Factors Associated with Turnover Intentions of Nurses Working in Japanese Hospitals Admitting COVID-19 Patients
Round 1
Reviewer 1 Report
The study presented is very interesting, both in its form and in its content. Contributing knowledge to a little-explored field of study such as the mental load derived from the pandemic. It would be advisable to expand the conclusions and extrapolate these results to possible cases associated with the increase in the workload of nurses.
Author Response
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Reviewer 2 Report
Thank you for submitting this interestings paper to NR.
The topic is of highest interest for readers of this journal and I have only some minor recommendations for improvement before a publication is warranted.
1. Introduction
Maybe you can refer in the introduction to the theories of turnover antecedents and the process how turnover intentions develop into turnover behavior. This would also support the selsction of the predictors in your study. On the other hand you copuld also argue in the discussion that this is all rather complex and many factors were not considered here.
Hom, P. W., Lee, T. W., Shaw, J. D., & Hausknecht, J. P. (2017). One hundred years of employee turnover theory and research. Journal of Applied Psychology, 102(3), 530–545. https://doi.org/10.1037/apl0000103
Hayes, L. J., O'Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., Laschinger, H. K., & North, N. (2012). Nurse turnover: a literature review - an update. International journal of nursing studies, 49(7), 887–905. https://doi.org/10.1016/j.ijnurstu.2011.10.001
2. In your survey you use retrospective, change-oriented (increased...) response formats. Do you know anything about the validity of such scales (because there might be some anchor effects but also a recall bias). It would be nice to add such information to the limitations (also that other pre-COVID-post designs were not feasible for you).
3. Practical Implications An issue might be also increasing recovery time at work, thus, time for breaks. There are some studies showing that breaks do also relate to nurse turnover and turnover intentions.
There are many studies from the past years showing how such short breaks could improve nurses well-being, find some with of them below:
Bodet-Contentin, L., Letourneur, M., & Ehrmann, S. (2022). Virtual reality during work breaks to reduce fatigue of intensive unit caregivers: a crossover, pilot, randomised trial. Australian Critical Care.
Fong, J. S. Y., Hui, A. N. N., Ho, K. M., Chan, A. K. M., & Lee, A. (2022). Brief mindful coloring for stress reduction in nurses working in a Hong Kong hospital during COVID-19 pandemic: A randomized controlled trial. Medicine, 101(43), e31253. https://doi.org/10.1097/MD.0000000000031253
Since poor break design is a general problem in nursing, redesign might be a protective approach for future pandemics or other types of crises affecting the healthcare system.
Author Response
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Reviewer 3 Report
Dear authors, thank you for the opportunity to read your research.
Next, I will provide recommendations for each section of your manuscript that needs to be corrected:
The introduction contains detailed information on the negative consequences of Covid-19 on the condition and professional workload of medical personnel in the world. The authors indicated the purpose of the study.
1. At the same time, in the introduction, it is possible for the authors to show (clarify) more clearly which groups of staff turnover factors should be taken into account when analyzing this problem in the context of the pandemic?
The description of research methods is described in detail.
2. Authors should intensify the discussion. It is important to prescribe what other factors that were not studied in this study could affect the turnover of medical personnel? This can also be specified in the study limitations.
3. Write more specifically what recommendations the authors make to the management of these medical institutions to reduce the turnover of nurses.
4. Designate further directions for the study of this problem.
The conclusion is specific and meaningful.
These recommendations do not diminish the overall positive impression of this study. In connection with the above, the manuscript can be recommended for publication after minor revisions.
Best regards, reviewer
Author Response
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Reviewer 4 Report
This study aims to identify the reasons why nurses in units providing care to covid-19 patients show an intention to request a replacement and change location.
The introduction is clear and provides sufficient data to provide context for the topic and justify the relevance of the study.
However, there are certain methodological aspects that need to be improved:
1. inclusion/exclusion criteria for participants are not defined.
2. In the Materiel and Methods section (line 74), the period in which the study was carried out is not identified either.
3. The platform with which the survey was designed and distributed is identified (line 90), but it is not explained how it is delivered to the participants (access via qr, sending by email, etc.).
The presentation of the results is complete and correct.
As for the discussion (lines 214-237), I consider that it is very brief and does not reflect deeply on the results obtained. In this section we would expect a broader comparison of the results obtained with those of other studies carried out in other countries and a reflection on the different factors that may influence these differences or similarities. For example, the different health systems or the age of the participants.
In relation to the conclusions section, it is not correct in any case to include references in this section.
Author Response
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