‘Should I stay or should I go?’: A mixed methods study on nurse retention during challenging times
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Keywords

humans
COVID-19
motivation
pandemics
Philippines
health personnel
nurses

How to Cite

Diño, M. J. S., Bracero, P. J. B., Buencamino, A., Cajayon, S. B., Catajan, M. W. Q., De Leon, M. L. L., Gregorio, J. E. J., Lucelo, P. A. A., Odon, B. C. C. P., Palma, J. A. F., Rosado, R. R. C., Taboada, M. P. D., & Uayan, M. L. (2022). ‘Should I stay or should I go?’: A mixed methods study on nurse retention during challenging times. Belitung Nursing Journal, 8(6), 481–490. https://doi.org/10.33546/bnj.2327
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Abstract

Background: The World Health Organization estimates that between 80,000 and 180,000 medical personnel perished as a result of COVID-19. Although studies about nurses’ organizational commitment during the COVID-19 pandemic have been conducted, the sources of motivations and resilience strategies of nurses in providing a quality healthcare service amidst the COVID-19 pandemic have yet to be explored.

Objective: This study aimed to investigate how motivation and resilience influence nurses to serve and cater to patients during the COVID-19 pandemic.    

Methods: A sequential exploratory mixed approach was used in this study between July and August 2022. The Connor-Davidson Resilience Scale (CD-RISC-10), Work Extrinsic and Intrinsic Motivations scale (WEIMS), and Garbee and Killacky’s Intent to Stay Scale (GKISS) were used to measure resilience, motivation, and intention to stay, among 50 nurses within Metro Manila. Quantitative data were analyzed using quantile regression, while qualitative data from eight participants were analyzed using thematic analysis.

Results: The majority of the nurses were working 12 hours and above (52%) and earning a bi-weekly income of PHP 15,001 to 20,000 (96%). The GKISS scores of most respondents indicated their likelihood of remaining in their current profession was moderately low (Mdn = 12.5; IQR = 12-14). It was also found that there was no sufficient statistical evidence to conclude that intention to stay was associated with resilience (p = 0.914) and work motivation (p = 0.560). The qualitative strand of this study explored the significant influences of motivation, resilience strategies, and sources of intention to stay among Filipino nurses while facing the COVID-19 pandemic. The primary motivations of nurses lie in family, passion for work, and career development, while the resilience strategies include adaptiveness, time management skills, and self-fulfillments. On the other hand, the intent to stay greatly lies in serving the people and the country.

Conclusion: This study concludes that positive and negative resilience and motivations from different facets of the social life of Filipino nurses, including passion, familial ties, patient care, and faith are the antecedents influencing the intention to serve in the healthcare service. In terms of staying for an extended period in a nursing career, the study found that institutionalized interventions, adequate compensation and benefits, and a good workplace are determinants of staying longer in the Philippines as Filipino nurses.

https://doi.org/10.33546/bnj.2327
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Copyright

Copyright (c) 2022 Michael Joseph S. Diño, Paul John B. Bracero, Arnel Buencamino, Sharon Cajayon, Michael William Q. Catajan, Michaela Liel L. De Leon, Jessie Elsid A. Gregorio Jr., Pamela Anne A. Lucelo, Bavy Charmy Cindy P. Odon, Jasmin Anne F. Palma, Roi Roel C. Rosado, Martin Phillip D. Taboada, Maria Luisa Uayan

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Declaration of Conflicting Interest

The authors declared no conflict of interest.

Acknowledgment

The authors thank the nurses from Valenzuela City, Philippines, for their outstanding collaboration during data collection.

Authors’ Contributions

All authors contributed equally to the study. In addition, all authors agreed to be accountable for all contents of the research and agreed with the final version to be published.

Data Availability

The dataset generated during and analyzed during the current study is available upon reasonable request to the Research Development and Innovation Center (RDIC) of Our Lady of Fatima University, Valenzuela City, Philippines.


