Psychosocial factors related to intention to stay as a nurse in urban and rural areas in Japan

Background and Aim

Nurse turnover today is a serious problem globally. In Japan, hospitals employ various strategies to secure nursing personnel. This ongoing prospective study aims to identify factors influencing intention to stay as a nurse for hospital nurses in urban and rural areas in Japan.

Method

A self-report questionnaire was distributed in September 2013 (baseline) and March 2014 (Time 1: T1), examining individual attributes, occupational commitment, effort-reward imbalance, cumulative fatigue, self-rated health, and intention to stay as a nurse. Hierarchical logistic regression analysis was performed to determine factors influencing intention to stay by area.

Results

Of 3,978 nurses, 608 completed both questionnaires (242 urban; 366 rural). In urban areas, baseline intention to stay was an important predictor of T1 intention to stay (OR = 56.03, p < 0.001), which moderated the effect of cumulative fatigue and affective occupational commitment. Effort-reward imbalance was not related to T1 intention to stay. In rural areas, effort-reward imbalance influenced T1 intention to stay through adverse health. Self-rated health, continuance occupational commitment, and intention to stay at baseline strongly predicted T1 intention to stay (OR = 2.44, p < 0.01; OR = 1.23, p < 0.01; OR = 6.47, p < 0.001). Responsibility for elder care also affected T1 intention to stay (OR = 0.30, p < 0.05).

Conclusions

The factors influencing intention to stay as a nurse differ between urban and rural areas. Nurse retention strategies should be implemented that reflect the characteristics of nursing staff and the region.