Study on the Relationship and Correlation between Turnover Tendency of Emergency Nursing Staff and Social and Work Factors.

The relationship and correlation between emergency nursing staff turnover intention and social and work factors are explored. A total of 110 nurses in the emergency department of our hospital from February 2021 to October 2021 are selected as the research subjects. A questionnaire survey is conducted among all the nurses. By comparing with the general information of the emergency nurses, the scores of turnover tendency, social support, workplace violence, and job burnout scales of the emergency nurses are calculated. Multifactor logistic regression is used to analyze the influencing factors of turnover tendency of emergency nursing staff, and Spearman correlation coefficient is used to analyze the correlation between turnover tendency of emergency nursing staff and its influencing factors. The results of the survey show that age, education level, social support, workplace violence, and job burnout can all affect the turnover tendency of emergency nursing staff. Managers should pay more attention and take reasonable measures to avoid staff turnover.

1. Introduction

By the end of 2020, the National Bureau of Statistics pointed out that the proportion of nursing personnel in China and developed European countries accounted for about 3.14% of the total population—in the context of China's total population of 137,462 million, only 3.24 million nursing personnel, and the allocation of nursing human resources is seriously insufficient. Besides, there are problems such as insufficient nursing staff and poor nursing quality, and staff turnover is also an important factor leading to the insufficient allocation of nursing staff in China, which seriously hinders the progress and development of nursing career in China [1]. Resignation intention is an important factor that indirectly shows whether an employee wants to leave the current organization or not and shows various behaviors of employees who are dissatisfied with their work, have resignation intention, and may look for other jobs. It can be said that resignation intention is an important Anzac variable to predict resignation behavior [2]. Emergency nursing staff need to bear higher intensity of work and have great pressure from work and patients. Therefore, compared with other departments, the turnover tendency is more serious [3]. This study explores the relationship and correlation between the dimission tendency of emergency nursing staff and social and work factors, in order to find the relevant influencing factors of the dimission of emergency nursing staff and implement improvement measures to avoid staff turnover.

The rest of this paper is organized as follows: Section 2 discusses related work, followed by nursing staff information and investigated methods designed in Section 3. Section 4 shows the experimental results and analysis, and Section 5 briefly summarizes all of standpoints of the whole text and points out the future research directions.

2. Related Work

Turnover intention can be intuitive, show the nurses' professional identity, and is one of the important variables predicted personnel turnover. By analyzing the factors affecting the turnover intention of nursing staff and solving the problems, it is an important way to improve the retention rate and reduce the turnover rate, which is an important entry point for the human resource management department to optimize the staffing [4].

Al Zamel et al. [5] found that age, gender, and number of children and work ward/unit had a moderating effect on turnover intention. The reason is that nursing staff aged 30 are mostly the only child and grew up in a good environment, so when they enter the work place, the role change will suddenly appear pressure. They not only have to deal with complicated work but also face marriage and childbirth problems. If they cannot balance work and family, they are prone to frustration and negative emotions. Therefore, the turnover rate of this group is generally higher. The nursing staff in 30–40 year-old group have more clinical work experience and higher professional ability, and their family and career have been stable. At the same time, most of them have become the backbone of the department and can better show their ability and obtain professional identity, so they have low turnover intention. At the same time, nursing staff ≥40 years old have retired to nonimportant positions, their work pressure is low, and their professional title is relatively high. Because they have experienced the development and change of the hospital, they have a strong sense of belonging to the hospital, so they will not easily have the idea of leaving. At the same time, studies have shown that education level also has an impact on the turnover intention of medical staff, which is consistent with the results of this study. The study showed that there were significant differences in the turnover intention of emergency nursing staff above and below the junior college in terms of educational background (P < 0.05), the analysis of the reason may be that the current higher education required nursing personnel, nursing staff through promotion degree, bachelor degree or above accounted for 70%, and with the community care and health service industry development, the nursing industry has broad prospects, and nursing staff face more employment opportunities and higher selectivity, so the tendency to leave will be higher. In view of the above situation, reducing turnover tendency can help young nurses to carry out reasonable career planning, improve their understanding and awareness of nursing profession, provide them with a development platform, and broaden their personal development space, so as to improve the professional identity and sense of belonging of nursing staff.