References

American Psychological Association. (2022). Resilience. https://www.apa.org/topics/resilience

Baljoon, R. A., Banjar, H. E., & Banakhar, M. A. (2018). Nurses’ work motivation and the factors affecting It: A scoping review. International Journal of Nursing & Clinical Practices, 5(1), 277. https://doi.org/10.15344/2394-4978/2018/277

Bennett, J. A. (2000). Mediator and moderator variables in nursing research: Conceptual and statistical differences. Research in Nursing & Health, 23(5), 415-420. https://doi.org/10.1002/1098-240X(200010)23:5%3C415::AID-NUR8%3E3.0.CO;2-H

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa

Chiang, Y.-C., Lee, H.-C., Chu, T.-L., Wu, C.-L., & Hsiao, Y.-C. (2021). The relationship between spiritual health, health-promoting behaviors, depression and resilience: A longitudinal study of new nurses. Nurse Education in Practice, 56, 103219. https://doi.org/10.1016/j.nepr.2021.103219

Clarke, V., & Braun, V. (2013). Teaching thematic analysis: Overcoming challenges and developing strategies for effective learning. The Psychologist, 26(2), 120-123.

Cook-Krieg, B. A. (2011). Are you man enough to be a nurse? The road less traveled [Doctoral Dissertation, Iowa State University]. Iowa.

Creswell, J. W. (2015). A concise introduction to mixed methods research. California: SAGE publications.

Cyr, J. P. (2005). Retaining older hospital nurses and delaying their retirement. JONA: The Journal of Nursing Administration, 35(12), 563-567.

Eketu, C. A., & Ogbu Edeh PhD, F. (2015). Social intelligence and employee intention to stay. International Journal of Novel Research in Marketing Management and Economics, 2(1), 27-34. https://dx.doi.org/10.2139/ssrn.3480576

Ekström, A. M., Berggren, C., Tomson, G., Gostin, L. O., Friberg, P., & Ottersen, O. P. (2021). The battle for COVID-19 vaccines highlights the need for a new global governance mechanism. Nature Medicine, 27(5), 739-740. https://doi.org/10.1038/s41591-021-01288-8

Ellis, E. G. (2020). How health care workers avoid bringing Covid-19 home. Wired. https://www.wired.com/story/coronavirus-covid-19-health-care-workers-families/

Gayol, M., & Lookingbill, T. (2022). Early career burnout in nursing. Nursing Clinics, 57(1), 21-28. https://doi.org/10.1016/j.cnur.2021.11.002

Gonzalez, S. P., Moore, E. W. G., Newton, M., & Galli, N. A. (2016). Validity and reliability of the Connor-Davidson Resilience Scale (CD-RISC) in competitive sport. Psychology of Sport and Exercise, 23, 31-39. https://doi.org/10.1016/j.psychsport.2015.10.005

Hewitt Associates. (2004). Strategies for cost management of the HR function. Illinois, USA: Aon Hewitt.

Jun, J., Ojemeni, M. M., Kalamani, R., Tong, J., & Crecelius, M. L. (2021). Relationship between nurse burnout, patient and organizational outcomes: Systematic review. International Journal of Nursing Studies, 119, 103933. https://doi.org/10.1016/j.ijnurstu.2021.103933

Koty, A. C. (2021). How COVID-19 has impacted Philippine medical worker recruitment. https://www.aseanbriefing.com/news/how-covid-19-has-impacted-philippine-medical-worker-recruitment/

Kuo, H. T., Lin, K. C., & Li, I. c. (2014). The mediating effects of job satisfaction on turnover intention for long‐term care nurses in Taiwan. Journal of Nursing Management, 22(2), 225-233. https://doi.org/10.1111/jonm.12044

Lai, C.-C., Shih, T.-P., Ko, W.-C., Tang, H.-J., & Hsueh, P.-R. (2020). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. International Journal of Antimicrobial Agents, 55(3), 105924. https://doi.org/10.1016/j.ijantimicag.2020.105924

Laschinger, H. K. S., Grau, A. L., Finegan, J., & Wilk, P. (2010). New graduate nurses’ experiences of bullying and burnout in hospital settings. Journal of Advanced Nursing, 66(12), 2732-2742. https://doi.org/10.1111/j.1365-2648.2010.05420.x

