Fengzhi Zhang1*†
Chunhui Lin
Ruolin Jia- 1Department of Nursing, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- 2Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- 3Department of Reproduction, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- 4Department of Administration Office, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- 5Department of Infection Control, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
Background: It is critical to minimize nurse turnover to improve the quality of care and patient safety. In-depth investigation is required to better understand the factors related to nurses' turnover intentions.
Aim: This study aimed to determine the relationships between burnout, general wellbeing, and psychological detachment with turnover intention among nurses in China.
Methods: A cross-sectional survey using convenience sampling was conducted in one hospital in China between January 2023 and March 2023. A total of 536 nurses were surveyed using the General Wellbeing Schedule (GWB), the Maslach Burnout Inventory scale (MBI), the Psychological Detachment scale, and the Turnover Intention scale. The collected data were analyzed using SPSS 26.0 statistical software. The chi-square test and binary logistic regression analysis were used to explore the factors related to turnover intention.
Results: Our data demonstrated that the turnover intention scores were 13 (10, 15.75), with 56% of nurses exhibiting a high level of turnover intention. Binary logistic regression analysis results indicated that being on a contract (OR = 4.385, 95% CI = 2.196–8.754), working in the pediatrics (OR = 2.392, 95% CI = 1.267–4.514) or obstetrics (OR = 2.423, 95% CI = 1.145–5.126) department, and experiencing burnout (OR = 1.024, 95% CI = 1.008–1.041) were associated with a heightened level of turnover intention. Conversely, organizational satisfaction (OR = 0.162, 95% CI = 0.033–0.787) and general wellbeing (OR = 0.967, 95% CI = 0.946–0.989) were identified as factors that hindered the intention to leave.
Conclusions: Findings from this study suggest that nurses were employed on a contract basis, working in pediatric or obstetric departments, expressing dissatisfaction with the organization, reporting low general wellbeing, and experiencing high levels of burnout that require special attention. The identification of these risk factors can inform targeted interventions and support programs aimed at improving the wellbeing and retention of nurses in these settings.
1. Introduction
Nurses constitute the predominant occupational cohort in the healthcare sector, making up approximately 59% of the workforce; however, current trends show a projected shortage of 5.7 million nurses by 2030 (1), and nurse departures affect the global healthcare sector. In China, a rapidly aging population, nurse outflow, and an unbalanced distribution of the nursing workforce across the country make the shortage a long-term issue (2). A survey of the current WHO data reveals that China's nurse population density is still below the level of global distribution (3.75 nurses per 1,000 population) and much lower than that of developed countries, including the USA (14.6 nurses per 1,000 population) and the UK (8.2 nurses per 1,000 population) (1). Nursing staff shortages directly increase the workload of nurses in service, thereby negatively impacting job satisfaction and increasing the possibility of nurses exiting (3). In addition, patient safety and medical care quality are both affected by nurse staffing shortages, which also cut into the clinic's profit margin (4). While there are various factors attributed to the shortage of nurses, the principal factor is widely acknowledged to be the significant turnover of nursing staff (5). Nurses' turnover intention can significantly predict departure behavior (6). The likelihood that a nurse will leave his or her current organization or institution is defined as turnover intention (7). Nurses in different countries vary greatly in their degree of intention from 43% in Lebanon to 74% in Iceland (8). One study showed that a wide range of approximately 4% to 54% of nurses considered leaving the profession (9). The proportion of nurses in China who reported intention to leave ranged from 20% to 70% (10–12). Although much research has been conducted on the topic, the situation has clearly not improved, and more research is needed in this area to reduce nurse dropout rates (13).
Burnout significantly impacts nurse turnover (14), and high levels of burnout are a significant factor in nurses' turnover intention (15, 16). Burnout refers to chronic work stress that is not effectively managed, which in turn leads to emotional exhaustion, depersonalization, and low personal achievement, which is a common phenomenon in the healthcare profession (17). High burnout levels correlate with deterioration in safety and quality of care, patient satisfaction, and productivity (18, 19). Recognizing and controlling the factors associated with burnout is considered one of the strategies to reduce nurses' turnover intention (20, 21).
Nurse wellbeing is a vital factor in stabilizing the nursing workforce (22), and general wellbeing is a general psychological indicator of quality of life that reflects satisfaction with personal conditions (23). A favorable sense of wellbeing can improve nurses' psychological resilience and mental health and improve job satisfaction and performance (24, 25). According to findings, greater wellbeing is associated with lower absence and turnover intention and higher quality of care delivery (26). However, the impact on turnover intention from the perspective of general wellbeing has rarely been explored.
Moving away from work-related actions and thoughts is termed as psychological detachment from work, and it is regarded as an essential step in the healing process (27). Poor psychological detachment is strongly correlated with weariness, poorer sleep, and decreased wellbeing according to a prior study (28–30). Improving the level of psychological detachment from work can have a positive impact on patient safety, improve nurses' physical and emotional health, and enhance staff wellbeing (31, 32). Research indicates that psychological detachment can decrease nurses' turnover intention (33, 34), while research examining the impact of psychological detachment on turnover intention remains limited. This relationship requires further verification and in-depth exploration.