The results of this study indicate that the social support degree of nursing staff with turnover intention is significantly lower than that of emergency nursing staff without turnover intention. The turnover tendency of emergency nurses with high level of workplace violence was significantly higher than that with low level of workplace violence. The degree of job burnout of emergency nursing staff with turnover tendency was significantly higher than that of staff without turnover tendency. Meanwhile, the degree of workplace violence and job burnout was positively correlated with turnover intention, while social support was negatively correlated with turnover intention (P < 0.05). Fazio et al. [6] showed in their study that the lower the social support, the stronger the dimission intention of employees. Li et al. [7] showed that those who suffered more violence at work, such as verbal assault, physical assault, and sexual harassment, generally had higher turnover tendency than those who suffered less violence at work. Studies have shown that the higher the degree of job burnout, the higher the turnover intention (P < 0.05) [8]. The above studies are consistent with the results of this study. Analysis of the reasons may be as follows: due to the particularity of the department, emergency nursing staff face great pressure. They not only have to take charge of nursing work but also need to complete other health education, nursing teaching, psychological nursing, and other work. Due to the shortage of human resources and other problems, nursing staff are overloaded with work. Due to the frequent occurrence of injury to doctors, the relationship between doctors and patients is relatively tense. As the people who have the closest contact with patients and their families, nursing staff have low social recognition and will be subjected to verbal and physical attacks from patients and their families. At the same time, nursing staff are faced with a series of problems such as low salary, frequent night shift, and high learning pressure. As a result, emergency nursing staff have higher turnover intention and are more inclined to find a relatively easy job with lower risk. Above all, while paying attention to the quality of work, we should also pay more attention to the life and psychological state of the nursing staff and provide help and support for the nursing staff.

3. Nursing Staff Information and Investigated Methods

3.1. Nursing Staff Information

A total of 110 nurses in the emergency department of our hospital from February 2021 to October 2021 are selected as subjects, aged 23–47 years, with an average age of 34.44 ± 5.78 years. Working years range from 1 to 15 years, with an average of 8.23 ± 4.88 years. 45 people are below junior college, 65 people are above junior college, 51 are unmarried, and 59 are married. 3 were deputy seniors, 29 head nurses, and 51 nurses. There are 110 valid questionnaires. The inclusion criteria include (1) obtaining a nurse's license; (2) have worked in emergency department for at least 3 months; (3) volunteer to participate in this study; (4) can participate in the whole study. The exclusion criteria include (1) interns; (2) training and rotation personnel; (3) did not obtain the nurse practice certificate; (4) involuntary participation of the research staff; (5) students who ask for leave or go out to study.

3.2. Investigated Methods

In this study, nursing staff are investigated by questionnaire, which mainly included 5 aspects (general data survey scale, turnover intention scale, social support rating scale, workplace violence measurement scale, and job burnout scale). Professional investigators will issue questionnaires to the selected research objects on the spot, and the researchers will fill them in anonymously. The questionnaires will be recovered on the spot.

3.2.1. General Information Questionnaire

The general information questionnaire is used to investigate the emergency nursing staff, including age, education level, marital status, working years, professional title, health status, and personal income.

3.2.2. Turnover Intention Scale

According to the questionnaire of turnover intention selected as the basis, the identification degree of turnover intention of emergency nursing staff is evaluated. The scale has three dimensions as follows. (1) Turnover intention I: possibility of current turnover, including items 1 and 6. (2) Turnover intention II: the tendency to look for other jobs, including items 2 and 3. (3) Turnover intention III: the possibility of obtaining external work, including items 4 and 5 [9].

3.2.3. Social Support Rating Scale

The social support rating scale is used to carry out the questionnaire survey, which included three dimensions: subjective support, objective support, and utilization of support. Items 1, 3, 4, and 5 belong to subjective support; items 2, 6, and 7 belong to objective support; and items 8, 9, and 10 belong to the utilization of support [10].

3.2.4. Workplace Violence Scale

Work violence scale is selected to measure the frequency of violence suffered by emergency nursing staff at work, which includes 5 items (verbal assault, physical assault, threat, emotional abuse, and sexual harassment) [11].

3.2.5. Job Burnout Scale

Job burnout includes 3 dimensions (emotional exhaustion, depersonalization, and low sense of personal accomplishment). Emotional exhaustion includes 9 items, which belong to the core dimension. The higher the score, the higher the degree of emotional exhaustion. Depersonalization includes 5 items, indicating the perfunctory attitude of emergency nursing staff to their service staff in the working environment. The higher the score is, the more depersonalization degree is. Low personal achievement includes 8 items; the higher the score, the lower the personal achievement [12].

3.3. Observation Indicators

The observation index includes the following steps.

Patients' turnover intention is observed, and the score is scored in reverse according to 1–4 points: 4—often, 3—occasionally, 2—rarely, and 1—never. The score is the sum of the scores of each item. The higher the score is, the higher the turnover intention is. The total score ≤1 indicates no turnover intention, and >1 indicates turnover intention. According to the dimission tendency, emergency nurses are divided into two groups: the dimission tendency group and the nondimission tendency group.

Univariate analysis is performed between the two groups to compare the differences in general data.

