores (p<.01), and less worry about being unable to work (p<.05) than those who had left and returned to their previous institution.

Thus, a year after taking the step of leaving, the wellbeing of those who changed to another institution, seemed to be better. Those who worked in a new institution were more satisfied with their work prospects (p<.01), the physical working conditions (p<.05), and their job as a whole (p<.05), and they also experienced less work-family conflict (p<.05) than those who had returned to the same place. As regards satisfaction with the salary, the groups did not differ. The results indicate that several work-related factors were associated with work commitment. It is possible to strengthen the nurses' commitment to working in their present institution as well as to continue working in the health care sector by improving the organization of work.

Additional attention should be paid to arranging the work so that nurses can use their abilities at work in an optimal way, and have good possibilities to develop further. It is important to ensure opportunities for continuous professional training, and to increase the possibilities to influence the work schedules. Special attention should be paid to the physical work environment of the older nurses. Young nurses' thoughts about leaving the profession should be reduced by ensuring as permanent work contracts as possible, and by defining their tasks so that they correspond to their professional education. Especially the health centre wards should be made more attractive for the nurses.

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