병원의 간호사이직률과 병원의 구조적 특성

The global burden of surgical disease has been studied to a limited extent. Despite the proven benefits of surgery, surgical services remain poorly resourced. Contributing to this global crisis is the critical lack of data regarding available resources. To analyse the distribution of some resources necessary for the provision of surgical care. The distribution and number of surgical resources (number of surgical beds) relative to the general resources (number of hospitals and total number of beds) in South Africa were analysed. All hospitals in the country, including those in the public and private sectors, were contacted, and the total number of hospitals, the level of care (district v. regional v. tertiary), the total number of hospital beds, and the number of surgical beds were determined. The data were analysed according to the provincial distribution and the public v. private sector distribution relative to the size of the population. A total of 544 hospitals were included in the study - 327 in the public sector and 217 in the private sector. The public sector hospitals included 257 district-, 49 regional- and 21 tertiary-level hospitals. Nationally, there were 1 hospital, 187 hospital beds and 42 surgical beds per 100 000 population. Gauteng Province (GP), the Eastern Cape, KwaZulu-Natal (KZN) and the Western Cape had the most hospitals and GP had the largest number of private hospitals. GP and KZN had the largest total number of beds (n=29 181 and n=22 889, respectively) and number of surgical beds (n=7 289 and n=4 651, respectively). GP had the largest number of private surgical beds (n=4 837). There was a marked variation in the number of hospitals, total number of beds, and number of surgical beds among provinces. This study provided an estimation of the number of hospitals, total number of beds, and number of surgical beds, and showed a marked variation among provinces and between the public and private sectors.

ObjectiveTo investigate the association between monthly turnover rates of hospital nurses and senior doctors and patient health outcomes (mortality and unplanned hospital readmissions).DesignRetrospective longitudinal study.SettingAll 148 NHS acute trusts in...

Hospital and unit characteristics associated with nursing turnover include skill mix but not staffing level: An observational cross-sectional study

Background: Demand for nurses is increasing in various fields of health care services. Despite the increase in the number of nurses, the shortage of nurses has not been solved. The leading cause of the lack of nursing staff is the high turnover rate. This study aims to examine the characteristics of the hospitals and working environment related to nurse turnover and identify the differences by age group. Methods: In this study, the data reported to the Health Insurance Review and Assessment Service were used. The subjects were nurses who worked in hospitals from 2017 to 2019. Nurse turnover, a dependent variable determined by a continuous work episode, was constructed in consideration of the date of employment and resignation. A total of 194,343 nurse staff in 1,316 hospitals and 245,004 work episodes were examined. Results: Among the work episodes analyzed, the turnover rate was 40.3%. The turnover of nurses was higher at a younger age, with lower clinical experience, and lower length of stay (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.51-1.63; OR, 2.11; 95% CI, 2.02-2.21; OR, 1.38; 95% CI, 1.33-1.44). Irregular work nurses had a very significant risk of turnover compared to regular work (OR, 3.15; 95% CI, 2.99-3.33). After stratification by age, irregular work nurses in the working environment and nurse rate grade of the hospital were the main factors affecting a turnover in all age groups. Conclusion: Nurse turnover was significantly differed according to the hospital characteristics and working environment. In the future, system design or health policy development to reduce the nurse turnover requires a customized design considering age, not introducing a comprehensive system for managing nurses.

