Retention of Staff in Nordic Healthcare— A Literature Review
DOI:
https://doi.org/10.18291/njwls.146465Keywords:
Health, Working Environment & Wellbeing, Employment, Wages, Unemployment & RehabilitationAbstract
The Nordic healthcare sector faces severe staff shortages.This paper is based on a rapid literature review, including 73 papers published between 2010 and 2020, addressing retention issues in the sector.The aim is to compile and discuss empirical research on retention of staff within Nordic healthcare.The paper fills an existing gap providing a comprehensive picture of crucial factors for retaining staff in the sector. Findings include that most studies were quantitative, often surveys, and mostly focusing on registered nurses and/or physicians/medical doctors. Further, high control, high levels of social support, good leadership, satisfactory opportunities for professional development, organizational continuity, reasonable demands, including absence of heavy physical exertion, were all shown to positively impact retention rates. While the results to some extent were as expected, they highlight key areas for healthcare employers, as well as policymakers at various levels, to concentrate on for improving staff retention within their organizations.
References
Abelsen, B., Strasser, R., Heaney, D., Berggren, P., Sigurðsson, S., Brandstorp, H., Wakegijig, J., Forsling, N., Moody-Corbett, P., Akearok, G. H., Mason, A., Savage, C., & Nicoll, P. (2020). Plan, recruit, retain: A framework for local healthcare organizations to achieve a stable remote rural workforce, Human Resources for Health 18(1): 63. doi: https://doi.org/10.1186/s12960-020-00502-x.
Adams, T. L. (2015). Sociology of professions: International divergences and research directions, Work, Employment and Society 29(1): 154–65. doi: https://doi.org/10.1177/0950017014523467
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., & Sermeus, W. (2013). Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe, International Journal of Nursing Studies 50(2): 143–153. doi: https://doi.org/10.1016/j.ijnurstu.2012.11.009
Brante, T. (2013). The professional landscape: The historical development of professions in Sweden, Professions and Professionalism 3(2): 1-18. doi: https://doi.org/10.7577/pp.558
Breinegaard, N., Høy Jensen, J., & Bonde, J. P. (2017). Organizational change, psychosocial work environment, and non-disability early retirement: A prospective study among senior public employees, Scandinavian Journal of Work, Environment & Health 43(3): 234-240. doi: https://doi.org/10.5271/sjweh.3624
Calenda, D., & Bellini, A. (2021). The challenging integration paths of migrant health professionals: the case of Filipino and Indian nurses in the UK, Professions and Professionalism 11(1): 1–20. doi: https://doi.org/10.7577/pp.3898
Carlson, B., & Hatti, N. (2016). The Swedish Welfare State Model: A brief overview. Social Science Spectrum 2(4): 216-229.
Carson, D. B., Shoo, A., & Berggren, P. (2015). The ‘rural pipeline’ and retention of rural health professionals in Europe’s northern peripheries, Health Policy 119(12): 1550-1556. doi: https://doi.org/10.1016/j.healthpol.2015.08.001
Cerasoli, C. P., Alliger, G. M, Donsbach, J. S., Mathieu, J. E., Tannenbaum, S. I., & Orvis, K. A. (2018). Antecedents and outcomes of informal learning behaviors: A meta-analysis, Journal of Business and Psychology 33(2): 203-230. doi: https://doi.org/10.1007/s10869-017-9492-y
Clausen, T., Friis Andersen, M., Bang Christensen, K., & Lund, T. (2011). Return to work among employees with long-term sickness absence in eldercare: A prospective analysis of register-based outcomes, International Journal of Rehabilitation Research 34(3): 249-254. doi: https://doi.org/10.1097/mrr.0b013e328348b171
Crawford, C., Boyd, C., Jain, S., Khorsan, R., & Jonas, W. (2015). Rapid Evidence Assessment of the Literature (REAL(©)): Streamlining the systematic review process and creating utility for evidence-based health care, BMC Research Notes 8:631. doi: https://doi.org/10.1186/s13104-015-1604-z
De Cuyper, N., Mauno, S., Kinnunen, U., & Mäkikangas, A. (2011). The role of job resources in the relation between perceived employability and turnover intention: A prospective two-sample study, Journal of Vocational Behaviour 78(2): 253-263. doi: https://doi.org/10.1016/j.jvb.2010.09.008
Ejdemo, T., & Parding, K. (2018). 51 000 anställningar i Norrbotten till och med 2030 [51,000 jobs in Norrbotten up to 2030], Luleå: Länsstyrelsen
Fernemark, H., Skagerström, J., Seing. I., Hårdstedt, M., Schildmeijer, K., & Nilsen, P. (2022). Working conditions in primary healthcare during the COVID-19 pandemic: An interview study with physicians in Sweden, BMJ Open 12(2): 1-9. doi: 10.1136/bmjopen-2021-055035
Franzén, E., & Andersson, B. (2021, April 21). Debatt: Brist på arbetskraft är ett hot mot den nordiska välfärdsmodellen [Debate: Lack of labour-power is a threat to the Nordic welfare model]. Nordic Welfare Centre. https://nordicwelfare.org/nyheter/debatt-brist-pa-arbetskraft-ar-ett-hot-mot-den-nordiska-valfardsmodellen/
Gaski, M., & Abelsen, B. (2017). Designing medical internships to improve recruitment and retention of doctors in rural areas, International Journal of Circumpolar Health 76(1). doi: https://doi.org/10.1080/22423982.2017.1314415