The characteristics of each job can be divided into work demands and resources based on the theory underlying the job demands–resources model (JD-R model) (35). In the workplace, job demands are the “negative variables” that drain an employee's energy, whereas job resources are the “positive factors” that make it easier to accomplish work objectives, lessen fatigue, and improve performance. Work resources become a motivational and supplementary way to mitigate the exhausting results of job demands and therefore significantly enhance employee wellbeing, which results in positive performance (36, 37). Based on the active process of the JD-R model, psychological detachment as a positive resource for individuals in the workplace helps restore individuals to their previous state during the process of burnout (38, 39), thus reducing nurses' turnover intentions. Other studies have demonstrated that psychological detachment from work might lessen stress related to work, which helps to prevent burnout (40, 41) and enhance nurses' wellbeing (30). Therefore, detachment from work and prevention of resource loss may increase nurses' willingness to stay in their jobs. However, few studies have examined the effects on nurses' turnover intentions from the perspective of psychological detachment and general wellbeing. Hence, this study aimed to explore the effects of burnout, general wellbeing, and psychological detachment on Chinese nurses' turnover intention.
2. Materials and methods
2.1. Design, setting, and participants
A cross-sectional survey using convenience sampling was conducted from January 2023 to March 2023 in a hospital in China. After being informed of the study's objectives, participants signed an informed consent form. The research was carried out using a paper questionnaire that included sociodemographic information, the General Wellbeing Schedule (GWB), the Maslach Burnout Inventory (MBI) scale, the Psychological Detachment scale, and the Turnover Intention scale. Finally, 536 eligible samples were analyzed for data. The inclusion criteria were being over age 18, having a nursing certificate from the People's Republic of China, working for more than a year, voluntarily engaging in the study, and providing complete informed consent. Nursing managers with the title of the head nurse or more, nurses working in administration, nurses on leave (sick leave, maternity leave, or marriage leave), and nurses suffering from serious illness were excluded.
2.2. Measurements
2.2.1. Sociodemographic information of nurses
Based on the preliminary study and review (10, 42–44), a sociodemographic questionnaire was designed to collect participant characteristics, including sex, whether being the only child or not, age, marital status, children, educational background, professional title, level of nursing, position, the form of employment, years of service, night shift work, weekly working hours, monthly net income (CNY), and satisfaction with the institution.
2.2.2. Turnover intention scale
We used the Chinese version of the 6-item Turnover Intention Scale, which was designed by Michael and Spector (45, 46), to evaluate participants' turnover intention as the outcome variable. The Turnover Intention Scale, which includes six items, covers three dimensions: one's probability of leaving a current job (2 items), the desire to look for another job (2 items), and the likelihood of finding a job beyond one's current sector (2 items). From “never” to “often,” all of the items were scored on a 4-point scale with values ranging from 1 to 4. The total points ranged between 6 and 24, and the turnover intention was stronger with a higher score. An entire average score of ≤1 indicated a very low desire for departure, >1 and ≤2 suggested a low desire to leave, >2 and ≤3 indicated a high desire to depart, and >3 indicated a very high desire to leave. The Chinese version of the Turnover Intention Scale showed good content validity (0.677) and reliability (Cronbach's alpha = 0.773) in its assessment (45). It is commonly used to measure nurses' intention to leave (42, 47). The Cronbach's alpha of the TIS-6 for the present study was 0.830.
2.2.3. Maslach burnout inventory scale (MBI)
The 22-item Maslach Burnout Inventory Human Services Survey (MBI-HSS) was employed to assess job burnout levels in the participants (48). This scale contains three dimensions, including emotional fatigue (EE), depersonalization (DP), and decreased personal achievement, which are rated on a seven-point Likert scale, from 0 = never to 6 = every day. The cutoff points for high risk were >26 for emotional exhaustion, >9 for depersonalization, and <33 for reduced personal achievement. As an international standard scale, when a respondent's score on any dimension exceeds the critical value, burnout can be diagnosed (49). The Chinese version of the MBI-HSS Scale has been shown to have excellent credibility and validity (50, 51). Cronbach's alpha (0.916 in this study) was tested to assess the reliability of this scale.
2.2.4. Psychological detachment from work
Sonnentag and Fritz constructed a four-item scale for assessing psychological detachment from work (38). The answers ranged from 1 (strongly disagree) to 5 (strongly agree) on a five-point Likert scale, with a sum score of 4 to 20 on the scale. Higher mean scores on the items suggest a greater level of psychological detachment. The Chinese version of the Psychological Detachment Scale, translated by Lu (34), demonstrated high reliability (α = 0.833) and satisfactory validity (r = 0.74) and has been employed in diverse studies (40, 52). The Cronbach's alpha score for this study was 0.909.
2.2.5. General wellbeing schedule (GWB)
Developed by Fazio (53), translated and revised by a Chinese scholar (54), the General Wellbeing Schedule (GWB), which has 18 items and 6 dimensions, was used to evaluate nurses' subjective wellbeing and how satisfied they were with their overall lives. Six dimensions focus on measuring health concerns (10, 15), energy level (1, 14, 17), emotional–behavioral control (3, 7, 13), satisfying interesting life (6, 11), depressed/cheerful mood (2, 4, 12, 18), and anxiety level (5, 8, 9, 16). Items 1, 3, 6, 7, 9, 11, 13, 15, and 16 were reverse-scored. With a full score of 120, the higher the score was the greater the happiness. The scores corresponding to low, moderate, high, and excellent general wellbeing were 0–24, 25–48, 49–72, 73–96, and 97–120, respectively. Previous studies (25, 55) have confirmed the GWB's reliability and validity. Cronbach's alpha coefficient in this study was 0.877.