Background and aimNurse staffing levels are associated with patient mortality, but little is known regarding the association between nurse turnover rate and patient mortality. This study investigated the combined effect of the bed-to-nurse ratio and the nurse turnover rate on in-hospital mortality in patients admitted to Korean acute care hospitals using national administrative data.MethodsThis study analyzed data from the National Health Insurance Service (NHIS) on 459,113 admitted patients and 111,342 employed nurses in 403 hospitals in South Korea from January to December 2016. Differences in in-hospital mortality and nurse turnover among hospital characteristics, including the bed-to-nurse ratio, were explored using the chi-square test. Multilevel, multivariate GEE logistic regression analyses were used to examine the combined effect of the bed-to-nurse ratio and the nurse turnover rate on in-hospital mortality.ResultsDuring the study period, 13,675 (3.0%) patients died during hospitalization, and 13,349 (12.0%) nurses left their jobs. The risk of death among patients admitted to hospitals with a bed-to-nurse ratio of < 2.5 and a nurse turnover rate of ≥ 12% was lower than among patients admitted to hospitals with a bed-to-nurse ratio of ≥ 4.5 and a nurse turnover rate of ≥ 12% (odds ratio [OR] = 0.63; 95% confidence interval [CI], 0.48–0.82). The risk of in-hospital mortality decreased further when the nurse turnover rate was < 12% (OR = 0.59; 95% CI, 0.44–0.79).ConclusionThe bed-to-nurse ratio and nurse turnover rate were jointly associated with patient mortality. When hospitals with a low bed-to-nurse ratio also experienced high nurse turnover, the risk of in-hospital mortality was even greater. The finding of this study will help health policy makers to better understand the importance of both nursing staffing levels and nurse turnover rates. It is necessary to create a comprehensive improvement plan that integrates policies aiming to improve nurse staffing levels and reduce turnover rates into a single strategy.

BackgroundSouth Korea is one of the countries with a very low percentage of active nurses among the Organization for Economic Cooperation and Development (OECD) countries. Although the number of nurses has increased steadily, the number of active nurses has not increased more than expected due to continued turnover.MethodsThis study used data of a longitudinal panel of Graduates Occupational Mobility Survey (GOMS) and performed survival analysis to determine the turnover rate of nurses and the average time of turnover.ResultsThe turnover rate was the highest at 25% within first year and 50% of nurses left their first job during the study period. The hospital size and salary levels were major factors that affected the turnover rate, with small-scale hospitals and extremely low salary levels having the highest turnover. Dissatisfaction with the organization and dissatisfaction with the profession also directly impacted job turnover. Turnover rate of male nurses was higher than that of female nurses.ConclusionTurnover of newly graduated nurses is highly inefficient personnel management. A strategy for reducing the turnover is needed.

The purpose of the present study was to design a preceptorship programme and to evaluate its effects on turnover rate, turnover cost, quality of care and professional development. A high turnover rate of nurses is a common global problem. How to improve nurses' willingness to stay in their jobs and reduce the high turnover rate has become a focus. Well-designed preceptorship programmes could possibly decrease turnover rates and improve professional development. A quasi-experimental research design was used. First, a preceptorship programme was designed to establish the role and responsibilities of preceptors in instructing new nurses. Second, a quasi-experimental design was used to evaluate the preceptorship programme. Data on new nurses' turnover rate, turnover cost, quality of nursing care, satisfaction of preceptor's teaching and preceptor's perception were measured. After conducting the preceptorship programme, the turnover rate was 46.5% less than the previous year. The turnover cost was decreased by US$186,102. Additionally, medication error rates made by new nurses dropped from 50-0% and incident rates of adverse events and falls decreased. All new nurses were satisfied with preceptor guidance. The preceptorship programme effectively lowered the turnover rate of new nurses, reduced turnover costs and enhanced the quality of nursing care, especially by reducing medication error incidents. Positive feedback about the programme was received from new nurses. Study findings may offer healthcare administrators another option for retaining new nurses, controlling costs, improving quality and fostering professional development. In addition, incentives and effective support from the organisation must be considered when preceptors perform preceptorship responsibilities.

