| Objective:Based on the Integrated Incentive Model of nursing staff and Basic Framework for nursing staff retention strategies,established by preliminary research,to establish the integrated retention strategies for nurses and to evaluate the effect of its application.In order to provide a reference for nursing managers to reduce the turnover rate and turnover intention of nurses,promote the retention of nurses,and reduce the loss of nursing human resources.Methods:By convenience sampling,4 general hospitals(two grade II,class A hospitals and two grade III,class A hospitals)in Jiangsu Province were included.The questionnaire designed by the research group was used to conduct a questionnaire survey on the directors of the nursing department of the included hospitals to understand the conventional nurse retention strategies in the included hospitals.Then,based on the Integrated Incentive Model of nursing staff and the Basic Framework for nursing staff retention strategies,combined with the research progress at home and abroad and the actual situation of included hospitals,the research team members discussed together to establish the integrated retention strategies for nurses,which mainly includes career management,performance management and stress management.Finally,the grade II and grade III hospitals included in the study were randomized into the experimental group and the control group.Taking the turnover intention of nursing staff as the sample size calculation index,according to the sample size estimation results based on the comparison of two sample means,the experimental group and control group of grade II hospital need to draw at least 177 nurses,and the experimental group and control group of grade III hospital need to draw at least 155 nurses.By cluster sampling,the clinical departments were chosen from high to low,according to the actual turnover rate of nurses in each clinical department of the included hospitals in the previous year,until the sample size was satisfied.Finally,7 departments including ICU,emergency department,pediatrics,obstetrics and gynecology,neurosurgery,orthopedics,and cardiovascular medicine in secondary hospitals have been chosen,totaling 10 nursing units;3 departments including ICU,emergency department,pediatrics in tertiary hospitals have been chosen,totaling 9 nursing units.Select nurses who meet the inclusion criteria in the nursing unit as the research objects,and finally the experimental group of secondary hospital included 187 nurses,the control group of secondary hospital included 190 nurses;and the experimental group of tertiary hospital included 194 nurses,the control group of tertiary hospital included 187 nurses.The experimental group has been given a one-year intervention using the integrated retention strategies for nurses,from January 2018 to December 2018.During the intervention period,the control groups of the secondary hospital and the tertiary hospital carried out their conventional nurse retention strategies.All data were collected before the intervention,6 months after intervention and 12 months after intervention.The questionnaires were used to measure nurses' turnover rate,turnover intention,job satisfaction,work environment satisfaction,organizational commitment and job burnout in order to evaluate the effect of the application of integrated retention strategies for nurses.Results:1.The integrated retention strategies for nurses:Include three dimensions: career management,performance management and stress management.Career management includes: career analysis,personal analysis,setting goals and routes,providing career development opportunities,assessment and evaluation.Performance management includes: conducting scientific work analysis;formulating performance evaluation standards;linking performance evaluation with nurses' recommendation,promotion,salary,career development,and job hiring.Stress management includes: pressure regulation knowledge lecture,stress event reviews,establish a three-level network mechanism of self-management--clinical department management--nursing department management,peer support.2.The intervention results for secondary hospital:Before the intervention,compared between the experimental group and the control group,there is no significant difference between the two groups in turnover rate(P>0.05).The total and all dimensions scores of the turnover intention,job satisfaction,and work environment satisfaction between the two groups have no statistically significant differences(P>0.05).Except the normative commitment,the total and all dimensions scores of the organizational commitment between the two groups have no significant differences(P>0.05).The scores of all dimensions of job burnout between the two groups have no statistically significant differences(P>0.05).Six months after intervention,there is no significant difference between the turnover rate in the experimental group and the control group(P>0.05).The total and all dimensions scores of the turnover intention in the experimental group are lower than the control group(P<0.05).Except the extrinsic rewards,the total and all dimensions scores of job satisfaction in the experimental group are higher than the control group,but only the total score of job satisfaction and family/work balance,interaction,professional opportunities,praise/recognition,control/responsibility have statistically significant(P<0.05).Except