الفهرس 
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Abstract
The current and projected shortage of nurses remains an ongoing issue for health care organizations. Mounting organizational and global attention is being focused on retention and recruitment of nurses. Among the causes of nursing shortage is turnover which is costly to the hospitals. In addition of direct costs of recruiting, hiring and training new nurses, turnover can have negative effects on quality of care, patient satisfaction and can reduce moral and satisfaction of remaining nurses.
It has become increasingly important to investigate the factors that contribute to nurses’ intent to stay which defined as nurses’ willingness and desire to stay with their current organization. One way to reduce turnover is to approach the issue from the prospective of what can be done to get nurses to stay in their current hospital. Perceived ownership, job involvement, career development, career advancement and authority are factors hypotheses to increase nurses’ intent to stay.
The bedside nursing shortage is continuing to rise, and health care organizations especially private hospitals are having trouble keeping their most experienced and competent staff. Hence the present study aims to determine the factors affecting nurses’ intent to stay in private hospitals. It is hoped that such study help administrators of health care organizations to understand which factors can prevent experienced nurses from leaving their organizations thereby reducing any associated negative impacts on patient care and increased costs.
Aim of the study:
This study aims to determine the factors affecting nurses’ intent to stay in private hospitals.
Setting:
The study was carried out in all inpatient units (n= 44) of eight private hospitals at Alexandria governorate. They were as follows: general units (n = 25), intensive care units (ICUs) (n = 14) and coronary care units (CCUs) (n = 5). The hospitals named, Alexandria New Medical Center Hospital, El Betrol Hospital, Mabert El Asafra Shark Hospital, German hospital, El Shefaa Hospital, Kasr El Shefaa Hospital, Louran Hospital and Victoria Hospital.
Subjects:
The study subjects included all nursing staff (n=350) assigned to previously mentioned units who were available during the period of data collection, with more than one year experience in the hospital. Their distribution was as follow:
Alexandria New Medical Center (n=73), El Betrol hospital (n=61), Mabert El Asafra Shark hospital (n=48), German hospital (n=42), El Shefa hospital (n=40), Kasr El Shefaa hospital (n=31), Louran hospital (n=30), Victoria hospital (n=25).
Tools of the study:
Five tools were used to conduct this study:
Tool (1) Perceived Ownership Questionnaire:
It was developed based on the work of Vandyne and Pierce (2004) and Moon (2005) and used to assess nurses’ perception of ownership in their work place. It consists of 12 items.
Tool (2) Perceived Job Involvement Questionnaire:
It was developed by Paullay et al. (1994) and used to assess nurses’ perception of their job involvement. It consists of 27 items classified under two dimensions: Job Involvement-Role (13 items) and Job Involvement-Setting (14 items).
Tool (3) Perceived Career Development and Advancement Questionnaire:
Part (1) Perceived Career Development Questionnaire:
It was derived from the turnover scale developed by Price and Muller (1981) and used to assess nurses’ perception of career development in their work place. It consists of 8 items.
Part (2) Perceived Career Advancement Questionnaire:
It was derived from job descriptive index developed by Smith (1969) and used to assess nurses’ perception of career advancement in their work place. It consists of 9 items.
Tool (4) Perceived Authority Questionnaire:
It was developed by Spreitzer (1995) and used to assess the nurses’ perception of psychological empowerment or authority. It consists of 12 items classified under four dimensions, namely: meaningful work (3 items), competence (3 items), self-determination (3 items), and impact (3 items).
Tool (5) Intent to Stay Questionnaire:
It was developed by Hinshaw and Atwood (1998) and used to assess nurses’ intent to stay. It contains 12 items.
In all tools responses were measured on five-points Likert scale ranging from (1) strongly disagree to (5) strongly agree. Reverses score were done for negative statements. Also, there was an open ended question about the causes to stay or leave the hospital. In addition, questions related to socio demographic and professional characteristics of nurses were added such as: age, sex, marital status…etc.