Labor turnover has been defined as a phenomenon which serves to reflect the degree of stagnation or instability in the labor market. Whenever the rate of labor turnover is high, vis-a-vis, no expansion, excess movement and waste are said to result. On the other hand, when the labor turnover rate is low or equal to zero, the labor market is defined as in a state of stagnation. In either case (extremely high levels of turnover or extremely low levels of turnover) waste and under utilization of manpower are said to result. The impact from either too much or too little labor movement is felt to be dependent upon the size and maturity of the labor market. Moreover, the general level and diversity of skill on the part of labor market participants, may act to enhance or abate the effect of job turnover. This study was undertaken to investigate labor turnover in a selected area of eastern Arkansas. The area was chosen because of the large number of displaced agricultural workers who were in the employ of small industrial establishments which had recently moved into the area. It was hoped that the study would provide information which would be of value in solving problems related to the process of rural industrialization. Also, it was felt that information could be gained on problems faced by displaced agricultural workers as they transfer out of agricultural occupations. The purpose of this study, stated in a more specific sense, was to provide answers to some basic questions. They were: (1) Are the labor turnover rates among the firms high enough or low enough to warrant concern? (2) If labor turnover does, in fact, persist at problem levels, are there circumventable costs which arise in direct relationship with labor turnover? (3) Are there specific variables which tend to enhance or have a directional relationship with job turnover and cost? (4) What is the nature and extent of the relationship between labor turnover and specified variables? Data utilized in the study came from a number of sources including: (1) a survey schedule, (2) personnel and payroll records of firms, (3) area manpower studies, and (4) United States Census Bureau. The data were analyzed through the employ of some basic statistical models adapted for use in this study. A form of the stepwise regression routine (Goodnight's Maximum R2 Improvement Technique) was used to investigate relationship's between dependent variables and sets of independent variables. The analysis of variance linear model was also adapted for use in the study. The simple linear form of the ANOVA technique was used in determining if the firms were of the same population when considerations were given to criteria such as: (1) the level of turnover, (2) the cost of turnover and (3) the rates of quits, discharge, layoff, recall, new hire, flux and replacement. A version of the three factor factorial model (with nested classifications) was used to investigate the effects of specified factors on the rate of labor turnover in the panel firms. This study was limited by a number of factors. Thus, the conclusions and generalizations are limited. The scope of the inquiry was limited to: (1) only those firms of the eastern Arkansas area which employed displaced agricultural workers and hired more than fifty factory employees, (2) a period of three years - January 1970 through December 1972, (3) a six county section of the East Planning, and Development District of eastern Arkansas, and (4) investigation of the extent, costs, and causes of labor turnover in the panel firms. By virtue of the process used in selecting the firms and in selecting the study area, this investigation was a case study in nature. The findings on the general extent of labor turnover were supportive of the initial hypothesis that depressed wage regions are subject to high rates of "job switching." In most of the panel firms the rate of labor turnover was highly variable and reached extreme periodic highs and lows. Estimates made on monthly, quarterly and yearly bases were all high relative to representative United States manufacturing firms during the same period. Fluctuations in the rate of job turnover for all firms were sharp and typified a situation of instability in the labor market. In 1970 the mean level of employee turnover reached a within year high of 18 per 100 workers and fell to a low of 2.2 per 100 workers at one point. Separate observations on individual firms show that some firms sustained even more severe fluctuations, although most firms experienced declining rates over the 1970-72 period. Job switching was not identified as a market-wide-time-specific phenomena as its presence was seldom of uniform and harmonic occurrence among firms over time. The high rate of labor turnover arose from a combination of voluntary quits, replacements, and a slightly expanded level of employment in the panel firms. From an aggregate perspective it appeared that turnover arose from a collection of individual worker decisions to switch from situations perculiar to each firm and from market phenomena which affected the firms in a dissimilar temporal manner. The costs of labor turnover were identified to have emerged in four basic categories: (1) recruitment cost, (2) selection and placement cost, (3) on-the-job cost, and (4) cost of separating the incumbent. The overall labor turnover bill was comprised of four major components. Their aggregate and per hire cost over the period were: Aggregate Per Hire Recruitment ........................ $ 25,727 $ 5 Selection and Placement ............ 603,645 124 On-the-Job Cost .................... 3,275,051 673 Cost of Separation................ 665,547 136 Total......................... $4,569,971 $939. While labor turnover cost was estimated at $939 per hire over the 1970-72 period, it varied over a range of from $819 to $1,094. Percent distribution of the aggregate cost of turnover among the four major categories was: less than one percent to recruitment, 13 percent to selection and placement, 72 percent to on-the-job cost, and 14 percent to separation. Shares of the total maintained by the above components remained relatively stable over the 36 month period. For all firms the relationship between labor turnover and cost was decidedly strong. The correlation between the rate of turnover and cost of turnover was highly significant. The relationships between the cost of turnover and the primary categories of worker movement were investigated. Voluntary quits were designated to have had the stronger relationships with labor turnover cost when consideration was extended to cover only the single most influential factor. Layoffs, new hires, recalls and discharges were found to have possessed a significant relationship with the cost of turnover. While voluntary quits and new hires, individually, were observed to have exerted strong influence on the rate of turnover and cost, the main brunt was felt when firms sustained high rates of new hire and voluntary quits in combination. The criteria selected for use in attempting to explain variance in the rate of turnover were wage level, experience required before granting wage increases, distance employees commuted, the level of female employment, firm size, industry type and expenditures for preventive practices. All factors were found to have had some effect upon the rate of turnover when all possible combined factor effects were considered. In a net-effect sense, the level of female employment and firm size were determined not to have weighed significantly upon the rate of turnover. It was concluded that labor turnover in the eastern Arkansas area, and areas of similar characteristics, represents a serious impediment to the efficient operation of the firms. To the extent that labor turnover leads to unnecessary cost and to instability in the labor market, it is felt that efforts to advance rural industrialization are subject to serious setbacks whenever turnover exists at chronically high levels.