2.3. Data collection
This survey was conducted from January 2023 to March 2023 after being reviewed by the hospital ethics committee, and consent was obtained from the hospital nursing department and chief nursing officer. A paper questionnaire was distributed to the clinical nursing units of the hospital by trained research staff, who conducted face-to-face, one-on-one surveys with participants. Participants in the study signed a written consent form willingly and also acknowledged their participation. All questionnaires were completed independently and took approximately 12 min. Participants were guaranteed anonymity and confidentiality. Figure 1 depicts the participants' flowchart.
Figure 1. A flow chart of the participants.
2.4. Data analysis
Frequency data were described using counts and percentages. The normality of continuous data was assessed using the Kolmogorov–Smirnov (K-S) test. Due to the non-normal distribution of variables, such as occupational burnout, general wellbeing, turnover intentions, psychological detachment total score, and scores for each dimension, descriptive statistics including the median and quartiles (M [Q25, Q75]) were utilized. Group comparisons were conducted using the chi-square test. Turnover intentions were treated as the dependent variable, with participants categorized into either the “low turnover intentions group” (Dimensional mean score ≤ 2) or the “high turnover intentions group” (Dimensional mean score >2). Pearson's chi-square test was employed to compare the two groups. Binary logistic regression analysis was performed to identify factors influencing turnover intention, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). Statistical significance was set at a p < 0.05 (two-tailed).
3. Results
3.1. Participant characteristics
A total of 536 valid questionnaires were analyzed. The participants were mainly women (95.1%) and married (70.3%). Most of them had obtained a bachelor's degree (90.1%), were at the intermediate or Junior (99.4%), and were general nurses (83.8%). Detailed information is shown in Table 1. In addition, the chi-square test results revealed statistically significant differences (P < 0.05) between the low turnover intention group and the high turnover intention group regarding variables such as age, marital status, children, professional title, nursing level, the form of employment, years of service, monthly night shifts, monthly net income (in RMB), ward of work, and satisfaction with the institution. Table 2 shows detailed information.
Table 1. Demographic characteristics of the participants (n = 536).
Table 2. Univariate analysis of the participants (n = 536).
3.2. Burnout, subjective wellbeing, psychological detachment, and intention to leave scores of the study participants and their correlation analysis
The overall mean scores of burnout, psychological detachment, subjective wellbeing, and intention to leave were 43(28,58), 12(8,14), 73(65,81.75), and 13(10,15.75), respectively. Spearman's correlation analysis showed that the turnover intention was positively correlated with burnout (r = 0.479, p < 0.01) and significantly negatively correlated with general wellbeing (r = −0.399, p < 0.01) and psychological detachment (r = −0.091, p < 0.05). Burnout was significantly negatively correlated with psychological detachment (r = −0.152, p < 0.01) and general wellbeing (r = −0.657, p < 0.01), and psychological detachment was significantly positively correlated with general wellbeing (r = −0.284, p < 0.01), as detailed in Table 3.
Table 3. Spearman correlation analysis and descriptive statistics of main variables.
3.3. Factors associated with turnover intention
In the binary logistic regression analysis, variables identified as statistically significant (p < 0.05) through univariate analysis and Spearman's rank correlation analysis were included as independent variables. The binary logistic regression analysis indicated significant associations between contract employment (OR = 4.385, 95% CI = 2.196–8.754), pediatrics (OR = 2.392, 95% CI = 1.267–4.514) or obstetrics (OR = 2.423, 95% CI = 1.145–5.126), work satisfaction with the organization (OR = 0.162, 95% CI = 0.033–0.787), burnout (OR = 1.024, 95% CI = 1.008–1.041), and general wellbeing (OR = 0.967, 95% CI = 0.946–0.989), and the level of nurse turnover intentions (Table 4). Specifically, nurses with contract employment, working in pediatrics or obstetrics, dissatisfaction with the organization, high levels of occupational burnout, and low levels of general wellbeing exhibited higher levels of turnover intentions.
Table 4. A binary logistic regression analysis of factors associated with nurses' turnover intention (n = 536).
4. Discussion
In this study, the mean total score for nurses' turnover intentions was 13 (10, 15.75), 56% of nurses have a high level of turnover intention, and these results are consistent with international studies on the same issue (36.5% to 64.9%) (56–59) but are lower than similar findings in China (11, 42). The difference may be due to the timing of the survey in this study; nurses who had the intention to leave may have already left, thus yielding a sample with a lower intention to leave (60). In addition, our study also found that contract nurses had higher turnover intentions than tenured nurses, which is consistent with previous studies (61). Contract nurses are paid less and receive fewer benefits than tenured nurses even though they perform the same job duties. This suggests that nurses working under contract arrangements may experience unique challenges or job-related factors that increase their likelihood of considering alternative employment options. Further investigation into the specific aspects of contract employment, such as limited job security or reduced benefits, could provide a deeper understanding of its impact on turnover intentions (62). In line with previous studies' findings (45, 63), nurses in pediatrics and obstetrics are more inclined to leave their jobs than those in other departments. This may be because pediatric or obstetrics work demands more time and effort due to the specificity of the population they serve and the high demand for nursing skills (64). Exploring the specific stressors and work-related challenges faced by nurses in these areas could shed light on interventions and support systems needed to improve retention rates. The study also found that nurses' turnover intentions were significantly influenced by their satisfaction with the institution, and those who were satisfied with their institution had less intention to leave, which aligns with the results of the previous investigation (65). Dissatisfaction with various aspects of the work environment, such as leadership, organizational culture, workload, or professional development opportunities, may contribute to nurses' decision to seek employment elsewhere (13, 66). It is essential for healthcare organizations to proactively identify and address these areas of dissatisfaction to enhance nurse retention and overall job satisfaction.