All tools were translated into Arabic by researcher, and tested for their validity by a panel of seven experts in the field of the study from the Faculty of Nursing, Alexandria University. Modifications were done based on their comments.
All tools were tested for their reliability using cronbach’ alpha coefficient test to measure the internal consistency of the items and they were all reliable.
A pilot study was carried out in 10% on staff nurses (n=40) based on the findings, modifications were made.
Data collection:
Data collection for this study was conducted by the researcher after meeting with each nurse to explain the aim of the study. Data collection took a period of four months from 1/1/2016 to 1/5/2016.
Data were statistically analyzed using number and percent, range, mean, mean score percentage and standard deviation. The following statistical tests were used: Pearson’s chi square test, Mont Carlo exact test and Fisher’s exact test, Pearson correlation analysis and Multivariate Regression Model to judge statistical differences among staff nurses in private hospitals regarding different variables in the study.
Results of the present study showed that:
1- More than half of the nurses were in the age group 20 to less than 25. More than half of the nurses were females. The highest percentage of nurses was working in intensive care unit while, the lowest percentage was working in coronary care units. In relation to the educational qualification, the highest percentage of nurses had bachelor of nursing science while, the lowest percentage of nurses had post graduate studies in nursing science. Concerning the years of experience since graduation, the highest percentage of nurses had less than 5 years experience, while, the lowest percentage had more than 15 years experience. Regarding the nurses’ position, the highest percentage of nurses is staff nurses while, the lowest percentage are in charge nurses.
2- Nurses’ perception of ownership, job involvement, career development, authority and intent to stay were moderate. While, Nurses’ perception regarding career advancement was low.
3- There were an intermediate significant positive correlation between mean score percentage of nurses’ perception of ownership, job involvement, career development, career advancement, authority and their intent to stay in hospitals.
4- The most independent factors affecting nurses’ intent to stay were ownership and job involvement.
5- There was a statically significant difference between the different study variables and some demographic and professional characteristics as follow:
There was a statistically significant difference among mean score percentage of nurses’ perception of ownership in relation to their age and position.
There was a statistically significant difference among mean score percentage of nurses’ perception of job involvement in relation to their marital status and position.
There was a statistically significant difference among mean score percentage of nurses’ perception of career development, career advancement and intent to stay in relation to their position.
There was a statistically significant difference among mean score percentage of nurses’ perception authority in relation to their working unit and position.
In the light of the study findings, the following recommendations are suggested:
The Hospitals’ Administrators have to:
Recruit new qualified nurses until reach optimal nurse- patient ratio and encourage internal recruitment for new vacancies.
Offer competitive basic salary, profit sharing as well as develop bonus program and reward system for nurses.
Establish staff development department in collaboration with Nursing Director to provide training programs and workshops for nurses to develop their knowledge and skills, provide newly hired nurses with proper orientation program, provide opportunities for continuous education and develop First Line Nurse Managers’ leadership skills through human relation and leadership development programs. This lead to increase nurses’ satisfaction and their intent to stay.
Provide fair opportunities for promotion and development through developing and application of clear policies for promotion and development.
The Nursing Directors have to:
Appraise First Line Nurse Managers’ leadership performance to ensure involvement of nurses in making decisions regarding their work and to encourage their creativity.
Assess nurses’ job satisfaction and their level of commitment frequently to determine any predisposing factors for leaving the hospital.
Develop clinical ladder for nurses’ advancement in the hospital in collaboration with the Hospital Administrators.
The First Line Nurse Managers have to:
Conduct frequent meetings and open discussion with nurses to identify and met their needs and problems, discuss issues related to their clinical practice as well as facilitate their participation in decision-making related to their work environment and patient care to improve their job satisfaction.
Provide a positive and supportive work environment for nurses through promoting teamwork, trust, respect, honesty, fairness, non blame system, flexible scheduling, listening to what they want to express as well as appreciating and acknowledging their efforts.