In an economic crisis, countries often apply austerity measures in many areas, and the health system emerges as one of the important areas in which these measures are implemented. In crises, these responses, which are generally given by countries as short-term changes in health policies, also indicate the effects of economic crises on the health system. Therefore, these influences on the health system also significantly affect the health of the population and the individual. Decisions on the health care system may protect health from the effects of the crisis, but on the contrary, may lead to the worsening of the health of the population and the individual. Studies show that mortality rates are higher in countries where economic crises have a relatively negative impact on the health system. In this study, the impacts of 1994, 2001 and 2009 economic crises on 9 indicators related to the health system in Turkey between 1974-2015 were investigated through the ARDL Cointegration approach. It was found that the 1994 economic crisis affected the total number of other health personnel significantly (p&amp;lt;0.05) in a negative way. The 2001 economic crisis was found to have a significantly negative effect on public health expenditures, total health expenditures and number of beds. For the 2009 economic crisis, private and total health expenditures decreased significantly (p&amp;lt;0,05), while public health expenditures increased significantly (p&amp;lt;0.05). As a result of the analyses made, in terms of the impacts of the economic crises on the health system in Turkey, it was found that the 1994 economic crisis affected 3 of the 9 indicators significantly (p&amp;lt;0.05) in a negative way, namely, total health expenditures, total number of health personnel, and total number of beds. In addition, the 1994 economic crisis was observed to not have had a significant positive effect on any variable (p&amp;gt;0.05). The 2001 economic crisis was found to have a significant negative effect on 3 out of 9 variables; public health expenditures, total health expenditures and total number of beds. On the other hand, it was found that the 2001 economic crisis affected only one variable significantly positive, which was the budget of the Ministry of Health. For the 2009 economic crisis, private and total health expenditures decreased significantly (p&amp;lt;0,05), while public health expenditures increased significantly (p&amp;lt;0.05). Conclusively, in this study, it has been found that political choice plays an important factor in the impacts of the economic crises on the health system.