nurse participation in hospital affairs,the total and all dimensions scores of work environment satisfaction in the experimental group are higher than the control group,but the differences have no statistically significant(P>0.05).The total and all dimensions scores of the organizational commitment in the experimental group are higher than the control group,but only the total score of organizational commitment and the normative commitment and opportunity commitment have statistically significance(P<0.05).The scores of emotional exhaustion and depersonalization in the experimental group are lower than the control group,and the score of self-achievement is higher than the control group,but all the differences have no statistically significant(P>0.05).Twelve months after intervention,the turnover rate in the experimental group is lower than the control group and before the intervention,and the differences have statistically significant(P<0.05).The total and all dimensions scores of the turnover intention in the experimental group are lower than the control group,and except opportunity,the differences have statistically significant(P<0.05).The total and all dimensions scores of job satisfaction,work environment satisfaction,organizational commitment in the experimental group are higher than the control group,and the differences have statistically significant(P<0.05).The scores of emotional exhaustion and depersonalization in the experimental group are lower than the control group and the differences have statistically significant(P<0.05);and the score of self-achievement in the experimental group is higher than the control group,but the differences have no statistically significant(P>0.05).3.The intervention results for tertiary hospitals:Before the intervention,compared between the experimental group and the control group,there is no significant difference between the two groups in turnover rate(P>0.05).Except opportunity,the total and all dimensions scores of the turnover intention have no statistically significant differences(P>0.05).Except extrinsic rewards and praise/recognition,the total and all dimensions scores of job satisfaction have no statistically significant differences(P>0.05).Except nurse–physician relations,the total and all dimensions scores of work environment satisfaction have no statistically significant differences(P>0.05).Except opportunity commitment,the total and all dimensions scores of the organizational commitment have no statistically significant differences(P>0.05).Except the depersonalization dimension,the scores of other dimensions of job burnout between the two groups have no statistically significant differences(P>0.05).Six months after intervention,there is no significant difference between the turnover rate in the experimental group and the control group(P>0.05).The total and all dimensions scores of the turnover intention in the experimental group have no statistically significant differences compared with the control group(P>0.05).The total and all dimensions scores of job satisfaction are higher than the control group,and the differences have statistically significant(P<0.05).The total and all dimensions scores of work environment satisfaction in the experimental group are higher than the control group,and except the nurse foundations for quality of care,the differences have statistically significant(P<0.05).The total and all dimensions scores of the organizational commitment in the experimental group are higher than the control group,but only the total score of the organizational commitment and the emotional commitment,financial commitment and opportunity commitment have statistically significant(P<0.05).The scores of emotional exhaustion and depersonalization in the experimental group are lower than the control group,and the score of self-achievement is higher than the control group,and the differences have statistically significant(P<0.05).Twelve months after intervention,the turnover rate in the experimental group is lower than the control group and before the intervention,but the differences have no statistically significant(P>0.05).The total and all dimensions scores of the turnover intention in the experimental group are lower than the control group,but the differences have no statistically significant(P>0.05).The total and all dimensions scores of job satisfaction,work environment satisfaction,organizational commitment in the experimental group are all higher than the control group,and the differences have statistically significant(P<0.05).The emotional exhaustion and depersonalization scores in the experimental group are lower than the control group,and the differences have statistically significant(P<0.05);and the score of self-achievement in the experimental group is lower than the control group,but the differences have no statistically significant(P>0.05).Conclusions:The integrated retention strategies for nurses with career management,performance management and stress management can effectively reduce the turnover rate and turnover intention of nurses in secondary hospitals;and improve job satisfaction,work environment satisfaction,organizational commitment and relieve job burnout of nurses in secondary and tertiary hospitals.However,its effect on reducing the turnover rate and turnover intention of nurses in tertiary hospitals is not significant. |
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