BackgroundNursing shortages are a serious problem in rural China. Little evidence has been found to determine the factors influencing turnover of rural nurses in China. Meanwhile, the effect of nurses' previous job mobility behaviours (ie, nurses who previously moved between different institutions) on their current turnover intentions is rarely identified. This study aimed to identify these factors and determine other factors related to the turnover of rural nurses in China. MethodsA cross-sectional survey was done in seven western provinces of China in 2013. 1163 rural nurses participated in the survey and 1158 were enrolled in this study after data cleaning. Turnover intention was set as a dependent variable; variables related to previous job mobility behaviour including whether they had a previous job mobility behaviour (ie, yes or no), the way of last job mobility behaviour (ie, moving from a same-level medical institution, from a low-level to a high-level medical institution, from a high-level to a low-level medical institution, or from a non-medical institution), and the time of last job mobility behaviour (ie, ≤3 years ago, 4–6 years ago, or ≥7 years ago) were set as the independent variables; and all other variables were set as confounders. We used a descriptive analysis, Pearson's χ2 test, one-way ANOVA, and binary logistic regression analysis for our data analyses. FindingsApproximately 326 (28·2%) of 1158 rural nurses disclosed turnover intentions. 525 (47·1%) had previous job mobility behaviours. The previous job mobility behaviours of rural nurses had a significant effect on their current turnover intentions (odds ratio [OR] 1·85, 95% CI 1·34–2·56); further analyses indicated that the specific way (moving from a same-level medical institution, OR 2·72, 1·59–4·66; moving from a high-level to a low-level medical institution, 1·82, 1·02–3·27; moving from a non-medical institution, 2·37, 1·09–5·17) and time (moving 4–6 years ago, 2·57, 1·59–4·17; moving ≥7 years ago, 2·01, 1·25–3·24) of last job mobility behaviour were significantly associated with nurses' turnover intentions. Other risk factors for turnover intention in rural nurses included a high-level professional title (eg, the title of chief [associate] nurse; OR 4·40, 1·43–13·54), low-level job satisfaction with effort–reward balance (0·77, 0·62–0·96), and social support from superiors (0·67, 0·55–0·83). InterpretationPrevious job mobility behaviours of rural nurses significantly increased their odds of current turnover intentions, especially for those rural nurses who moved between two same-level medical institutions within 4–6 years for the last time of job mobility behaviour. Hospital managers should pay more attention to these rural nurses to reduce their turnover. Reasonable job mobility channels related to career development for rural nurses should also be established. FundingChina Medical Board: Situational Analysis and Policy Evaluation of Development and Retention of Human Resources for Health in Rural Western China (10-029).
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