Factors Contributing Career Change among Nurses working at selected hospitals

Introduction

Good career choice outcomes should produce a series of positions that give opportunity for good performance, maintain a commitment to the field, and give high work satisfaction. In Egypt, nursing was considered as a chance to work in other countries. The image of nursing as a profession is affected by numerous factors that decide nursing as a career. These factors include media, public image, social prestige, nurses themselves, having a family member, relative, or a friend who is a nurse, role models, physician–nurse interaction, nursing educators, nurse preceptors, risk for violence, exposure to health hazards, and nursing education programs (Ali, 2017).

Nursing is defined as the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations. It is also defined as the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death (Kaur, Kanika, & Kumar, 2016).

The patient-nurse-staff ratios are directly associated with turnover intention levels in hospitals. The high-performing hospitals have an elevated level of nurse involvement and a flat management structure, and life-long learning is inculcated in the organizational culture. When structural empowerment is ingrained into a healthcare organization’s processes, organizational leaders are accessible and receptive to employee concerns, nurses can participate in policy decisions, and are involved in the governance of the organization, specifically related to their practice and nursing units (Lo, Chien, Hwang, Huang, & Chiou, 2018).

Career change is alternatively defined as any major change in work-role requirements or work context and as a process that may result in a change of job, profession, or a change in one’s orientation to work. Career change is 'the movement of a person from one job group to another (Ibarra, 2018). In nursing context, career change occurs when registered nurse may leave the nursing field to work in a different industry. Moreover, nurses who have been leaving profession were defined as follows: ‘a nurse who voluntarily discontinues nursing profession after working a certain time after graduation from the school of nursing’(Chang et al., 2015)

         Career change in relation to job refers to changes in the staff some leave and new employees begin. Turnover intentions, however, intention to change job– are considered an outcome of affective variables, while actual turnover also includes nurses retiring and leaving involuntarily. Turnover intention also measures what influences the nurses and makes them want to quit (Andresen et al., 2017).

One in four nurses wants to leave the job. The high turnover rate of nurses frequently results in a decrease in job satisfaction for the remaining nurses. Job satisfaction is a concept incorporating each of the nurses' subjective opinions on their 'satisfaction with the job (Valizadeh et al., 2016).

Therefore, there is a need to increase the recruitment of nurses into healthcare institutions and devise ways to retain the nurses. This is a major challenge in today's nursing shortage environment as many factors determine the reasons why a Registered Nurse (RN) would accept a certain job whether they will still work in the same institution after the employment or move to other more gainful areas of employment (Goodare, 2017).

There are many factors that have a major and decisive role to frame the nurses career change; which can be wages, job satisfaction, growth of the career, service conditions, work environment, style of supervisor, employee commitment, support of manager, organizational culture, and policies that support human resource. Career change of nurses is the results from number of pressures and attractive factors that can be done during the relationship of employment (Barthauer et al., 2020; Acosta-Ramos et al., 2021)

Moreover, there are various factors which implicit high rates of career change among nurses. These factors include high burnout, insufficiency of career development, poor advocacy from supervisors with shortage of autonomy in making the decision, pauper communication and connection within the organization, low self-esteem, ambiguity of role, high workload with insufficient income, and the exposition to injuries whether it is physically or psychologically (Al Shaibani et al., 2020; Brzostek, 2020; & Garcia and Marziale, 2021)

Significance of The Study

During the researcher work in fever hospital as a professional nurse, I noticed that there is an observable degree of dissatisfaction with nurse's career, and there is intent to leave and change nursing career as a whole.

Nursing manpower is one of the most important healthcare organizations that represent a critical element in their success. When there are career changes, the quality of care provided to the population will be at risk.  Efforts to retain nurses within the profession are critical for resolving the global nursing shortage, but very little research explores the factors affecting career changes in Egypt.

A recent study done in Middle Egypt by Ahmed et al., (2017) explored career changes and organizational commitment among staff nurses in a selected hospital at Beni- Suef city. It revealed that staff nurses had higher career changes in their hospitals and had a moderate level of total organizational commitment. There was a statistically significant negative correlation between organizational commitment and career changes among the nursing profession.

Also, a recent study done in Upper Egypt by Ali, (2017) to determine the societal factors that induce career change decisions among nurses working at different Sohag city hospitals revealed a highly statistically significant positive correlation between societal satisfaction and participants' decision to leave the nursing career.

Subjects and methods

Aim of the Study

The current study aims to investigate factors contributing to career change among nursing staff.

Research Questions:

1. What are factors contributing to career change among nurses?
2. Is there a relation between factors contributing to career change among nurses and their socio-demographic data?

Research Design

                A descriptive research design was utilized to fulfill the aim of this study.