The mean score for nurse burnout was 43 (28, 56) with average scores of 20 (14, 27) for emotional exhaustion, 5 (2, 10) for depersonalization, and 16 (9, 23) for low personal accomplishment. These findings are in line with previous studies by Chen R (67) and Karimi L (68), indicating that nurses are currently experiencing moderate levels of burnout. Importantly, these results also suggest that the impact of COVID-19 on nurses' mental health may have been underestimated (69). Additionally, this study's findings revealed that nurses' turnover intentions were positively correlated with burnout; the higher the degree of burnout was, the more likely they were to leave, similar to the results of existing studies (70, 71). Therefore, managers should monitor nurses' physical and emotional symptoms and establish emotional and social support networks (72), such as the Three Good Things based on WeChat (73), to improve nurses' psychological wellbeing and thus stabilize the nursing workforce.
The total general wellbeing score in this study was 73 (65, 81.75), suggesting that the nurses in this study had high general wellbeing, a result that was higher than other reports (74, 75) and lower than Iranian findings (76). In addition, this research found a significant negative effect of general wellbeing on turnover intentions, and these results are similar to those of previous studies (77–79), indicating that enhancing nurses' wellbeing can reduce their turnover intentions and turnover rates. Wellbeing is a positive psychological feeling and cognition; the stronger the happiness of nurses is, the better their psychological adaptability, which helps them maintain career stability (25). However, a meta-analysis (80) showed that the wellbeing of Chinese healthcare staff was on the decline. Therefore, measures such as positive psychology interventions can be taken to improve the wellbeing of nurses and thus reduce the turnover rate (81).
The total score of psychological detachment in this study was 12 (8, 14), which is a moderate level of psychological detachment, a result similar to the findings of Majeed's (82) study and Allen's research (52) and lower than other results (83). In addition, binary logistic regression analysis in this research found no statistically significant effect of psychological detachment on nurses' turnover intention, which is inconsistent with previous studies (33, 34). The disparities observed between our study and earlier research may be attributed to variances in cultural contexts and the diversity of sample sources. Further research is needed in the future to explore the relationship between psychological detachment and turnover intention.
5. Conclusion
The findings of this study indicated that among the 536 Chinese nurses surveyed, the prevalence of turnover intention was 56%. Satisfaction with the organization, employment on a contract basis, working in pediatrics or obstetrics departments, general wellbeing, and burnout are identified as significant predictors of nurses' turnover intention. Understanding these factors is crucial for developing targeted interventions to promote the stability of the nursing workforce.
5.1. Limitations of this study
There are several limitations to this study. First, this study uses a convenient sampling procedure that is considered direct, practical, and appropriate to the study's objectives but may have introduced bias. Second, using self-report questionnaires may have biased the results. Then, because only nurses from a tertiary hospital in Henan Province, China, were included in this study, the results may not be generalizable. Therefore, the number and scope of the study population need to be expanded for a comparative study. Third, since this survey was cross-sectional research, the results were unable to clarify the association of dependency among the factors involved and turnover intention. Finally, we recommend further research on the mediating models of psychological detachment, general wellbeing, burnout, and turnover intentions in the future, which will likely facilitate the development of related theories.
5.2. Implications for nursing management
The results of this study indicate the need to improve the working conditions and benefits of contract nurses to reduce the gap between contract and regular nurses. Creating a positive, supportive, and collaborative work environment is essential to increase nurses' organizational satisfaction. Providing professional training and support is essential to help pediatric or obstetric nurses meet the specific challenges and needs of their respective fields while considering improving the benefits package in the relevant departments. In addition, attention to the physical and mental health of nurses and the provision of stress management training and psychological counseling are important considerations.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving human participants were reviewed and approved by the Ethics Committee of the Third Affiliated Hospital of Zhengzhou University and the Chinese Health Department. The patients/participants provided their written informed consent to participate in this study.
Author contributions
FZ contributed to editing the manuscript. CL participated in the drafting of the manuscript and survey design. XL participated in data collection. ML and RJ helped with data analysis and draft revision. The manuscript was examined by FZ, XG, and HB for quality and modifications were made in English. All authors contributed to the manuscript and approved the final version.
Funding
The Medical Science and Technology Research Project of Henan Province, China [LHGJ20190335], provided support for this study.