Le Cook, B., & Manning, W. G. (2013). Thinking beyond the mean: A practical guide for using quantile regression methods for health services research. Shanghai Archives of Psychiatry, 25(1), 55-59. https://doi.org/10.3969%2Fj.issn.1002-0829.2013.01.011

Leys, C., Arnal, C., Wollast, R., Rolin, H., Kotsou, I., & Fossion, P. (2020). Perspectives on resilience: Personality trait or skill? European Journal of Trauma & Dissociation, 4(2), 100074. https://doi.org/10.1016/j.ejtd.2018.07.002

Liu, Y., Kumar, M., Katul, G. G., & Porporato, A. (2019). Reduced resilience as an early warning signal of forest mortality. Nature Climate Change, 9(11), 880-885. https://doi.org/10.1038/s41558-019-0583-9

Major, C. H., & Savin-Baden, M. (2020). An introduction to qualitative research synthesis: Managing the information explosion in social science research (1st ed.). London: Routledge. https://doi.org/10.4324/9780203497555

Mao, A., Cheong, P. L., Van, I. K., & Tam, H. L. (2021). “I am called girl, but that doesn’t matter”-perspectives of male nurses regarding gender-related advantages and disadvantages in professional development. BMC Nursing, 20, 24. https://doi.org/10.1186/s12912-021-00539-w

Marzilli, C. (2021). A year later: Life after the Year of the Nurse. Belitung Nursing Journal, 7(2), 59-61. https://doi.org/10.33546/bnj.1509

Mealer, M., Schmiege, S. J., & Meek, P. (2016). The Connor-Davidson Resilience Scale in critical care nurses: A psychometric analysis. Journal of Nursing Measurement, 24(1), 28-39. https://doi.org/10.1891/1061-3749.24.1.28

Middleton, R., Loveday, C., Hobbs, C., Almasi, E., Moxham, L., Green, H., Halcomb, E., & Fernandez, R. (2021). The COVID-19 pandemic–A focus on nurse managers’ mental health, coping behaviours and organisational commitment. Collegian, 28(6), 703-708. https://doi.org/10.1016/j.colegn.2021.10.006

Morika, H. D., Suharizal, K., & Yasmi, L. (2019). Characteristics and motivation with nurse performance in applying patient safety in hospital. International Journal Of Community Medicine And Public Health, 6(1), 44-50. https://doi.org/10.18203/2394-6040.ijcmph20185225

Nazareno, J., Yoshioka, E., Adia, A. C., Restar, A., Operario, D., & Choy, C. C. (2021). From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID‐19 through an intersectional lens. Gender, Work & Organization, 28(4), 1426-1446. https://doi.org/10.1111/gwao.12657

Negussie, B. B., & Oliksa, G. B. (2020). Factors influence nurses’ job motivation at governmental health institutions of Jimma Town, South-west Ethiopia. International Journal of Africa Nursing Sciences, 13, 100253. https://doi.org/10.1016/j.ijans.2020.100253

Nimako, B. P., Osei, S. A., Antwi, F. B., & Peprah, W. K. (2019, 2019). Psychosocial well-being and Job Satisfaction among Nurses in the Philippines. 7th International Scholar Conference, Indonesia.

Nurmohamed, N. S., Collard, D., Reeskamp, L. F., Kaiser, Y., Kroon, J., Tromp, T. R., Van den Born, B.-J. H., Coppens, M., Vlaar, A. P. J., & Beudel, M. (2022). Lipoprotein (a), venous thromboembolism and COVID-19: A pilot study. Atherosclerosis, 341, 43-49. https://doi.org/10.1016/j.atherosclerosis.2021.12.008

Ortiga, Y. Y., Diño, M. J., & Macabasag, R. L. A. (2022). Clocking out: Nurses refusing to work in a time of pandemic. Social Science & Medicine, 115114. https://doi.org/10.1016/j.socscimed.2022.115114

