This study aimed to explore turnover rates for Korean acute care hospital nurses and identify factors influencing their turnover. The study was retrospective in nature. Nurse cohort data were obtained from hospital status data from Korea's Health Insurance Review Assessment Service. The observation period was from January 1, 2012 to December 31, 2016, and data for 96,158 nurses were analyzed. Independent variables included nurses' age and sex and hospital setting, type, ownership, and nurse staffing level. Kaplan-Meier analysis was performed to estimate survival curves, and factors influencing turnover were analyzed using Cox's proportional hazard regression. The cumulative turnover probability for all nurses was .17, .29, .38, .45, and .50 for the first, second, third, fourth, and fifth years, respectively. The results showed that the longer the career duration, the lower the turnover rates. According to the factors influencing nurse turnover, both nurses' (i.e., sex and career duration) and hospitals' (i.e., hospital setting, type, ownership, and nurse staffing level) characteristics were statistically significant. It should be noted that the turnover rate of nurses with less than three year of career duration and of those with less than one year has been shown to be quite high. Therefore, target populations for acute care hospital nurse turnover should be expanded from new graduate nurses to experienced nurses with less than 3 years of career. Further studies are required to examine the causes of high turnover rates in hospitals that are small and/or have low nurse staffing levels.

Aim: This study aimed to calculate the total daily nursing workload and the optimal number of nurses per general unit based on the nursing intensity.Design: This study was conducted using a cross‐sectional study.Methods: Three units at one general hospital were investigated. Patient classification according to nursing needs was performed for over 10 days in each unit in September 2018. The direct and non‐direct nursing time and nursing intensity scores were analysed using descriptive statistics.Results: For the internal medicine unit, the average direct nursing time per patient was 1.0, 1.5, 2.2 and 2.9 h for Groups 1, 2, 3 and 4, respectively. For the surgical unit, the average direct nursing time per patient was 0.9, 1.4, 2.1 and 2.6 h for Groups 1, 2, 3 and 4, respectively. 5 and 9 additional nurses were needed in the internal medicine and surgical nursing units.Patient Contribution: This study confirmed that the optimal number of nurses was not achieved and that the nursing intensity was very high. Long‐term efforts, such as improving the nursing environment, should be made to ensure an optimal number of nurses in various nursing units.

Nurses are frequently faced with ethical dilemmas in their nursing practice. Nurse can experience moral distress when they know the morally correct response to a situation but cannot act accordingly because of institutional or hierarchical constraints. The aim of this integrated review was to synthesize the available quantitative and qualitative evidence in the literature on moral distress experienced by nurses. We appraised seven articles published between January 1984 and December 2015. This review revealed that many nurses in South Korea experience moral distress associated with difficult care situations and feel negative psychological symptoms, which can have an impact on their job performance. Further research is required to examine workplace strategies to support nurses in these situations and to develop coping strategies for dealing with moral distress.

손행미, et al. J Korean Acad Community Health Nurs. 2021 Dec;32(4):578-592. https://doi.org/10.12799/jkachn.2021.32.4.578

Aim To develop a new general wards patient classification tool based on the nursing intensity level that reflects patients’ clinical characteristics and indirect nursing activities. Design A cross‐sectional design was adopted. This methodological study developed a patient classification system to sort general ward patients based on the intensity of their nursing needs and verified the validity and reliability of this classification system. Methods Thirteen experts verified the tools’ content validity. Data collectors and head nurses classified 150 patients from two hospitals with four general wards and various nurse staffing levels. Inter‐rater reliability was analysed. Staff nurses classified 846 patients following the Korean patient classification system on nursing intensity scores that reflected patients’ clinical status. Content validity was verified based on the classification results. Using K‐group cluster analysis, score ranges for four groups were identified. Results The developed tool includes 8 domains, (symptom management, infection control, nutrition and medication, personal hygiene and secretion, activity, sleep and rest, guidance in nursing/emotional support, nursing activity planning and coordination, indirect activity), 24 subdomains, 66 nursing activities and 124 criteria. Inter‐rater reliability showed high agreement.

The turnover of new and mid-career nurses has been increasing, leading to challenges in recruiting and retaining nursing staff. Securing and retaining mid-career nurses is crucial for ensuring high-quality care. However, little is known about mid-career nurses' experiences regarding turnover. This study aimed to understand the experiences of mid-career nurses and identify strategies to enable mid-career nurses to maintain long-term employment in health services. Colaizzi's phenomenological methodology was adopted to illuminate the subjective meaning derived from the work-related challenges of mid-career nurses, leading to turnover. Focus group interviews were conducted to delve into the work challenges faced by mid-career nurses. The participants were 23 mid-career nurses working in one tertiary hospital and six secondary hospitals across three Korean cities, recruited using purposive and snowball sampling. The inclusion criteria entailed a minimum of three years of nursing experience and current employment within a designated department or clinical area within the hospital environment, commonly known as a nursing unit. Such units encompassed a range of clinical settings, including medical-surgical units, intensive care units, and emergency rooms. The interview data were transcribed verbatim, and significant statements were extracted from abstract sentences to derive themes through an analytical process. Analysis of the work experiences of 23 mid-career nurses in medical institutions yielded 15 themes and 4 theme clusters derived from 353 meaningful statements. These theme collections were identified as 'Difficulties endured as a mid-career nurse', 'Meaningless and regrettable new graduate nurses' education', 'An inexpressibly poor work environment', and 'Systems and policies needed to remain in the hospital'. Difficulties faced by mid-career nurses including the establishment of an education and career development system, provisions for guaranteed leave, a diverse and flexible work system, opportunities for effective communication, and engagement with the opinions of mid-career nurses should promptly be addressed.