The Study of Nurse’s Work Alienation and Its Influence on Turnover Intention ()
1. Introduction
As an important force in realizing the “Health China 2030” strategy, the quantity and quality of nurses are directly related to the supply and quality of medical and health services [1]. In order to meet the overall needs of the development of national health, meet the people’s diversified and multi-level nursing needs, strengthen the nursing workforce construction work, enhance the sense of professional honor and mobilize nurses’ enthusiasm is the basic work for the development of health care in China [2]. But in any industry, there are separation phenomena and will change with the society changes. Nurses are one of the high turnover groups in the health care industry. The human resource crisis in nursing is also faced by all countries today [3].
Work alienation is a workplace phenomenon of negative work attitudes, understood as a separation or disconnection from work caused by the needs or expectations of employees, emphasizing the relationship between work and work environment, that is, a person’s psychological alienation in the environment will not be able to establish an emotional relationship with the organization, resulting in a low-level contact between employees and work, manifested as a sense of helpless, helplessness and meaningless feeling and other psychological and behavioral [4]. If they are not accommodated in a timely manner, they may lead to a propensity to leave or even develop into separation behavior [5]. Turnover intention is the likelihood that an individual will change his or her job within a certain period of time [6], and it is an antecedent variable of turnover behavior, which has good predictive power for actual turnover behavior, which can reduce the quality of care and increase labor costs [7]. This study aims to provide theoretical references for nursing managers to effectively reduce nurses’ willingness to leave and stabilize the nursing workforce through the investigation and analysis of clinical nurses’ work alienation and turnover intentions.
2. Materials and Methods
2.1. Participants
From May to August 2021, the hospitals ranged in size from 400 beds to 1200 beds and were run by a non-profit organization affiliated with the Wuhan province. All nurses including the department of internal medicine, surgery, emergency medicine, obstetrics and gynecology, pediatrics and intensive care units who were currently full-time employees in the study.
2.2. Instruments
The general socio-demographic information questionnaire of the study subjects was designed by the researcher, which included the gender, age, working hours, nature of employment, education, title, position, and marital status of the study subjects.
The work alienation of the nurse’s questionnaire developed by Xiaojing Ren [8] was used, including three dimensions of helplessness feeling, helpless feeling, and meaninglessness feeling, with four items per dimension, for a total of 12 items. Each item was scored on a 5-point Likert scale from 1 to 5 on a scale from “not conform” to “very conform”, with higher scores indicating a stronger sense of alienation among nurses. The Cronbach’s alpha coefficient of the questionnaire was 0.89.
Micheal and Spector [9] developed the turnover intention of the nurse’s Scale in 1982, which was translated and revised by Jingyuan Li et al. [10]. The scale contains three dimensions (six items), namely, the likelihood of quitting the current job, the motivation to find another job, and the likelihood of obtaining an outside job. The Likert 4-point scale was used, with “never” scoring 1, “rarely” scoring 2, “occasionally” scoring 3, and “often” scoring 4. The higher the score, the stronger the intention to leave. The overall Cronbach’s alpha coefficient of the scale in this study was 0.830, and the Cronbach’s alpha coefficients of each dimension were 0.719, 0.762, and 0.787, respectively.
2.3. Methods
Using a convenience sampling method, potential participants’ names and units were obtained from personnel departments at the three hospitals which the school has a relationship. Individual departments at each hospital, including nursing and other departments, were contacted to schedule dates for administering the survey. The questionnaires were then distributed to participants with a cover page explaining the purposes and procedures of this study. All questionnaires were then collected by the researcher or were returned with the consent form in the addressed envelope provided or in mailboxes at the hospitals.
A total of 1200 questionnaires were distributed in this study, 1180 were collected, 1112 were valid, and the effective recovery rate was 93%.
