Mohsin Sultan, M.S., Ohio University; Ryan Johnson, Ph.D., Ohio University; Rachel Clift, RN, MSN, Ohio University

The purpose of our study is to examine burnout as a linking mechanism between perceptions of understaffing and both occupational and organizational turnover intentions among nurses. Further, forms of support (organizational support and coworker support) are examined as potential buffers for the relationship between understaffing and burnout. We expect that burnout will partially mediate the relationships between nurses’ perceptions of understaffing in their work unit and both forms of turnover intentions (H1 & H2). It is also expected that perceived support from the organization (H3) and from coworkers (H4) will moderate the relationship between understaffing and burnout, such that the relationship will be weaker for those who perceive more support.

Employee turnover is associated with a variety of ramifications, such as financial consequences for the organization, as well as negative impacts on employee morale and productivity (Makawatsakul & Kleiner, 2003). Nursing is an occupation with an exceptionally high turnover rate, which combined with an increased need for nurses due an aging population, has contributed to numerous healthcare facilities (e.g., hospitals, nursing homes) to be understaffed. For example, in 2019, there were over 1,600 Medicare & Medicaid Certified nursing homes that did not meet the adequate staffing requirements set by the Centers for Medicare & Medicaid Services.

Understaffing has also been reported as one of the top reasons why nurses voluntarily leave their jobs (Nursing Solutions, 2020), and is thus a contributing factor to turnover which ultimately exacerbates the nursing shortage. Understaffed healthcare environments are related to consequences for patients, as patients who are exposed to more understaffed work shifts are more likely to develop injury or infection (Twigg et al., 2015). In addition, understaffed work environments negatively impact the health of nurses. For example, research suggests that nurses in understaffed workplaces are at increased risk of harmful cholesterol levels (Weigl et al., 2019). Given the nature of the nursing occupation, an understaffed work environment is likely to be an additional factor which may increase the likelihood of burnout among nurses, thus burnout is examined here as a mechanism linking understaffing and turnover intentions.

A potential solution to improve the well-being of nurses is support. For example, nurses who perceive their supervisor to be supportive have less absences due to illness compared to those who perceive less support (Hall, 2007). Thus, support may be a critical buffer in understaffed work environments, therefore this study examines both organizational and coworker support as potential buffers of the negative role of understaffing on the well-being of nurses. Further, despite turnover studies often including nurses, such studies often only examine organizational turnover or do not differentiate between both forms of turnover. Given that nurses that are leaving the nursing occupation altogether are contributing to the nursing shortage, the distinction between both forms of turnover is important, thus this study examines both forms of turnover intentions.

Data for the study were collected through an online questionnaire which consisted of self-report measures. The sample consists of 365 nurses who work a minimum of 35 hours per week and are employed as part of a larger organization (e.g., hospital). Participants responded to self-report measures of the focal variables of the study (e.g., burnout, coworker support), items related to COVID-19, demographics (e.g., geographic location, age), as well as work schedule (e.g., shift schedule). Bivariate correlations were calculated to ensure all of the relationships among the focal variables were in the expected direction. The remaining analyses (which will be reported for the conference) will involve simple mediation and moderated-mediation analyses which will be conducted in SPSS through the PROCESS macro (v 3.4).

All relationships among the focal variables in the study were significant and in the expected direction. Simple mediation analyses will be conducted to test Hypothesis 1 and 2, moderated mediation analyses will be conducted to test Hypothesis 3 and 4. Contextual variables (e.g., shift schedule) will also be examined as moderators and/or controls. Data collection for this study just concluded, thus full analyses will be conducted and included in the conference poster.

If organizational and/or coworker support are found to buffer the relationship between understaffing and burnout, this would highlight an opportunity for intervention. Organizations may engage in programs to foster a supportive environment to improve the well-being of nurses. Improved well-being among nurses may also mitigate turnover which may lessen the prevalence of the nursing shortage.

If the hypotheses for the study are supported, future research could develop support-focused interventions and identify which specific behaviors and forms of support are the most beneficial. Healthcare organizations could also expand the data they use to predict workforce turnover and planning based on a clearer understanding of the cyclical role understaffing may have in prolonging occupation-level labor shortages.

Tags: Applied research, Comprehensive Approaches to Healthy Work Design and Well-Being, COVID-19, Empirical study, Health care and social assistance, Job Attitudes; Turnover; and Retention, Organization- and Job-Level Environments and Practices, Social and Organizational Environment, Total Worker Health, Work Organization and Stress, Workplace Stress; Outcomes; and Recovery