Acknowledgments
The authors deeply appreciate all of the participants and the ethical approval authorities for their contributions to this study.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. World Health Organization. State of the World's Nursing 2020: Investing in Education, Jobs and Leadership E.coli. (2020). Available online at: https://apps.who.int/iris/bitstream/handle/10665/331673/9789240003293-eng.pdf
2. Zhang H, Luo D, Lu Y, Zhu H, Zhang G, Li M. Growth and challenges of China's nursing workforce from 1998 to 2018: a retrospective data analysis. Int J Nurs Stud. (2021) 124:104084. doi: 10.1016/j.ijnurstu.2021.104084
3. Lu H, Barriball KL, Zhang X, While AE. Job satisfaction among hospital nurses revisited: a systematic review. Int J Nurs Stud. (2012) 49:1017–38. doi: 10.1016/j.ijnurstu.2011.11.009
4. Dewanto A, Wardhani V. Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC Nurs. (2018) 17:52. doi: 10.1186/s12912-018-0317-8
5. Sokhanvar M, Kakemam E, Chegini Z, Sarbakhsh P. Hospital nurses' job security and turnover intention and factors contributing to their turnover intention: a cross-sectional study. Nurs Midwifery Stud. (2018) 7:133–40. doi: 10.4103/nms.nms_2_17
6. Nei D, Snyder LA, Litwiller BJ. Promoting retention of nurses: a meta-analytic examination of causes of nurse turnover. Health Care Manage Rev. (2015) 40:237–53. doi: 10.1097/HMR.0000000000000025
7. Hayes LJ, O'Brien-Pallas L, Duffield C, Shamian J, Buchan J, Hughes F, et al. Nurse turnover: a literature review - an update. Int J Nurs Stud. (2012) 49:887–905. doi: 10.1016/j.ijnurstu.2011.10.001
8. Burmeister EA, Kalisch BJ, Xie B, Doumit MAA, Lee E, Ferraresion A, et al. Determinants of nurse absenteeism and intent to leave: an international study. J Nurs Manag. (2019) 27:143–53. doi: 10.1111/jonm.12659
9. Gizaw A, Lema T, Debancho W, Germossa G. Intention to stay in nursing profession and its predictors among nurses working in jimma zone public hospitals, South West Ethiopia. J Nurs Care. (2017) 7:1–8. doi: 10.4172/2167-1168.1000440
10. Tang Y, Dias Martins LM, Wang SB, He QX, Huang HG. The impact of nurses' sense of security on turnover intention during the normalization of COVID-19 epidemic: the mediating role of work engagement. Front Public Health. (2022) 10:1051895. doi: 10.3389/fpubh.2022.1051895
11. Hu H, Wang C, Lan Y, Wu X. Nurses' turnover intention, hope and career identity: the mediating role of job satisfaction. BMC Nurs. (2022) 21:43. doi: 10.1186/s12912-022-00821-5
12. Jiang F, Zhou H, Rakofsky J, Hu L, Liu T, Wu S, et al. Intention to leave and associated factors among psychiatric nurses in china: a nationwide cross-sectional study. Int J Nurs Stud. (2019) 94:159–65. doi: 10.1016/j.ijnurstu.2019.03.013
13. Hwang J, Song EK, Ko S. Relationships among basic psychological needs, organizational commitment, perceived authentic leadership and turnover intention in Korean nurses: a cross-sectional study. J Nurs Manag. (2022) 30:2176–84. doi: 10.1111/jonm.13546
14. Kelly LA, Gee PM, Butler RJ. Impact of nurse burnout on organizational and position turnover. Nurs Outlook. (2021) 69:96–102. doi: 10.1016/j.outlook.2020.06.008
15. Bourdeanu L, Pearl Zhou Q, DeSamper M, Pericak KA, Pericak A. Burnout, workplace factors, and intent to leave among hematology/oncology nurse practitioners. J Adv Pract Oncol. (2020) 11:141–8. doi: 10.6004/jadpro.2020.11.2.2
16. Lee SE, MacPhee M. Dahinten vs. factors related to perioperative nurses' job satisfaction and intention to leave. Jpn J Nurs Sci. (2020) 17:e12263. doi: 10.1111/jjns.12263
17. Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. (2016) 15:103–11. doi: 10.1002/wps.20311
18. Jun J, Ojemeni MM, Kalamani R, Tong J, Crecelius ML. Relationship between nurse burnout, patient and organizational outcomes: systematic review. Int J Nurs Stud. (2021) 119:103933. doi: 10.1016/j.ijnurstu.2021.103933
19. Brooks Carthon JM, Hatfield L, Brom H, Houton M, Kelly-Hellyer E, Schlak A, et al. System-level improvements in work environments lead to lower nurse burnout and higher patient satisfaction. J Nurs Care Qual. (2021) 36:7–13. doi: 10.1097/NCQ.0000000000000475
20. Jiménez-Labaig P, Pacheco-Barcia V, Cebrià A, Gálvez F, Obispo B, Páez D, et al. Identifying and preventing burnout in young oncologists, an overwhelming challenge in the COVID-19 era: a study of the Spanish society of medical oncology (Seom). ESMO Open. (2021) 6:100215. doi: 10.1016/j.esmoop.2021.100215
