Nursing turnover continues to be a problem for healthcare organizations. Longitudinal research is needed in order to monitor the development of turnover intentions to leave the profession over time.
The objectives were: (1) to investigate the prevalence of new graduates' intentions to leave the nursing profession, (2) to prospectively monitor the development of intention to leave during the first five years of professional life, and (3) to study the impact of sex, age, occupational preparedness and burnout (i.e. exhaustion and disengagement) on the development of intention to leave the profession.
Longitudinal observational study.
Participants were recruited from first-year nursing students at any of the 26 universities in Sweden offering nursing education. Of the 2331 student nurses who were invited to participate in the study, 1702 (73%) gave informed consent and thus constituted the cohort. This cohort was prospectively followed yearly (three times during education and five times post graduation) from late autumn 2002 to spring 2010. Of the 1501 respondents who continued to participate after graduating, 1417 worked as nurses at the time of data collection and responded to the items regarding intention to leave the nursing profession during at least one wave of measurement; these constituted the sample of the present longitudinal study.
The outcome variable was intention to leave the nursing profession. This was measured using a scale of three items, covering thoughts of leaving the profession. The main predictor was burnout, and this was measured by the exhaustion and disengagement scale from the Oldenburg Burnout Inventory. Data were analysed using latent growth curve modelling.
After five years, every fifth nurse strongly intended to leave the profession. The longitudinal analysis of change in intention to leave showed that levels increased during the first years of employment. High levels of burnout were related to an increase in intention to leave.
It is important for organizations employing new graduates to pay attention to nurses who show early signs of burnout, and provide a resourceful work environment with a suitable workload, sufficient introduction, management support, satisfactory collaboration with colleagues, and role clarity.
To outline the development and implementation of the Canadian Intercollegiate Sport Injury Registry (CISIR), to examine its validity, including the data collection forms, the recording of athlete exposure, and the mechanism of injury, and to determine the ability of the CISIR to meet its stated objectives of assessing rates and risk of injury.
Prospective cohort study.
Canadian intercollegiate athletics.
344 varsity football players from five western Canadian universities. ASSESSMENT OF RISK FACTORS AND OUTCOME MEASURES: Three data collection instruments were developed to capture the principle types of information forming the cornerstones of the CISIR: a medical form for preseason assessment of risk factors, a weekly exposure sheet (WES) for the documentation of daily individual athlete participation, and an individual injury report form (IIRF) for collection of injury-related information. Design and implementation input was provided by therapists and physicians through initial meetings, pilot testing, site visits, questionnaire, and final consensus meeting. The completeness of injury reporting was assessed through cross-referencing with participation time loss data. An item analysis was conducted on the principal elements of the IIRF. The categorization of participation itself was also examined, as was the diagnostic agreement between the therapists and physicians involved in data collection. The recorded mechanism of injury was compared with that noted through a video analysis for game-related injuries. Lastly, a test analysis was conducted to extract data and compute rates and risks of injury.
This developmental phase was successful, with 99.7% subject enrollment, high therapist satisfaction, and good flow of data. A relational database, incorporating dual-entry data verification, was designed and functioned well. The collection process revealed that 100% of the WESs were submitted, and the data therein was 99.7% complete. The injuries resulting in participation time loss were recorded on an IIRF 97.9% of the time. The exposure (participation) codes were thought to be overly precise, and a simplification of these categories is suggested. The diagnostic agreement between physicians and therapists was 70%. It was possible to validate game exposures, but no standard was identified to permit validation of the categories of exposure. Likewise, the mechanism of injury as recorded by the therapists was thought to be more precise than the video analysis. After two modifications in the table structure of the relational database, it was possible to extract data relating to rates and risks of injury.
This study demonstrated a high degree of validity for many elements of the CISIR. One limitation was that no reference standard existed for some components, limiting some aspects of validity assessment. With the suggested revisions, the CISIR represents the current standard in athletic injury reporting in terms of individual injury risk assessment. This system will be used in the future to explore the prediction and prevention of sport injuries.
During a 5-year period (1978-1983) the clinical features and operative morbidity/mortality were registered prospectively for all patients in Denmark with an unruptured symptomatic (27 patients) or incidental (21 patients) intracranial saccular aneurysm. A follow-up examination was performed 2 years after diagnosis of the aneurysm. Thirty symptomatic aneurysms in 27 patients most frequently involved the visual pathways or ocular motility (66%). The median diagnostic delay for patients with impaired visual acuity was 7 months but only 14 days for patients with impaired ocular motility. The localisation of the 30 symptomatic and 23 incidental aneurysms were: internal carotid artery (73% approximately 35%), anterior communicating artery (3% approximately 26%) and middle cerebral artery (7% approximately 35%). The diameters of 73% of the symptomatic aneurysms were greater than 10 mm, while the diameter of 74% of the incidental aneurysms were below 10 mm. The total operative morbidity and mortality were 15% and 4%, respectively. The mortality rate in the follow-up period was 10-11% mainly due to fatal bleeding from unoccluded aneurysms. In 21 survivors, a normal mental status was found in 43% and mild dementia was found in another 43%. The impaired visual acuity was unchanged in 67% of patients, while the ocular motility had normalised in 75%. A normal daily functional capacity was enjoyed by 57% while 43% had a moderate reduction, mostly due to visual disturbances.