Health Review | May – August 2023

Introduction: Addressing nurse turnover is a challenge for both health service leaders and human resources researchers. Researchers continue to highlight the importance of job satisfaction in nurses' turnover intention, which appears to be more important than other determinants such as age, night shift, and career advancement. Aim: The purpose of this research study was to investigate the job satisfaction of the nursing staff of the 251 Air Force General Hospital (251AGH) and their intention to leave the profession in the next five years. Material and Method: A cross-sectional study was conducted during the summer season of 2022 involving nurses and licensed practical nurses working in 251 GNA. Data were collected via structured anonymous questionnaire with closed-ended questions, consisting of three thematic sections: the first section included the Job Satisfaction Survey - JSS tool of the Professor of Psychology at the University of South Florida, United States of America, Paul Spector-, the second section presented questions about the healthcare professionals’ intention to leave their job and the organization and the third part demonstrated the demographic characteristics of the study sample. Results: The sample of our study consisted of 205 nurses and licensed practical nurses, of whom 63 (30%) were men and 142 (69%) were women. The participants reported dissatisfaction with salary, promotion, fringe benefits, contingent rewards, and working conditions. They felt ambivalent about partners, the nature of work and communication, but satisfied with the supervision. Finally, in terms of overall job satisfaction, they felt dissatisfied. Regarding the intention of leaving nursing profession, seems to be moderately to quite likely for the next five years. Conclusions: Job satisfaction as a whole and subsequently satisfaction with potential rewards and salary are significantly and negatively related to intention to leave AGH. Post-secondary graduates are less likely to drop out of nursing than college/university and postgraduate professionals. Finally, it was mentioned a strong positive correlation between age and years of service with their intention to leave their job.

All over the world, the shortages in the field of public nursing constitute a major challenge among health systems, not only due to the increasing life expectancy but also to emerging diseases that require sufficient staff for qualitative and equitable health services. This study aims to explore the increasing turnover intention of Professional Nurses (PN) in Greece, mainly in public hospitals as a multidimensional phenomenon, and to also highlight the factors that contribute either positively or negatively to this intention. To better understand the determinants of PN‘s turnover intention, and to explore the place of Greece concerning other European countries, data from Organisation for Economic Co-operation and Development (OECD), Eurostat and Hellenic Statistical Authority (ELSTAT) were analyzed in terms of the proportion of PN per population, the proportion of PN to doctors, the average remuneration level, and the ratio nurse to hospital bed. Low job satisfaction, burnout, emotional exhaustion, rotating hours, low remuneration levels, unjustified transfers, feelings of injustice, and bureaucracy are the main factors that contribute to the turnover intention of Greek PN. After the pandemic crisis and significant reductions in nursing staff, many measures are required, not only by the Greek government but also by hospital managers to strengthen the nursing sector.

The Budgeting and Cost Analysis Department of Papageorgiou General Hospital created a new tool that utilizes real-time data and feedback from all clinics and departments and produces accurate reporting. The purpose of this tool is to calculate and predict the cost of medical services in a Diagnosis Related Group (DRG) oriented integrated environment. Data processing through Cost/Profit Centers produces and updates key economic and operational indicators (e.g. material and drug consumption, the average duration of hospitalization), which set the framework for the evaluation of clinics’ efficiency and performance. The revenues and expenses of each clinic and the deviations concerning the budget are monitored monthly. The reimbursement of health services based on the DRG system, depending on the medical procedures performed at each clinic, is regarded as revenue. On the other hand, cost analysis involves direct costs, and indirect costs which shape the cost of accommodation of hospitalization per day, estimated by algorithms and specific weighting factors. Thus, the operating cost of each clinic is calculated and then compared against its corresponding revenues. Papageorgiou General Hospital aims and pursues the further development of this budget monitoring tool, which is developed on the actual core health services of each clinic respectively. Fair reimbursement can be secured if data is linked to a dynamic, regularly updated data processing tool, i.e. accurate cost analysis & sourcing.

Healthcare jobs and especially medicine and nursing profession continue to face big shortages. The situation became even worse during the COVID-19 pandemic, since the existing inadequate healthcare staff experienced high levels of burnout. In this context, both the physical and mental health of healthcare workers (HCWs) deteriorated, facing problems such as anxiety, stress, depression, post-traumatic stress, and insomnia. A projection from the Organization for Economic Co-operation and Development (OECD) before the pandemic reported that there would be a shortage of 400,000 doctors across 32 OECD countries and 2.5 million nurses across 23 OECD countries until 2030. These numbers are now expected to increase significantly following the devastating effects of the pandemic. For instance, Abbasi et al. found that 40% of nurses and 23.8% of doctors planned to leave their jobs during the first year of the pandemic. Moreover, during the pandemic another work-related issue is emerged among HCWs: the quiet quitting phenomenon. Quiet quitters limit their work effort to the minimum and they do not go above and beyond.6 In this context, HCWs do not leave their jobs but work without passion and enthusiasm. A recent study in Greece with a sample of 1760 HCWs revealed that 57.9% were quiet quitters.7 More interestingly, prevalence of quiet quitting was higher among nurses compared to other HCWs (53.8% vs. 40.3%). Several other work-related factors such as job burnout and shift work affected levels of quiet quitting among HCWs.