Single factor analysis is conducted on the differences between the two groups in the scores of the social support rating scale. The full score of the scale's three dimensions is 32 points, 20 points, and 12 points, respectively. The higher the score is, the higher the social support is.

Univariate analysis of the differences of the workplace violence scale between the two groups: the scale is divided into 4 levels, with 0∼3 points for each level, and the total score is 0∼15 points. 0 points: no phenomenon; 1–5 points: low frequency; 6–10 points: medium frequency; 11–15 points: high frequency. The higher the score, the higher the frequency of workplace violence.

In univariate analysis, 0∼8: depersonalization; 9∼20: low sense of personal achievement; and 21∼27: emotional exhaustion. The higher the score, the higher the degree of job burnout.

Multiple logistic regression is used to analyze the influencing factors of turnover intention, and Spearman correlation coefficient is used to analyze the correlation between turnover intention of emergency nursing staff and its influencing factors.

3.4. Statistical Methods

All the data in this study were cleared, and the corresponding database was established. SPSS 26.0 was used to process the data of all the database entries. Normality and F-test were conducted on the measurement data by the Bank of China, and the data were in line with normal distribution, which was expressed as mean ± standard deviation (X + S). Multiple logistic regression method is used to analyze the influencing factors of turnover tendency of emergency nursing staff, and Spearman correlation coefficient is used to analyze the correlation between turnover tendency of emergency nursing staff and its influencing factors. P < 0.05 indicates the difference is statistically significant.

4. Experimental Results and Analysis

4.1. Comparison of Turnover Tendency of Emergency Nursing Staff

Table 1 shows the comparison of turnover tendency of emergency nursing staff (n, %). According to the investigation, it can be seen from Table 1 that 69 out of 110 emergency nurses have turnover tendency and 41 have no turnover tendency. The number of emergency nurses with turnover tendency is significantly more than that without turnover tendency (P < 0.05).

Table 1

Comparison of turnover tendency of emergency nursing staff (n, %).

Number	Have a tendency to quit	No tendency to quit	χ 2	P
110	69 (62.73)	41 (37.27)	5.362	0.001

4.2. Univariate Analysis of Individual Situation Differences of Emergency Nursing Staff

Table 2 shows the single factor analysis of individual situation difference of emergency nurses. It can be seen from Table 2 that emergency nursing staff with age <30 and education level above junior college have a higher turnover tendency, and the difference is statistically significant (P < 0.05), while there is no significant difference in turnover tendency in other general data (P > 0.05).

Table 2

Single factor analysis of individual situation difference of emergency nurses (n, %).

	n	Have a tendency to quit (n = 69)	No tendency to quit (n = 41)	x 2	P
Age(years)				8.476	0.002
<30	45	33 (73.33)	12 (26.67)
≥30	65	21 (32.31)	44 (67.69)
Level of education				8.639	0.001
Junior college and below	37	7 (18.99)	30 (81.08)
College degree or above	73	43 (58.90)	30 (41.10)
Marital status				0.578	0.389
Unmarried	76	31 (40.79)	45 (59.21)
Married	34	16 (47.06)	18 (52.94)
Working time				0.172	0.768
<5	55	20 (36.36)	35 (63.64)
5∼10	34	12 (35.29)	22 (64.71)
≥10	21	7 (33.33)	14 (66.67)
Professional title				0.243	0.375
Vice director	3	0 (0.00)	3 (100)
Nurse-in-charge	29	9 (31.03)	20 (68.97)
Nurse practitioner	51	24 (47.06)	27 (52.94)
The nurse	27	18 (66.67)	9 (33.33)
State of health				0.311	0.542
Good	100	37 (37.00)	63 (63.00)
Bad	10	4 (40.00)	6 (60.00)
Monthly income				4.215	0.172
≤5000	81	31 (38.27)	50 (61.73)
>5000	29	11 (37.93)	18 (62.07)

4.3. Univariate Analysis of the Scores of Social Support Scale for Emergency Nursing Staff

Table 3 shows the score of social support scale for emergency nursing staff in univariate analysis. It is clearly evident from Table 3 that the total score of social support of nurses with no turnover intention is 45.58 ± 5.89 points and that of nurses with turnover intention is 30.38 ± 5.46 points. The total score of social support of emergency nurses with turnover intention is significantly lower than that of nurses with no turnover intention (P < 0.05).

Table 3

Score of social support scale for emergency nursing staff in univariate analysis ().