Setting:

The study was conducted randomly at Fever Hospital and Minia University Hospital, Fever Hospital located in alhamiyaat square , El Minia، Minia Governorate, Egypt, this hospital was consisted  of  three building; The first building contain four floors; the first floor contains the emergency Department,  radiology, pharmacy, and all out patients clinics. The second floor contains; infection control team, quality team, nursing directors. The third floor contains isolation Department and investigation lab the fourth floor contain PCR lab. The second building contains three floors ; the first contain  dialysis unite, The second and third floor contain all in patients Departments. The third building contain two floors ;the first floor contains the HIV Department, The second floor contains hospital administration.

Minia Uuniversity Hospital located in Kurnish al/Nile street, El Minia، Minia Governorate , this hospital was consisted of  three building; The first building contains one floor; this floor contains the emergency Department, pharmacy, and all outpatients clinics. The second building contains three floors; infection control team, quality team, Operating Rooms (OR) and Intensive Care Units (ICUs), The second floor contains  investigation lab, and poison unit . The third floor contains; all inpatients Departments. The third building contains two  floors; which contain all inpatient administrative Departments.

Subjects

The study sample subjects included a convenience sample of staff nurses their age under 40 years working in Minia University and Fever Hospitals during the data collection period. Their total number was 128 nurses.

Inclusion criteria

• Male and female
• Under 40 years
• On working time

Data Collection Tools

Data was collected through the utilization of three scales as follows:

Tool (1): It was included three parts:

Part I: Personal data

It was used to collect data about nurses and encompass age, gender, marital status, residence, educational level, salary, and years of experience, place of work, health, and time spend with their family.

Part II: Factors contributing to career change questionnaire

It consists of four dimensions autonomy, job satisfaction, Burnout, and workload.

1)   Autonomy

Autonomy Likert scale: it was adopted from Blegen et al., (1993) to measure nurses' work autonomy. The researcher makes necessary adjustments and changes according to the nature of the selected topic.

Scoring system: The scale contains 12 items with responses ranging from 1 to 3 as the following (agree- neutral-disagree) with a scoring system (1-2-3) respectively. A total score of less than 50% was considered low, 50% -75% moderate, 75% or more high autonomy.

2)       Satisfaction

Job satisfaction scale:  it was adopted from Mueller and McCloskey, (1990), it consists of 25 items.

Scoring system: the responses were scored under three-points Likert scales, as 1 (dissatisfied), 2 (neutral), 3 (satisfied), Total score less than 50% was considered as low satisfaction, 50% -75% moderate job satisfaction, 75% or more was high job satisfaction.

3)       Burnout

Burnout Inventory (MBI):  it was adopted from Maslach and Jackson (2016), necessary changes were done according to the researcher's research needs after reviewing the literature. It contains (10) items with responses ranging from 1 to 3 as the following (often-always-never), with the scoring system (1-2-3) respectively. Total score less than 50% was considered low burnout, 50% -75% moderate burnout, 75% or more was high burnout.       

4)       Workload

Workload it was adopted from Rosen et al. (2018), consist of (9) items, with responses ranging from 1 to 3 as the following (agree-neutral-disagree) with the scoring system (1-2-3) respectively. Total score less than 50% was considered low workload, 50% -75% moderate workload, 75% or more was high workload.

Part III: Social factors

It was adopted from Ali,  (2017) to determine social factors included the society in Upper Egypt respects nursing career and their employee, the societal view of the reasoning of entering nursing is the need for money, society views nurses who work at night shifts as if they have a deviant behavior, nurses' behavior and attitude are suspected in the society, mass media show nurses in bad behavior, being a nurse does not affect their relations in the society, the family respects them as a nurse and supports them all the time when they decided to be a nurse, the family supports them, the Egyptian laws and legislation protect nursing, and they think that the Egyptian Nursing Syndicate support nurses everywhere.

Social factors Likert scale: it consists of 10 items that assess the participants' perception about possible societal factors that affect nurses' career change. With scoring system: 1 (disagree), 2 (neutral), and 3 (agree). Total score less than 50% was considered low effect of social factors, 50% -75% moderate effect of social factors, 75% or more were high effect of social factors.

Validity and Reliability of Tool:

The tool was submitted to a jury of 5 experts in the field of nursing administration field to determine its applicability and content validity, and modification was done.

Reliability of the tools ( tool: ІІ, ІІІ) was performed to confirm the validity of the tool and calculated statistically. The internal consistency was measured to identify the extent to which the items of the tool measure the same concept and correlate with each other by Cronbach’s alpha test.

Cronbach’s alpha reliability test for tools of data collection

Pilot Study:

  A pilot study was carried out before starting data collection on 10% of nurses from Fever Hospital and Minia university hospital. This pilot study aims to test the clarity, comprehensiveness, accessibility, and applicability of tools and estimate the appropriate time required to fill the questionnaire. It also served to estimate the time required for filling the questionnaire sheets, which was about 20 minutes. They were included in the main study subjects during the actual collection of data. The process of pilot study took two weeks (from 05/1 to 20/1) in January 2020.

