Establishment And Empirical Study Of Retention Strategies For Nurses Based On The Integrated Incentive Model

Objective: To establish nurse retention strategies based on the integrated incentive model and to evaluate the effect of the application of the nursing staff comprehensive incentive strategies in order to provide a reference for improving nurse retention and reducing the loss of nursing staff,and to provide policy suggestions for health administrative departments at the same time.Methods: This study is divided into two parts.The first part is to preliminarily construct retention strategies of nurses using integrated incentive model based on our previous analysis of nursing human resource loss factors,domestic and foreign literature review,as well as group discussion.According to the measures,we designed "Retention strategies of nurses in tertiary hospitals expert advisory questionnaire" and "Retention strategies of nurses in secondary hospitals expert advisory questionnaire",all the indexes were screened by Delphi expert consultation method to determine the retention strategies of nurses in tertiary and secondary hospitals ultimately.The second part is to carry out and evaluate the effect of the strategies.Nurses in four chosen clinical departments of two grade III,class A hospitals and two grade II,class A hospitals in Nanjing were selected from August 2017 to January 2018.The sample in tertiary hospitals contained 36 nurses in observation group hospital and 35 nurses in control group hospital.The sample in secondary hospitals contained 36 nurses in observation group hospital and 34 nurses in control group hospital.The control group only used its normal measures to manage.The observation group implemented the established comprehensive incentive measures of nurses for 6 months which were in combination with the practical situation of hospital,to make nurse career planning,strengthen performance management and optimize their work environment.All data were collected before the intervention and intervention after six months.The nursing staff questionnaire was used to measure nurse turnover intention,job satisfaction,work environment satisfaction,organizational commitment and job burnout in order to evaluate the effect of comprehensive incentive measures among nurses.Results:1.Experts’ opinions tended to be consistent after two rounds of consultation.The effective response rate of the two rounds of consultation are 96.97% and 93.75%;the expert authority coefficients are 0.834 and 0.836;the coefficient of variation of first-grade indexes、second-grade indexes and the third-grade indexes of nurse retention strategies in tertiary hospital are 0.085~0.162、0.085~0.164、0.090~0.193;coordination coefficient are 0.45、0.32 and 0.35(P<0.01).The coefficient of variation of first-grade indexes、second-grade indexes and the third-grade indexes of nurse retention strategies in secondary hospital are0.095~0.141、0.099~0.194、0.108~0.198;coordination coefficient are 0.57、0.52 and 0.44(P<0.01).Ultimately,retention strategies of nurses are composed of six aspects: rational allocation of nursing human resources,optimization of nurses working environment,the implementation of reasonable compensation incentives,strengthening performance management,nurse career management,and nurse education training.2.Tertiary hospitals: Compared between observation group and control group,there is no statistical difference between the two groups regarding turnover intention,job satisfaction,work ervironment satisfaction,organizational commitment,job burnout scores and related dimensions scores before intervention(P>0.05).Six months after intervention,the total turnover intention scores and all dimensions scores in observation group are lower than control group(P<0.05).The total job satisfaction scores and all dimensions scores in observation group are higher than control group,except the shift schedule,work and family balance,relationships with co-workers and work recognized scores have no significance(P>0.05).The total work ervironment satisfaction scores and all dimensions scores in observation group are higher than control group,except the enough manpower and high quality nursing services scores have no significance(P>0.05).The total organizational commitment scores and each dimension score are higher than control group(P<0.05).The emotional exhaustion and depersonalization scores are lower than control group,and the score of self-achievement is higher than control group(P<0.05),except depersonalization scores(P>0.05).Secondary hospital: Compared between observation group and control group,there is no statistical difference between the two groups regarding turnover intention,job satisfaction,work ervironment satisfaction,organizational commitment,and job burnout scores before intervention(P>0.05).Six months after intervention,the total turnover intention scores and all dimensions scores in observation group are lower than control group(P<0.05),except the external opportunity scores(P>0.05).The difference of total job satisfaction scores between two groups is not significant(P>0.05),except the welfare benefits and control of work(P<0.05).The total work ervironment satisfaction scores and doctor-nurse collaboration scores are higher than control group(P<0.05).The total organizational commitment scores and each dimension score are higher than control group(P<0.05).The emotional exhaustion and depersonalization scores are lower than those of control group,and the score of self-achievement is higher than control group,and the difference of emotional exhaustion score is statistically significant(P<0.05).Conclusions:1.The retention strategies of nurses in tertiary and secondary hospitals are composed of rational allocation of nursing human resources,optimization of nurses working environment,the implementation of reasonable compensation incentives,strengthening performance management,nurse career management,and nurse education training.Among them,nurse career management is the main strategy to motivate nurses remaining in tertiary hospitals.The implementation of reasonable compensation incentives is the main strategy to motivate nurses remaining in secondary hospitals.2.Comprehensive incentive strategies for nurses we established could be better applied to nursing human resource management in tertiary and secondary hospitals.Comprehensive incentive strategies could effectively reduce nurse turnover intention,improve their job satisfaction,work environment satisfaction and organizational commitment,decrease emotional exhaustion,and improve personal accomplishment of nurses in tertiary and secondary hospitals.