2.4. Data Analysis
An Excel database was established and SPSS 22.0 software was used for statistical analysis, with double entry and checking of the data to ensure the correctness of the data. General socio-demographic data, work alienation and scores of each dimension, willingness to leave and scores of each dimension of clinical nurses were statistically described using, composition ratios; two independent samples t-test or ANOVA was applied for one-way analysis of work alienation; Pearson correlation analysis was applied for correlation between turnover intention and work alienation; with the level of statistical significance set at P = 0.05.
3. Results
3.1. Participant Demographics
Among the 1112 subjects included in the study, 30 (2.7%) were male and 1082 (97.3%) were female; age ranged from 20 to 52 years, with a mean age of (31.05 ± 6.33) years; initial education: 902 (81.1%) were specialists, 300 (18.9%) were bachelor’s degree and above; highest education: 569 (51.1%) were specialists, 546 (48.8%) were bachelor’s degree and above; marital status: 711 (63.9%) were unmarried, 375 (33.7%) were married, and 26 (2.3%) were others; job establishment: 329 (29.7%) were formally on the staff. 546 (48.8%); marital status: 711 (63.9%) unmarried, 375 (33.7%) married, 26 (2.3%) other; job establishment: 329 (29.6%) formally on staff, 783 (70.4%) personnel agency or contract system, the rest see Table 1.
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Table 1. Participant demographics (N = 1113).
3.2. The Work Alienation of the Nurse’s Score
The total score of work alienation among nurses was (30.32 ± 9.84) and the scores of each dimension were: helplessness feeling (11.81 ± 3.83), helpless feeling (9.04 ± 3.62) and meaninglessness feeling (9.46 ± 3.82).
3.3. The Turnover Intention of the Nurse’s Score
The total score of nurses’ turnover intention was (14.83 ± 3.99) and the scores of each dimension were: value conflict dimension (4.80 ± 1.70), individual responsibility dimension (4.57 ± 1.73) and failure to maintain the best interests of patients (5.46 ± 1.33).
3.4. Comparison of Work Alienation among Nurses with Different Demographic Characteristics
The results showed that there was a statistically significant difference (P < 0.05) in the total work alienation score of nurses comparing the scores of different positions, titles, salaries, departments, and years of work, as shown in Table 1.
3.5. Correlation Analysis of Work Alienation and Turnover Intention of Nurses
Pearson correlation analysis showed that the total nurse’s work alienation score was positively correlated with the total turnover intention score and its dimensions, as shown in Table 2.
4. Discussion
The results of this study showed that nurses’ work alienation score was 30.18 ± 9.24, which was at a medium level and was basically consistent with the findings of Xiaohe Chen [11], and the scores of each dimension were, in descending order, meaninglessness feeling, helplessness feeling, and helpless feeling. In a study by Tong Zhong et al. [12], it was shown that nurses’ sense of work alienation leads to silent behavior, which affects organizational effectiveness, hinders organizational innovation, reduces employee satisfaction, generates job burnout, and is detrimental to the development of nurses themselves and the organization. In addition, in a survey of 287 emergency department nurses by Qiongjie Zhang [13], it was shown that quality of life of emergency nurses was negatively correlated with work alienation. Nowadays, with the fierce competition in nursing work, the constant updating of professional knowledge, the complexity of work appraisal mechanism and the increasingly severe nurse-patient relationship [14], coupled with the special characteristics of hospital work environment and service recipients, the work pressure faced by nurses is constantly increasing, and when the welfare and salary are often unsatisfactory, they are unable to realize the improvement of self-worth in their work, which is very easy to generate burnout and create a sense of work alienation. It is known that nurses are the key to patients’ recovery.
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Table 2. Correlation between work alienation and turnover intention of nurses (r value).
**P < 0.01 *P < 0.05.
It is known that nurses are one of the important determinants of patients’ recovery, and the psychological environment of nurses plays a vital role in patients’ recovery. If nurses show sincere feelings and optimism in the nursing process, patients can also gain more confidence and positive attributions in the recovery process. Therefore, reducing nurses’ work alienation is a proven measure for both the establishment of a good doctor-patient relationship and the improvement of the medical environment.