Ethical Considerations:

A written initial approval was obtained from the research ethics committee of the Faculty of Nursing, Minia University.  An informed consent was obtained from the Undersecretary of the Ministry of Health and Minia University. Collecting the study data before data collection, after explanation of the purpose of the study, the participants were informed that their participation in the study was completely voluntary and there was no harm if they not participate in the study.  Confidentiality, anonymity and privacy were assured.

Data Collection Procedure:

Approval to conduct the study was obtained from the Undersecretary of the Ministry of Health and Minia University , Meet directors of Fever Hospital and Minia university Hospital to gain cooperation . Questionnaire was translated from English language to Arabic language. Participant was self administred questionnaireto explain the nature and purpose of the study. The questionnaire was distributed for nurses to fill it. After distribution of the sheet, the researcher explained the content of each part of the tool.  Nurses Participant was meet in a groups to explain the purpose of this study. Each group consisted of five to seven nurses. Then, the questionnaire was introduced for nurses to be filled. After distribution of the sheet, the researcher explained the content of each part of the tool. Data collection was done during the morning, afternoon, and night shifts two days/week, from January to June 2020.

Data processing and analysis:

data of this study were processed and analyzed using number of sheets collected from the study subject as follows: For Minia University Hospital (sheets= 68), and for Fever Hospital (sheets= 60). Data were fed to the computer and statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 20). Significance of the obtained results was judged at the 5 % level of significance. Quantitative data were expressed as frequency and percentage. For quantitative data, comparison between two variables was done using t-test, and comparison between more than two variables used ANOVA test. Probability (p-value) ٧ less than 0.05 was considered significant

Results

Table (1): Distribution of the staff nurse personal characteristics (n=128).

Table (1): shows that the mean age of studied nurses was 30.3 ± 5.4 years. Regarding gender, 78.1 % of the studied nurses were females, 43.8% had diploma nursing, and 57.8% lived in rural areas. Concerning marital status, 71.1% of the studied nurses were married, 88.3% of them had unsatisfied with their salary, and 61.7% of them had 1- < 10 years' experience in the nursing field.

Figure (1): Levels of factors contributing to a career change among the studied staff nurses (N=128).

Figure (1): illustrates  that 82.0%, 80.5%, 77.3, and 52.3% of the studied nurses had moderate level of total anticipated factors, job satisfaction, burnout level, and autonomy, respectively, while 64.1%, 41.4%, 21.1%, 18.0%, 14.8% of them had high-level workload, autonomy, Burnout, anticipated factors, and job satisfaction respectively.

Figure (2): Levels of social factors contributing to a career change among the studied staff nurses' (N=128).

Figure (2): illustrates that 53.1% of the studied nurses had moderate social factors to career change, 44.5% of them had a high level, and 2.3% had low levels.

Table (2) Mean scores of Factors Contributing Career Change among staff nurses (n=128)

T-test was used for quantitative data,*Significant difference between groups (p-value ≤ 0.05), NS= Not Significant difference.

Table (2): presents that mean scores of job satisfaction and Burnout are higher among studied nurses in fever hospital than studied nurses in Minia university hospital with statistically significant differences p-value ≤ .01 & .028 respectively.

Table (3) Mean scores comparison between of Factors Contributing Career Change among staff nurses educational qualification (n=128)

ANOVA- test was used for quantitative data,*Significant difference in between groups (p-value ≤ 0.05)     NS= Not Significant difference

Table (3): presents that mean scores (21.98+2.30) of diploma nurses higher than other educational qualifications regarding Burnout with statistically significant differences, mean scores (22.97+2.22) of technical nurses higher than other educational qualifications regarding positive social view with statistically significant differences, and mean scores (29.04+3.45) of bachelor nurses higher than other educational qualification regarding autonomy with statistically significant differences but mean scores (52.08+5.60) of bachelor nurse higher than other educational qualification regarding job satisfaction and workload dimension with no statistically significant differences.

Table (4) Mean scores comparison between of Factors Contributing Career Change and gender among staff nurses  (n=128)

T-test was used for quantitative data,*Significant difference in two groups (p-value ≤ 0.05)     NS= Not Significant difference.

Table (4): shows that mean scores (27.04 ± 4.32 & 21.57 ±2.46 respectively) of female nurses higher than male nurses regarding autonomy and burnout with statistically significant differences. In comparison, mean scores (51.50 ± 6.58 &21.42 ± 2.53 respectively) of female nurses were higher than male nurses regarding job satisfaction and workload dimension with no statistically significant differences but mean scores (23.35 ±1.83) of male nurses were higher than female nurses regarding positive social view dimension with no statistically significant differences.