Wspólnotowy Serwis Informacyjny Badan i Rozwoju - CORDIS

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

In almost all European countries there is a big concern about the negative consequences implied by the nursing shortage on the quality of care provision. The NEXT-Study started in 2001 and ran until June 2005. In Italy, the investigation was carried out by means of pre-validated questionnaires on a longitudinal basis. The assessment of reasons and possible consequences of premature departure from nursing was based on the NEXT-Study conceptual model, depicting "push" and "pull" factors related to retention and recruitment of nurses into the healthcare system.

Nurses from public and private hospitals, long-term and home care services were sampled according to their distribution in the north, the centre and the south areas of the national territory. Out of a total of 7447 nurses approached in 2003, 5641 filled-in the baseline questionnaire.

In 2004, 4088 nurses who remained in their institution also filled-in the follow-up questionnaire. Of the 466 nurses who left the institution, 139 answered the exit and 131 the follow-up exit questionnaire. The study was conducted in the course of profound changes in the Italian healthcare system, during an unstable political situation and an important phase of severe economical recession.

However, significant measures were taken to ameliorate the professional profile of nurses through higher education, autonomy and managerial career opportunities. The Italian sample was characterized by: an high percentage of male nurses (25,9%) due to preceding unemployment rates in the south area and the impact of laws facilitating the entry of males into nursing; a low percentage of young nurses (9,1% <30y), since nursing was considered as not rewarding and with a poor social image; low percentage of old nurses (12% >50y) as a result of massive early retirement policies which were launched until recent years. Furthermore, Italian nurses were employed mainly in hospitals (86,3%), as transition to the territory was only partially accomplished.

Finally, the Italian sample consisted of a low percentage of ward sister and nurse managers, since steps of vertical or horizontal career were still lacking or not yet well organized inside the healthcare institutions.

Nurses reported high intent to leave nursing (20,7%) and even higher intent to change institution. Among nurses who remained, intent to leave the profession was elicited mainly by higher emotional demands only in the younger, while in both the younger and the older by lower career perspectives and higher work/home conflict. Out of the 101 nurses who left the institution and also responded to the exit questionnaire after the baseline, 71 continued to work inside nursing (70,3%), 6 outside (5,9%), while 24 didn’t answer the question.

One year after exiting previous institution, nurses declared to be more satisfied mainly in relation to their health and private life. These 71 institution leavers were characterized by higher intent to change compared to stayers, higher uncertainty concerning treatment, worry about making mistakes and work/home conflict, more understaffing and wish to change work schedule. Compared to stayers, nurses <45 yrs old who left their job (N=210) reported more job demands and work-home conflict, were born outside the region of employment, were without children or without support for childcare and more willing to change work schedules. Nurses over 50y with higher perceived health status reported better working conditions and effort/rewards balance. A protected physical work environment and the possibility to share and discuss problems among colleagues and other medical and administrative staff sustained nurses’ work ability.

In Italy, the major problems were related to fewer people entering nursing and to the high internal mobility among the younger.

Different social parts involved in confrontation on these results proposed the following: providing nurses with the possibility to certificate patient’s care needs as a way to improve their professional image towards the public and the institutions, better territorial distribution of nursing education posts or establishment of grants and housing facilities for sustaining nursing students’ internal mobility, more selective criteria to nursing applicants in order to avoid subsequent loss of students not bearing a real vocation for nursing, mentoring for the young and valorisation of older nurses’ expertise, assigning adequate time to care provision within hospitals and/or creating continuity of care between hospitals and home care services, more institutional support for a better matching between healthcare staff planning and staff private life obligations, providing more time for handovers, providing more sustainable nurse to patient ratios and more worker-oriented flexibility and mobility, renegotiating nurses’ institutional spaces of autonomy to match up their tasks and engagements with their professional skills.

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