Price, J. L., & Mueller, C. W. (1981). A causal model of turnover for nurses. Academy of Management Journal, 24(3), 543-565. https://doi.org/10.5465/255574

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78. https://psycnet.apa.org/doi/10.1037/0003-066X.55.1.68

Schoonenboom, J., & Johnson, R. B. (2017). How to construct a mixed methods research design. KZfSS Kölner Zeitschrift für Soziologie und Sozialpsychologie, 69(2), 107-131. https://doi.org/10.1007/s11577-017-0454-1

Schwartz, J., King, C.-C., & Yen, M.-Y. (2020). Protecting healthcare workers during the coronavirus disease 2019 (COVID-19) outbreak: Lessons from Taiwan’s severe acute respiratory syndrome response. Clinical Infectious Diseases, 71(15), 858-860. https://doi.org/10.1093/cid/ciaa255

Singhal, T. (2020). A review of coronavirus disease-2019 (COVID-19). The Indian Journal of Pediatrics, 87(4), 281-286. https://doi.org/10.1007/s12098-020-03263-6

Smith, C. (2020). The structural vulnerability of healthcare workers during COVID-19: Observations on the social context of risk and the equitable distribution of resources. Social Science & Medicine, 258, 113119. https://doi.org/10.1016/j.socscimed.2020.113119

Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: Interdisciplinary perspectives. European Journal of Psychotraumatology, 5(1), 25338. https://doi.org/10.3402/ejpt.v5.25338

Speth, M. M., Singer‐Cornelius, T., Oberle, M., Gengler, I., Brockmeier, S. J., & Sedaghat, A. R. (2020). Mood, anxiety and olfactory dysfunction in COVID‐19: Evidence of central nervous system involvement? The Laryngoscope, 130(11), 2520-2525. https://doi.org/10.1002/lary.28964

Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509. https://doi.org/10.1377/hlthaff.2011.1377

Subedi, D. (2016). Explanatory sequential mixed method design as the third research community of knowledge claim. American Journal of Educational Research, 4(7), 570-577.

Tett, R. P., & Meyer, J. P. (1993). Job satisfaction, organizational commitment, turnover intention, and turnover: Path analyses based on meta‐analytic findings. Personnel Psychology, 46(2), 259-293. https://doi.org/10.1111/j.1744-6570.1993.tb00874.x

Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8(1), 1-10. https://doi.org/10.1186/1471-2288-8-45

Tremblay, M. A., Blanchard, C. M., Taylor, S., Pelletier, L. G., & Villeneuve, M. (2009). Work Extrinsic and Intrinsic Motivation Scale: Its value for organizational psychology research. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 41(4), 213-226. https://doi.org/10.1037/a0015167

Uthaman, T., Chua, T. L., & Ang, S. Y. (2016). Older nurses: A literature review on challenges, factors in early retirement and workforce retention. Proceedings of Singapore Healthcare, 25(1), 50-55. https://doi.org/10.1177/2010105815610138

Wei, H., Roberts, P., Strickler, J., & Corbett, R. W. (2019). Nurse leaders’ strategies to foster nurse resilience. Journal of Nursing Management, 27(4), 681-687. https://doi.org/10.1111/jonm.12736

World Health Organization. (2021). Health and care worker deaths during COVID-19. https://www.who.int/news/item/20-10-2021-health-and-care-worker-deaths-during-covid-19

Yang, L., Liu, S., Liu, J., Zhang, Z., Wan, X., Huang, B., Chen, Y., & Zhang, Y. (2020). COVID-19: Immunopathogenesis and Immunotherapeutics. Signal Transduction and Targeted Therapy, 5(1), 1-8. https://doi.org/10.1038/s41392-020-00243-2

Yu, H., Huang, C., Chin, Y., Shen, Y., Chiang, Y., Chang, C., & Lou, J. (2021). The mediating effects of nursing professional commitment on the relationship between Social support, resilience, and intention to stay among newly graduated male nurses: A cross-sectional questionnaire survey. International Journal of Environmental Research and Public Health, 18(14), 7546. https://doi.org/10.3390/ijerph18147546