21. Hämmig O. Explaining burnout and the intention to leave the profession among health professionals - a cross-sectional study in a hospital setting in Switzerland. BMC Health Serv Res. (2018) 18:785. doi: 10.1186/s12913-018-3556-1
22. Raso R, Fitzpatrick JJ, Masick K. Perceptions of us nurses and nurse leaders on authentic nurse leadership, healthy work environment, intent to leave and nurse well-being during a second pandemic year: a cross sectional study. J Nurs Manag. (2022) 30:2699–706. doi: 10.1111/jonm.13712
23. Bi D, Li X. Psychological flexibility profiles, college adjustment, and subjective well-being among college students in china: a latent profile analysis. J Cont Behav Sci. (2021) 20:20–6. doi: 10.1016/j.jcbs.2021.01.008
24. Anglim J, Horwood S, Smillie LD, Marrero RJ, Wood JK. Predicting psychological and subjective well-being from personality: a meta-analysis. Psychol Bull. (2020) 146:279–323. doi: 10.1037/bul0000226
25. Gao T, Ding X, Chai J, Zhang Z, Zhang H, Kong Y, et al. The influence of resilience on mental health: the role of general wellbeing. Int J Nurs Pract. (2017) 23:20170314. doi: 10.1111/ijn.12535
26. Abdullah MI, Huang D, Sarfraz M, Ivascu L, Riaz A. Effects of internal service quality on nurses' job satisfaction, commitment and performance: mediating role of employee wellbeing. Nurs Open. (2021) 8:607–19. doi: 10.1002/nop2.665
27. Sonnentag S, Bayer UV. Switching off mentally: predictors and consequences of psychological detachment from work during off-job time. J Occup Health Psychol. (2005) 10:393–414. doi: 10.1037/1076-8998.10.4.393
28. Wendsche J, Lohmann-Haislah A. A meta-analysis on antecedents and outcomes of detachment from work. Front Psychol. (2016) 7:2072. doi: 10.3389/fpsyg.2016.02072
29. Sonnentag S, Fritz C. Recovery from job stress: the stressor-detachment model as an integrative framework. J Organ Behav. (2015) 36:S72–S103. doi: 10.1002/job.1924
30. Bennett AA, Bakker AB, Field JG. Recovery from work-related effort: a meta-analysis. J Organ Behav. (2018) 39:262–75. doi: 10.1002/job.2217
31. Buljac-SamardŽić M. Dekker-van Doorn C, Van Wijngaarden J. Detach yourself: the positive effect of psychological detachment on patient safety in long-term care. J Patient Saf. (2021) 17:490–6. doi: 10.1097/PTS.0000000000000479
32. Schulz AD, Schollgen I, Wendsche J, Fay D, Wegge J. The dynamics of social stressors and detachment: long-term mechanisms impacting wellbeing. Int J Stress Manag. (2021) 28:207–19. doi: 10.1037/str0000216
33. Singh P, Burke RJ, Boekhorst J. Recovery after work experiences, employee well-being and intent to quit. Personnel Review. (2016) 45:232–54. doi: 10.1108/PR-07-2014-0154
34. Lu D. Measurement of psychological detachment and its influence on the turnover intention of nursing staffs in the public hospital. Chin Hosp Manag. (2018) 07:65–9.
35. Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J Appl Psychol. (2001) 86:499–512. doi: 10.1037/0021-9010.86.3.499
36. Bakker AB, Demerouti E, Euwema MC. Job resources buffer the impact of job demands on burnout. J Occup Health Psychol. (2005) 10:170–80. doi: 10.1037/1076-8998.10.2.170
37. Steed LB, Swider BW, Keem S, Liu JT. Leaving work at work: a meta-analysis on employee recovery from work. J Manage. (2021) 47:867–97. doi: 10.1177/0149206319864153
38. Sonnentag S, Fritz C. The recovery experience questionnaire: development and validation of a measure for assessing recuperation and unwinding from work. J Occup Health Psychol. (2007) 12:204–21. doi: 10.1037/1076-8998.12.3.204
39. Kinnunen U, Feldt T, Siltaloppi M, Sonnentag S. Job demands-resources model in the context of recovery: testing recovery experiences as mediators. Eur. J. Work. Organ. Psychol. (2011) 20:805–32. doi: 10.1080/1359432X.2010.524411
40. Wang H, Xu G, Liang C, Li Z. Coping with job stress for hospital nurses during the COVID-19 crisis: the joint roles of micro-breaks and psychological detachment. J Nurs Manage. (2022) 30:7. doi: 10.1111/jonm.13431
41. Muhamad Nasharudin NA, Idris MA, Loh MY, Tuckey M. The role of psychological detachment in burnout and depression: a longitudinal study of malaysian workers. Scand J Psychol. (2020) 61:423–35. doi: 10.1111/sjop.12622
42. Cao J, Jia Z, Zhu C, Li Z, Liu H, Li F, et al. Nurses' turnover intention and associated factors in general hospitals in china: a cross-sectional study. J Nurs Manag. (2021) 29:1613–22. doi: 10.1111/jonm.13295