The dimension	Have a tendency to quit (n = 69)	No tendency to quit (n = 41)	t	P
Subjective support	21.57 ± 1.34	27.34 ± 2.57
Objective to support	10.55 ± 0.23	18.57 ± 1.78
Utilization of support	2.33 ± 1.76	11.23 ± 0.54
Total score	30.38 ± 5.46	45.58 ± 5.89	0.879	0.001

4.4. Single Factor Analysis of Workplace Violence Rating Scale Scores of Emergency Nursing Staff

Table 4 shows the single factor analysis of workplace violence rating scale scores of emergency nursing staff. It can be seen from Table 4 that the total score of workplace violence of emergency nursing staff with turnover intention is 12.56 ± 1.73 and that of nonturnover intention is 4.23 ± 1.89. The total score of workplace violence of emergency nursing staff with turnover intention is significantly higher than that of nonturnover intention, and the difference is statistically significant (P < 0.05).

Table 4

Single factor analysis of workplace violence rating scale scores of emergency nursing staff.

The dimension	Have a tendency to quit (n = 69)	No tendency to quit (n = 41)	t	P
Language attack	10.23 ± 2.15	3.51 ± 1.34
The body attacks	4.45 ± 1.76	2.17 ± 0.87
Threat	3.34 ± 1.15	1.07 ± 0.03
Emotional abuse	2.33 ± 0.43	1.04 ± 0.05
Sexual harassment	2.01 ± 0.06	0
Total score	12.56 ± 1.73	4.23 ± 1.89	0.769	0.001

4.5. Univariate Analysis of Burnout Scale Scores of Emergency Nursing Staff

Table 5 shows the univariate analysis of burnout scale scores of emergency nursing staff. It can be seen from Table 5 that the total score of job burnout scale of those with turnover intention is significantly higher than that of those without turnover intention, and the difference is statistically significant (P < 0.05).

Table 5

Univariate analysis of burnout scale scores of emergency nursing staff.

The dimension	Have a tendency to quit (n = 69)	No tendency to quit (n = 41)	t	P
Emotional exhaustion	25.45 ± 1.31	22.31 ± 1.21
Low personal achievement	19.57 ± 0.09	11.67 ± 0.08
Go to the personal	7.58 ± 0.13	1.23 ± 0.34
Total score	25.33 ± 2.42	18.22 ± 2.88	0.876	0.001

4.6. Analysis of the Influencing Factors of Turnover Intention of Emergency Nursing Staff

Single factor (P < 0.05) and turnover intention of emergency staff were used as independent variables and dependent variables for multivariate logistic regression analysis. Table 6 is a variable assignment table. Table 7 shows the multifactor logistic regression analysis of the influencing factors of turnover intention of emergency nursing staff. Figure 1 is multivariate regression forest map. Table 8 shows the correlation between turnover intention and influencing factors of emergency nursing staff. Through the above experimental results, it can be observed that age <30 years old, cultural degree, workplace violence, and job burnout are independent risk factors of turnover intention and are positively correlated with the incidence of emergency nursing staff turnover intention. Social support is a protective factor of turnover intention of emergency nursing staff and is negatively correlated with it.

Table 6

Variable assignment table.

	The variable name	Assignment
Age (years)	X1	<30 = 1, ≥30 = 2
Level of education	X2	College or below = 1, college or above = 2
Social support	X3	High = 1, low = 2
Levels of workplace violence	X4	High = 1, low = 2
Job burnout level	X5	High = 1, low = 2

Table 7

Multifactor logistic regression analysis of the influencing factors of turnover intention of emergency nursing staff.

Factors affecting the	B	S.E.	Wald	P	OR	95% CI
Age <30	1.401	1.354	4.216	0.001	0.146	0.043∼0.768
Level of education	1.134	1.214	7.315	0.002	0.217	0.021∼0.561
Social support	−1.152	0.351	8.104	0.001	0.079	0.019∼0.411
Levels of workplace violence	1.301	0.512	5.247	0.002	0.068	0.021∼0.324
Job burnout level	3.372	1.462	3.492	0.001	0.187	0.051∼0.658

Figure 1

Multivariate regression forest map.

Table 8

Correlation between turnover intention and influencing factors of emergency nursing staff.

Factors affecting the	Turnover intention incidence (%)
	r	P
Age (years)	0.587	<0.001
Level of education	0.681	<0.001
Social support	−0.654	<0.001
Levels of workplace violence	0.532	<0.001
Job burnout level	0.714	<0.001

5. Conclusion and Future Work

The relationship and correlation between emergency nursing staff turnover intention and social and work factors are explored. The results of the survey show that age <30, education level, workplace violence, and job burnout are all risk factors for turnover intention of emergency nursing staff, while social support is a protective factor. It shows that hospital managers should not only provide absolute support to emergency nurses and rationally plan their work and development but also prevent the occurrence of work violence, pay attention to the psychological state of emergency nurses, and timely guide the nurses who appear job burnout, so as to reduce the loss of emergency nurses. However, due to the small sample size of this study, there may be some errors. Further research can be carried out by increasing the sample size to provide a more accurate basis for preventing the loss of emergency nursing staff.