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      Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review

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          Abstract

          Background

          During the COVID-19 pandemic, shortage of nursing staff became even more evident. Nurses experienced great strain, putting them at risk to leave their jobs. Individual and organizational factors were known to be associated with nurses’ turnover intention before the pandemic. The knowledge of factors associated with turnover intention during the pandemic could help to foster nurses’ retention. Therefore, this review aims to identify factors associated with nurses’ turnover intention during the COVID-19 pandemic.

          Methods

          After a systematic search of six databases, the resulting records were screened in a two-step process based on pre-defined inclusion and exclusion criteria. The included quantitative studies were synthesized qualitatively due to their methodological heterogeneity.

          Results

          A total of 19 articles were included in the analysis. Individual factors such as health factors or psychological symptoms and demographic characteristics were associated with nurses’ turnover intention. Organizational factors associated with turnover intention were e.g., caring for COVID-19 patients, low job control or high job demands, and moral distress. Resilience and supporting leadership could mitigate adverse associations with turnover intention.

          Conclusions

          The results help to identify high-risk groups according to individual factors and to develop possible interventions, such as trainings for nurses and their superiors, addressing individual and organizational factors. Future research should focus on longitudinal designs applying carefully defined concepts of turnover intention.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12912-022-00949-4.

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          Most cited references60

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          Stigma during the COVID-19 pandemic

          Healthcare workers and patients who have survived COVID-19 are facing stigma and discrimination all over the world. Sanjeet Bagcchi reports. Stigma associated with COVID-19 poses a serious threat to the lives of healthcare workers, patients, and survivors of the disease. In May 2020, a community of advocates comprising of 13 medical and humanitarian organisations including, among others, the International Committee of the Red Cross, the International Federation of the Red Cross and Red Crescent Societies, the the International Hospital Federation, and World Medical Association issued a declaration that condemned more than 200 incidents of COVID-19 related attacks on healthcare workers and health facilities during the ongoing pandemic. According to the declaration, “The recent displays of public support for COVID-19 responders are heartwarming, but many responders are nevertheless experiencing harassment, stigmatization and physical violence.” In a Mar 18, 2020 statement, WHO also unveiled that “some healthcare workers may unfortunately experience avoidance by their family or community owing to stigma or fear. This can make an already challenging situation far more difficult.” Several incidents of stigmatization of healthcare workers, COVID-19 patients, and survivors have come up during this pandemic across the world. For instance, in Mexico, doctors and nurses were found to use bicycles, as they were reportedly denied access to public transport and were subjected to physical assaults. Similarly, in Malawi, healthcare workers were reportedly disallowed from using public transport, insulted in the street, and evicted from rented apartments. In India, media reports revealed that doctors and medical staff dealing with COVID-19 patients faced substantial social ostracism; they were asked to vacate the rented homes, and were even attacked while carrying out their duties. With respect to social stigma of COVID-19 patients, there was an incident where a pregnant woman was reportedly abandoned by her family in India, after she gave birth to a child at a hospital in Maharashtra state, and was found positive for SARS-CoV-2. In some cases, COVID-19 survivors in India were stalked in social media. A COVID-19 survivor in Harare, Zimbabwe, got surprised, according to a media report, when the road in front of his house was named as “corona road” and some people even preferred to avoid the road fearing the possibilities of infection. “COVID-19 pandemic has created an unprecedented panic in the minds of people in India and several other countries”, says Diptendra Kumar Sarkar, a professor of surgery and Covid-19 strategist affiliated to the Institute of Post Graduate Medical Education Research (Kolkata, India). According to him, healthcare workers in India have become a natural target in the society, which is why they are suffering mental stress. Many of them faced social isolation, because of their job, and some had even faced near lynching situations, he points out. “Such a situation of social isolation may be linked to the high infectivity of the virus”, he suggests. Rahuldeb Sarkar, a respiratory medicine consultant at the Medway Maritime Hospital (Kent, UK) adds that, in countries such as India and Mexico, healthcare workers have to face substantial stigma during the pandemic as a result of the fear (about the infection) of the general public. “People do not have clear idea about modes of transmission of the virus”, he says. “Social stigma in COVID-19 pandemic is attributable to unscientific belief and improper understanding of common masses”, says Asis Manna, a professor of microbiology at the Infectious Diseases and Beliaghata General Hospital (Kolkata, India). According to him, some people believe that healthcare staff working in a hospital are a potential source of infection. This baseless belief extends to drivers of ambulances, family members of COVID-19 patients, and also patients discharged from the hospital after cure, he notes. However, in USA and UK, the doctors' experience of COVID-19 related stigma is different. “In the USA, we have had several instances where healthcare workers have faced harassment at public places because they have been perceived as at higher risk of transmission”, says Anish Ray, a consultant pediatrician at the Cook Children's Medical Center (TX, USA). However, according to Sarkar put, “In the UK, we were fortunate not to have stigma around healthcare workers' possibility of catching COVID. Instead of turning on against us, our neighbors truly appreciated the work we have been doing”. To tackle social stigma derived from COVID-19, WHO speaks of creating an environment where open discussion among people and healthcare workers is possible. “How we communicate about COVID-19 is critical in supporting people to take effective action to help combat the disease and to avoid fuelling fear and stigma”, WHO says, in a statement. “All efforts must be taken to scientifically destigmatise COVID-19 instead of statutory sermons by law makers”, urges Sarkar. “Proper health education targeting the public appears to be the most effective method to prevent social harassments of both healthcare workers and COVID-19 survivors”, says Ray. “It would also help create a proper environment to work as a team to contain this pandemic”, he stresses. © 2020 Flickr - Harsha K R 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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            Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID‐19 health crisis in Spain

            To evaluate compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and perceived stress in healthcare professionals during the coronavirus disease 2019 (COVID-19) health crisis in Spain.
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              Fear and avoidance of healthcare workers: An important, under-recognized form of stigmatization during the COVID-19 pandemic

              Highlights • Little is known about healthcare worker stigmatization (HCWS) during COVID-19. • HCWS involves fear and avoidance of healthcare workers, for fear of infection. • Our research indicates that HCWS is a widespread, under-recognized problem. • HCWS is associated with the COVID Stress Syndrome. • Interventions that reduce the COVID Stress Syndrome may reduce HCWS.
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                Author and article information

                Contributors
                katherina.heinrichs@charite.de
                Journal
                BMC Nurs
                BMC Nurs
                BMC Nursing
                BioMed Central (London )
                1472-6955
                4 July 2022
                4 July 2022
                2022
                : 21
                : 174
                Affiliations
                [1 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ; Berlin, Germany
                [2 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Institute of Health and Nursing Science, , Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ; Augustenburger Platz 1, 13353 Berlin, Germany
                Article
                949
                10.1186/s12912-022-00949-4
                9252069
                35787700
                4e1d0e33-a6f8-47c7-bef0-71156454775a
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 28 February 2022
                : 22 June 2022
                Funding
                Funded by: Charité - Universitätsmedizin Berlin (3093)
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Nursing
                covid-19,nurses,retention,review,turnover intention
                Nursing
                covid-19, nurses, retention, review, turnover intention

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