43. Ulupinar F, Erden Y. Intention to leave among nurses during the COVID-19 outbreak: a rapid systematic review and meta-analysis. J Clin Nurs. (2022). doi: 10.1111/jocn.16588
44. Tolksdorf KH, Tischler U, Heinrichs K. Correlates of turnover intention among nursing staff in the covid-19 pandemic: a systematic review. BMC Nurs. (2022) 21:174. doi: 10.1186/s12912-022-00949-4
45. Yang H, Lv J, Zhou X, Liu H, Mi B. Validation of work pressure and associated factors influencing hospital nurse turnover: a cross-sectional investigation in Shaanxi Province, China. BMC Health Services Res. (2017) 17:2056. doi: 10.1186/s12913-017-2056-z
46. Michael C, Spector PE. Causes of employee turnover: a test of the mobley, griffeth, hand, and meglino model. J Appl Psychol. (1982) 67:53–59. doi: 10.1037/0021-9010.67.1.53
47. Zhang Y, Wu X, Wan X, Hayter M, Wu J, Li S, et al. Relationship between burnout and intention to leave amongst clinical nurses: the role of spiritual climate. J Nurs Manag. (2019) 27:1285–93. doi: 10.1111/jonm.12810
48. Schaufeli WB, Bakker AB, Hoogduin K, Schaap C, Kladler A. On the clinical validity of the maslach burnout inventory and the burnout measure. Psychol Health. (2001) 16:565–82. doi: 10.1080/08870440108405527
49. Chao SF, McCallion P, Nickle T. Factorial validity and consistency of the maslach burnout inventory among staff working with persons with intellectual disability and dementia. J Intellect Disabil Res. (2011) 55:529–36. doi: 10.1111/j.1365-2788.2011.01413.x
50. Li C, Shi K, Luo Z. An investigation on job burnout of doctor and nurse. Chinese J Clini Psychol. (2003) 11:170–2. doi: 10.3969/j.issn.1005-3611.2003.03.004
51. Zhang S, Xu Y, Jiang J. Revision and application of mbi - human services survey in chinese police officers. Chinese Mental Health J. (2006) 20:85–8. doi: 10.3321/j.issn:1000-6729.2006.02.004
52. Allen BC, Holland P, Reynolds R. The effect of bullying on burnout in nurses: the moderating role of psychological detachment. J Adv Nurs. (2015) 71:381–90. doi: 10.1111/jan.12489
53. Fazio AF. A Concurrent validational study of the nchs general wellbeing schedule. Vital Health Stat 2. (1977) 73:1–53. doi: 10.1037/e409022004-001
54. Duan J. Results and analysis of the general wellbeing schedule in chinese college students. Chin J Clinical Psychol. (1996) 4:56–57.
55. Wu X, Yang Y. Survey of relationship between work environment and subjective wellbeing of nurses. J Shanghai Jiaotong University Med Sci. (2014) 34:913–8. doi: 10.3969/j.issn.1674-8115.2014.06.030
56. Mat Rifin H, Danaee M. Association between burnout, job dissatisfaction and intention to leave among medical researchers in a research organisation in Malaysia during the COVID-19 pandemic. Int J Environ Res Public Health. (2022) 19:20220814. doi: 10.3390/ijerph191610017
57. de Cordova PB, Johansen ML, Grafova IB, Crincoli S, Prado J, Pogorzelska-Maziarz M. Burnout and intent to leave during covid-19: a cross-sectional study of new jersey hospital nurses. J Nurs Manag. (2022) 30:1913–21. doi: 10.1111/jonm.13647
58. Maleki R, Janatolmakan M, Fallahi M, Andayeshgar B, Khatony A. Intention to leave the profession and related factors in nurses: a cross-sectional study in Kermanshah, Iran. Nurs Open. (2023). doi: 10.1002/nop2.1670
59. Gebregziabher D, Berhanie E, Berihu H, Belstie A, Teklay G. The relationship between job satisfaction and turnover intention among nurses in axum comprehensive and specialized hospital Tigray, Ethiopia. BMC Nurs. (2020) 19:79. doi: 10.1186/s12912-020-00468-0
60. Kleier JA, Lawrence C, Cavanaugh G, Schivinski E, Holland S, Bruewer J. Professional commitment, resilience and intent to leave the profession among nurses during the COVID-19 pandemic - a descriptive study. J Nurs Manag. (2022) 30:2577–84. doi: 10.1111/jonm.13788
61. Wang T, Chen Y, He Y, Shen L, Wang P, Zhu M, et al. Stressors, coping strategies and intention to leave the nursing profession: a cross-sectional nationwide study in China. J Nurs Manag. (2022) 30:4398–408. doi: 10.1111/jonm.13865
62. Zhang ZZ, Wang SS, Miao C, Su MZ, Chen T, Yao NA. Substantial differences in turnover intention between direct care workers in Chinese hospitals and long-term care facilities. J Am Med Dir Assoc. (2021) 22:696. doi: 10.1016/j.jamda.2020.09.006
63. Yang T, Li X, Wang Y, Yao X, Li S, Yan H. Current status and influencing factors of clinical nurses' turnover intention in tertiary grade a hospitals in Wuhan. Chin Nursing Manage. (2019) 19:569–74.