This study aimed to investigate the reasons that affect nurses' decisions to leave their setting. Nurse turnover impacts organisational costs, organisational stability, and quality of care. The role of nurse leaders' practices in nurse turnover remains underexplored. Descriptive phenomenological design was used in the current study. Giorgi's phenomenological method was used to explore the staff nurses' lived experiences and perceptions of turnover. The data was collected from semi-structured interviews with nurses who had left their current positions, moved to another organisation, changed professions, or retired. Five themes emerged from the analysis: (1) poor communication, (2) a lack of leader support, (3) workloads and staffing issues, (4) a lack of professional development opportunities, and (5) inconsistent policies and leadership. Nurse leaders and administration play a critical role in driving nurses to stay or to leave the healthcare organisation by providing different and important practices and behaviours. Reducing the nursing turnover rate can create a more stable environment and enhance nurse satisfaction, which leads to better patient care. Nursing administration must create supportive workplace environments by enhancing leadership practices to reduce the nursing turnover rates, especially among new graduate nurses. The current study addresses the nurse turnover issue, with a particular focus on the role of nurse leaders' practices in nurse turnover. High nursing turnover rates impact organisational costs, organisational stability, and quality of care. This study will have a significant impact on nursing leadership, healthcare administration and policymakers. No Patient or Public Contribution.

High turnover rates among nurses are a global concern. Previous studies show the negative impact on quality of care. The purpose of this study was to examine the relationship between nurse turnover and nurse's perceptions of patient outcomes. A cross-sectional study design was used. Nurses working in 35 general hospitals in South Korea were invited to participate in a survey assessing their perceptions of patient outcomes, including quality of care, patient safety, and adverse events. Nurse turnover was measured for the prior 6months. Data from 159 nurses were analyzed. There was a significant positive relationship between turnover rates and perceptions of poor quality of care, after controlling for demographic and work-related characteristics. Nurse turnover was not significantly associated with perceptions of patient safety or adverse events. The negative consequence of nurse turnover on patient outcomes is partially supported in this study.

Focusing on the elderly living in Seoul, this study aims to analyze empirically the effects of the local medical resources on the needs for community medical environment based on the number of medical institutions, total number of doctors, total number of beds in the district as a representative of local medical resources. Multi-level logistic regression model was used. 2018 Seoul Elderly Survey was used for the data of the level one and Seoul Statistics 2018 were used for the data of the level 2. As a result, as the total number of doctors and beds increase, the elderly's needs for community medical environment significantly decreased. It exhibits that the total number of doctors and beds are critical rather than the total number of medical institutions in the district. Based on the above results, it is hospitals that affect the needs for community medical environment of the elderly. The results of this study suggest in order to provide the pro-aging social ecological system it is necessary to examine the elderly's needs for community medical environment for the higher medical institutions in preparation for the super aging society

Turnover Rates and Factors Influencing Turnover of Korean Acute Care Hospital Nurses: A Retrospective Study Based on Survival Analysis

According to the 2007 Taiwan Labor Front Human Resources Report, as much as 47.6% of nurses at some public hospitals were contracted rather than full time. Furthermore, turnover rates for contract nurses were found to be as high as five to eight times of those for full-time nurses. Because high turnover rates are likely to induce negative impacts on the stability of care provided in the absence of staffing continuity, the association between nursing employment arrangement and nursing care quality is attracting greater attention. This study was designed to investigate the work status of contract versus full-time nurses at a public hospital in Taiwan and to examine the impact of such on work-related attitudes, organizational citizenship behavior, and job performance. Samples were recruited from a public hospital in Taiwan. In addition to self-rated items, researchers used supervisor-rated structured questionnaires for job performance to attenuate the possible effect of common method bias. The study investigated the impact of hospital nurse employment status on work-related attitudes, organizational citizenship behavior, and job performance using a regression model that included the critical work-related attitudes variables of job satisfaction and organizational commitment. Study findings included the following: (a) organizational commitment, job satisfaction, organizational citizenship behavior, and job performance correlate positively with one another. (b) No significant difference between contract and full-time nurses was found in terms of organizational commitment, job satisfaction, organizational citizenship behavior, and self-rated job performance. However, when rated by supervisors, reported job performance levels for full-time nurses were significantly higher than those of contract nurses. (c) Organizational citizenship behavior exhibited a mediating effect between job satisfaction, organizational commitment, and job performance. In this study, supervisors gave higher job performance ratings to full-time nurses than to contract nurses. This result deserves further investigation.

Revisiting the impact of job satisfaction and organizational commitment on nurse turnover intention: An individual differences analysis