Risk factors for job turnover among Dutch nurse anaesthetists : the influence of job satisfaction, work climate, work context and personality dimensions

The aim of this thesis was to explore bottlenecks and to make recommendations for an optimalisation of the work environment of nurse anaesthetists in order to keep them preserved for the job. NAs have been providing anaesthesia care in the United States and in some European countries for nearly 150 years, and were the first "nursing specialty group". Though not universally so but especially in those countries where anaesthesia developed after WWII, Health Departments opted not to employ NAs and chose, essentially, to restrict anaesthesia to physician anaesthetists. At present, the anaesthesia workforce in Europe is very diversified and on average two European models can be defined: the nurse anaesthetists who are allowed to maintain anaesthesia without a direct supervision of the anaesthesiologist; and circulation nurses who can just help for a specific procedure but need a direct supervision of the anaesthesiologist and cannot monitor patients and maintain anaesthesia alone. The Dutch healthcare system employs nurse anaesthetists both with and without nursing backgrounds. Perceptions about work context factors, psychosomatic symptoms, burnout, sickness absence, general health and job satisfaction were similar between NA’s with or without nursing degree which suggests an equal perception on the part of both groups of competence to perform their jobs. We found four work context factors (career/rewards, relation with supervisor, task contents and social environment) that explain 48% of variance in work context, which Dutch nurse anaesthetists consider important in their job. The size and type of the anaesthesia department did not show to have an impact. Supervisors differed from nurse anaesthetists in their perception of the work context factors ‘relation with supervisor’, ‘task contents’ and ‘social environment’. Four personality dimensions, easy going’, ‘orderly’, ‘receptive’ and ‘compassionate’ were found in which the personality dimensions ‘easy going’ and ‘orderly’ explained 3.5% of the variance in job satisfaction. The negative correlation between age and the personality dimension ‘easy going’ showed the expected evolution in this personality dimension. Five work climate characteristics (‘recognition’, ‘encourage development’, ‘mission statement’, ‘progress’ and ‘learning & growing’) showed a relatively high correlation with job satisfaction, but a mean work climate value below four. Burnout and psychosomatic symptoms were negatively associated with job satisfaction, and perceived general health was positively and sickness absence was negatively related to job satisfaction. Age related significantly to exhaustion and depersonalization and possibly be explained by the limited career options. Nurse anaesthetists’ turnover intentions were predicted by burnout symptoms and job satisfaction, which in turn were predicted by personality dimensions (in case of burnout), work climate (in case of personality and job satisfaction) and work context characteristics (in case of job satisfaction). Examining the relationship between events, emotions and job satisfaction and the influence of several ‘uncertainties’ on this process, a mediating effect of positive emotions on positive and negative events and job satisfaction was demonstrated. In hospitals, where humans are the main capital of the organization, creating a culture of retention is one key strategy for reducing staff turnover and replacement costs