64. Yang YY, Chen JJ. Related factors of turnover intention among pediatric nurses in mainland china: a structural equation modeling analysis. J Pediatric Nurs. (2020) 53:E217–E23. doi: 10.1016/j.pedn.2020.04.018
65. Kavakli BD, Yildirim N. The relationship between workplace incivility and turnover intention in nurses: a cross-sectional study. J Nurs Manag. (2022) 30:1235–42. doi: 10.1111/jonm.13594
66. Labrague LJ, Nwafor CE, Tsaras K. Influence of toxic and transformational leadership practices on nurses' job satisfaction, job stress, absenteeism and turnover intention: a cross-sectional study. J Nurs Manag. (2020) 28:1104–13. doi: 10.1111/jonm.13053
67. Chen R, Sun C, Chen JJ, Jen HJ, Kang XL, Kao CC, et al. A large-scale survey on trauma, burnout, and posttraumatic growth among nurses during the COVID-19 pandemic. Int J Ment Health Nurs. (2021) 30:102–16. doi: 10.1111/inm.12796
68. Karimi L, Raei M, Parandeh A. Association between dimensions of professional burnout and turnover intention among nurses working in hospitals during Coronavirus Disease (Covid-19) pandemic in Iran based on structural model. Front Public Health. (2022) 10:860264. doi: 10.3389/fpubh.2022.860264
69. Aymerich C, Pedruzo B, Pérez JL, Laborda M, Herrero J, Blanco J, et al. Covid-19 Pandemic effects on health worker's mental health: systematic review and meta-analysis. Eur Psychiatry. (2022) 65:e10. doi: 10.1192/j.eurpsy.2022.1
70. Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and factors associated with nurse burnout in the us. JAMA Netw Open. (2021) 4:e2036469. doi: 10.1001/jamanetworkopen.2020.36469
71. Gu M, Kim YS, Sok S. Factors influencing turnover intention among operating room nurses in South Korea. J Nurs Res. (2021) 30:e192. doi: 10.1097/jnr.0000000000000467
72. Dopelt K, Bashkin O, Davidovitch N, Asna N. Facing the unknown: healthcare workers' concerns, experiences, and burnout during the COVID-19 pandemic-a mixed-methods study in an Israeli hospital. Sustainability. (2021) 13:16. doi: 10.3390/su13169021
73. Guo YF, Plummer V, Cross W, Lam L, Zhang JP. Impact of Wechat-based 'three good things' on turnover intention and coping style in burnout nurses. J Nurs Manag. (2020) 28:1570–7. doi: 10.1111/jonm.13111
74. Yu M, Yang S, Qiu T, Gao X, Wu H. Moderating role of self-esteem between perceived organizational support and subjective wellbeing in Chinese nurses: a cross-sectional study. Fronti Psychol. (2019) 10:02315. doi: 10.3389/fpsyg.2019.02315
75. Ren Z, Zhang X, Sun Y, Li X, He M, Shi H, et al. Relationships of professional identity and psychological reward satisfaction with subjective wellbeing among Chinese nurses. J Nurs Manag. (2021) 29:1508–16. doi: 10.1111/jonm.13276
76. Khosrojerdi Z, Tagharrobi Z, Sooki Z, Sharifi K. Predictors of happiness among iranian nurses. Int J Nurs Sci. (2018) 5:281–6. doi: 10.1016/j.ijnss.2018.06.008
77. Marques-Pinto A, Jesus EH, Mendes AMOC, Fronteira I, Roberto MS. Nurses' intention to leave the organization: a mediation study of professional burnout and engagement. Spanish J Psycho. (2018) 21:E32. doi: 10.1017/sjp.2018.30
78. Wang L, Li H, Li X, Zhang J, Lv Y, Jia P, et al. Current occupational well-being status and protective and risk factors of male nurses in Chengdu, China: a cross-sectional study. Nursing Open. (2022) 9:1700–8. doi: 10.1002/nop2.1194
79. Gillet N, Le Gouge A, Pierre R, Bongro J, Meplaux V, Brunault P, et al. Managerial style and wellbeing among psychiatric nurses: a prospective study. J Psychiatr Ment Health Nurs. (2019) 26:265–73. doi: 10.1111/jpm.12544
80. Sheng L, Zhao T, Liu J, Gao J, Peng H, Xin S. Changes of medical staffs' subjective wellbeing in China (2004-2020): a cross-temporal meta-analysis. Appl Psychol-Health Well Being. (2022). doi: 10.1111/aphw.12387
81. Li L, Peng L, Wang F, Xu H, Qu Q. Impact of positive psychology interventions on resilience and subjective wellbeing of nurses born in the 1990s. J Nurs Sci. (2021) 36:82–5. doi: 10.3870/j.issn.1001-4152.2021.14.082
82. Majeed M, Fatima T. Impact of exploitative leadership on psychological distress: a study of nurses. J Nurs Manag. (2020) 28:1713–24. doi: 10.1111/jonm.13127
Keywords: psychological detachment, turnover intention, nursing, burnout, general wellbeing
Citation: Zhang F, Lin C, Li X, Li M, Jia R, Guo X and Bai H (2023) The relationships between burnout, general wellbeing, and psychological detachment with turnover intention in Chinese nurses: a cross-sectional study. Front. Public Health 11:1216810. doi: 10.3389/fpubh.2023.1216810
Received: 04 May 2023; Accepted: 30 June 2023;
Published: 20 July 2023.
Edited by:
Yong Shian Shawn Goh, National University of Singapore, SingaporeReviewed by:
Jeffrey Woo, Curtin University, AustraliaOsnat Bashkin, Ashkelon Academic College, Israel
Copyright © 2023 Zhang, Lin, Li, Li, Jia, Guo and Bai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Fengzhi Zhang, zhangfz2003@zzu.edu.cn
†These authors have contributed equally to this work