This study showed that nurses’ intention to leave their jobs scored (14.83 ± 3.99), which is basically consistent with the findings of Duan Yinglong [15], where the highest scoring dimension was the possibility of obtaining another job and the lowest scoring dimension was the possibility of finding a job of another department. The results suggest that the study subjects have a strong initiative and advantage in employment and career selection, with the expansion of nurses’ scope of practice and increased flexibility in career selection, and the current medical environment, where there is a general shortage of nurses [16], the study subjects work in tertiary general class A hospitals, where nurses have higher professional quality and business ability, and nurses have increased opportunities to choose different forms of hospitals, such as community nursing, hospice care, family wards, etc., but on the other hand, due to the technical, knowledgeable, and professional nature of nursing work and the nursing education received over the years, many nurses do not completely abandon the nursing profession even if they have the will to leave [5]. This also gives nursing managers a hint to improve nurses’ work mechanism and help nurses realize their own value by guiding them to make scientific career planning in order to minimize their willingness to leave.
The results of this study indicate that nurses’ work alienation has a positive effect on their willingness to leave, which is consistent with the results of a related study [8], suggesting that the higher the nurses’ work alienation, the stronger their willingness to leave accordingly. Affective event theory [17] suggests that employees are affected by work events that affect their emotions and cause them to have positive or negative emotions, which in turn affect their behavior. Specifically, nurses’ perceived job loss, job performance, salary advancement, excessive competition and interpersonal disturbances all affect their emotions and mood changes, which affect their quality of work life and make their quality of work life lower, which in turn affects nurses’ willingness to leave their jobs [18]. In other words, the stronger the sense of work alienation felt by nurses, the lower their quality of work life will be, which will further intensify nurses’ willingness to leave. Once turnover behavior occurs, it will not only cause the situation of nursing manpower shortage in hospitals to further deteriorate, but will also have a series of potential negative effects [19]. Therefore, it is necessary to take targeted measures to reduce nurses’ sense of work alienation, reduce turnover behavior, prevent a series of problems caused by nursing human resource shortage, stabilize the nursing team, and improve the quality of nursing services.
5. Conclusion
In summary, managers can improve nursing staff’s recognition of the work they do and alleviate negative psychological experiences in order to enhance nursing staff motivation and satisfaction and improve job performance. This study shows that nurses’ work alienation is at a moderate level and work alienation has a positive relationship with willingness to leave. Therefore, it is necessary for managers to pay attention to nurses’ psychological experience, reduce their sense of work alienation, improve nurses’ job satisfaction, stabilize the development of the nursing team, reduce their willingness to leave, and improve the quality of nursing services.
6. Limitations of the Study
This study only investigated the current situation of turnover intention and work alienation of clinical nurses in the tertiary hospitals in Wuhan region, and did not investigate other regions, sub-hospitals, and other health care providers due to the limitation of human and material resources, suggesting that future studies could investigate other health care institutions such as nursing homes and community health centers.
Part 1. The Work Alienation of the Nurse’s Scale
Please rate how well the following statements match your real-life work and tick the one that best matches your situation.
Part 2. The Turnover Intention of the Nurse’s Scale
From the situations described by the individuals below, check the one that best fits your current situation and feelings.
1) Are you considering quitting your current job?
A. Often B. Occasionally C. Rarely D. Never
2) Do you want to find other jobs of the same nature?
A. Often B. Occasionally C. Rarely D. Never
3) Do you want to find other jobs of different nature?
A. Often B. Occasionally C. Rarely D. Never
4) Given your current situation and conditions, how likely do you think you are to find a suitable position in another organization?
A. very likely B. likely C. unlikely D. highly unlikely
5) If you know there is a suitable job vacancy for you in another organization now, how likely are you to get the job?
A. very likely B. likely C. unlikely D. highly unlikely
6) Will you quit your current job?
A. definitely will B. probably will C. probably won’t D. definitely won’t
Please check if there are any missing items, this questionnaire ends here, thank you for your sincere help!