Akira Tagaya

Factors affecting turnover of Japanese novice nurses in university hospitals in early and later periods of employment

AIM To explore the factors affecting turnover of novice nurses during the 10th-15th months of employment in comparison with those during the preceding 6 months. BACKGROUND The early turnover of novice nurses is a serious issue. Our previous study showed that 4.0% (37/923) of novice nurses quit their jobs in the initial 3rd-9th months of employment. The major determinants of their turnover were education (i.e. graduation from vocational nursing schools), undesired ward assignment and lack of peer support. METHODS The cohort of 762 novice nurses from our previous study was followed up during the next 10th-15th months of employment. Their turnover in this period was predicted using variables from baseline data such as demographic attributes, burnout (J-MBI), assertiveness (J-RAS) and perceptions about the workplace. RESULTS The findings showed that 4.6% (35/762) of novice nurses quitted their jobs during the first 15-month period. The factors affecting the turnover were: burnout, dissatisfaction with the workplace and hospital location being in Tokyo. All these factors were different from those observed for the preceding follow-up period. CONCLUSION Burnout was revealed to be the most significant factor affecting the turnover of novice nurses. Implications for nursing management Nurse managers should be vigilant and exercise care in the prevention of burnout among novice nurses.

Relationship between assertiveness and burnout among nurse managers

AIM We aimed to clarify the relationship between assertiveness and burnout among nurse managers at university hospitals. METHODS The directors at three university hospitals agreed to cooperate with our study. During a one-month period from May to June 2007, a self-administered questionnaire was distributed to 203 nurse managers (head and sub-head nurses). The Japanese version of the Rathus Assertiveness Schedule (J-RAS) and the Japanese version of the Maslach Burnout Inventory (MBI) were used as scales. Burnout was operationally defined as a total MBI score in the highest tertile. RESULTS Valid responses were obtained from 172 nurse managers. The mean J-RAS score of the burnout group (-14.3) was significantly lower than that of the non-burnout group (-3.3). Responses about work experience and age showed no significant group difference. Total MBI score was inversely correlated with J-RAS score (R = -0.30, P < 0.01). Multiple logistic regression analyses indicated a decrease in the risk of burnout by 26% (0.74 times) for every 10 point increase in the J-RAS score, and by 60% (0.40 times) for greater satisfaction with own care provision. CONCLUSIONS The results suggest that increasing assertiveness and satisfaction with own care provision contributes to preventing burnout among Japanese nurse managers.

Elderly Japanese People Living in Small Towns Reflect on End-Of-Life Issues:

This article, reporting on selected data from a larger study, discusses some responses to end-of-life questions that elderly Japanese people who were living in small towns gave in a questionnaire survey. Japan is now the country with the largest number of elderly people in the world and confronts numerous social and economic questions concerning how best to cope with its older population. Although it is a highly urbanized society, Japan also has large semirural areas. The focus here is on the questions in the survey that sought responses to ethical dimensions of end-of-life issues. The findings demonstrate the strength of traditional values that still exist throughout small towns in Japan.

Patient advocacy: Japanese psychiatric nurses recognizing necessity for intervention

Background: Advocacy is an important role of psychiatric nurses because their patients are ethically, socially, and legally vulnerable. This study of Japanese expert psychiatric nurses’ judgments of interventions for patient advocacy will show effective strategies for ethical nursing practice and their relationship with Japanese culture. Objectives: This article explores Japanese psychiatric nurses’ decision to intervene as a patient advocate and examine their ethical, cultural, and social implications. Research design: Using semi-structured interviews verbatim, themes of the problems that required interventions were inductively summarized by a qualitative analysis and their contexts and nursing judgments were examined. Participants and research context: The participants were 21 nurses with 5 or more years of experience in psychiatric nursing. Ethical considerations: The research was approved by Institutional Review Board of research site and study facilities. The participants gave written informed consent. Findings: Analysis of 45 cases showed that nurses decided to intervene when (a) surrounding people’s opinions impeded patients’ safety, (b) healthcare professionals’ policies impeded patients’ decision-making, (c) own violent behaviors impeded treatment and welfare services for patients, (d) own or families’ low acceptance of illness impeded patients’ self-actualization, (e) inappropriate treatment or care impeded patients’ liberty, and (f) their families abused patients’ property. Discussion: To solve conflicts between patients and their surrounding people, the nurses sought reconciliation between them, which is in accordance with Japanese cultural norms respecting harmony. When necessary, however, they protected patients’ rights against cultural norms. Therefore, their judgments cannot be explained by cultural norms alone. Conclusion: The findings indicate that the nurses’ judgments were based on respect for patients’ rights apart from cultural norms, and they first sought solutions fitting the cultural norms before other solutions. This seems to be an ethical, effective strategy if advocates know the culture in depth.