Giacometti, A., & Cuadrado, A. (2020). Skills supply and governance in the Bothnian Arc cross-border region, Nordregio Report 2020:10. doi: https://doi.org/10.6027/R2020:10.1403-2503
Giver, H., Faber., Hannerz, H., Strøyer, J., & Rugulies, R. (2010). Psychological well-being as a predicator of dropout among recently qualified Danish eldercare workers, Scandinavian Journal of Public Health 38(3): 239-245. doi: https://doi.org/10.1177/1403494809348939
Govaerts, N., Kyndt, E., Dochy, F., & Baert, H. (2011). Influence of learning and working climate on the retention of talented employees, Journal of Workplace Learning 23(1): 35-55. doi: https://doi.org/10.1108/13665621111097245
Grant, M., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies, Health Information and Libraries Journal 26(2): 91-108. doi: https://doi.org/10.1111/j.1471-1842.2009.00848.x
Grønstad, A., Kjekshus, L. E., Tjerbo, T., & Bernstrøm, V. H. (2019). Organizational change and the risk of sickness absence: A longitudinal mulitilevel analysis of organisational unit-level change in hospitals, BMC Health Services Research 19:895. doi: https://doi.org/10.1186/s12913-019-4745-2
Grønstad, A., Kjekshus, L. E., Tjerbo, T., & Bernstrøm, V. H. (2020). Work-related moderators of the relationship between organisational change and sickness absence: A longitudinal multilevel study, BMC Public Health 20:1218. doi: https://doi.org/10.1186/s12889-020-09325-w
Hansson, M. (2021). A Meaningful Work in a Strained Context – Exploring Midwives’ Work Situation and Professional Role, Doctoral thesis: University of Gothenburg.
Heponiemi, T., Presseau, J., & Elovainio, M. (2016). On-call work and physicians’ turnover intention: The moderating effect of job strain, Psychology, Health & Medicine 21(1): 74-80. doi: https://doi.org/10.1080/13548506.2015.1051061
Heponiemi, T., Hietapakka, L., Kaihlanen, A., & Aalto, A-M. (2019). The turnover intentions and intentions to leave the country of foreign-born physicians in Finland: A cross-sectional questionnaire study, BMC Health Services Research 19:624. doi: https://doi.org/10.1186/s12913-019-4487-1
Hognestad Haaland, G., Olsen, E., & Mikkelsen, A. (2020). The association between supervisor support and ethical dilemmas on Nurses' intention to leave: The mediating role of the meaning of work, Journal of Nursing Management 29(2): 286-293. doi: https://doi.org/10.1111/jonm.13153
Holmberg, C., Caro, J., & Sobis, I. (2018). Job satisfaction among Swedish mental health nursing personnel: Revisiting the two-factor theory, International Journal of Mental Health Nursing 27(2): 581-592. doi: https://doi.org/10.1111/inm.12339
Ingelsrud, M. H. (2014). Reorganization increases long-term sickness absence at all levels of hospital staff: Panel data analysis of employees of Norwegian public hospitals, BMC Health Services Research 14:411. doi: https://doi.org/10.1186/1472-6963-14-411
Ingelsrud, M. H. (2017). Hospital Mergers in Norway: Employee health and turnover to three destinations, Nordic Journal of Working Life Studies 7(1): 107-123. doi: http://doi.org/10.18291/njwls.v7i1.81403
Jensen, J. H., Flachs, E. M., Skakon, J., Rod, N. H., & Bonde, J. P. (2018). Dual impact of organisational change on subsequent exit from work unit and sickness absence: A longitudinal study among public healthcare employees, Occupational & Environmental Medicine 75(7): 479-485. doi: https://doi.org/10.1136/oemed-2017-104865
Jensen, J. H., Flachs, E. M., Skakon, J., Rod, N. H., & Bonde, J. P. (2019). Longitudinal associations between organisational change, work-unit social capital, and employee exit from the work unit among public healthcare workers: A mediation analysis, Scandinavian Journal of Work, Environment & Health 45(1): 53-62. doi: https://doi.org/10.5271/sjweh.3766
Karasek, R., & Theorell, T. (1990). Healthy Work: Stress, Productivity and Reconstruction of
Working Life, New York: Basic Books.
Kjekshus, L. E., Bernstrøm, V. H., Dahl, E., & Lorentzen, T. (2014). The effect of hospital mergers on long-term sickness absence among hospital employees: A fixed effects multivariate regression analysis using panel data, BMC Health Services Research 14:50. doi: https://doi.org/10.1186/1472-6963-14-50
Kuusio, H., Heponiemi, T., Sinervo, T., & Elovainio, M. (2010). Organizational commitment among general practitioners: A cross-sectional study of the role of psychosocial factors, Scandinavian Journal of Primary Health Care 28(2): 108-114. doi: https://doi.org/10.3109/02813431003779647
Kuusio, H., Heponiemi, T., Vänskä, J., Aalto, A-M., Ruskoaho, J., & Elovainio, M. (2013). Psychosocial stress factors and intention to leave job: Differences between foreign-born and Finnish-born general practictioners, Scandinavian Journal of Public Health 41(4): 405-411. doi: https://doi.org/10.1177/1403494813477248
Kuusio, H., Lämsä, R., Aalto, A-M., Manderbacka, K., Keskimäki, I., & Elovainio, M. (2014). Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: Qualitative and quantitative study, Human Resources for Health 12:41. doi: https://doi.org/10.1186/1478-4491-12-41
Leineweber, C., Chungkham, H. S., Lindqvist, R., Westerlund, H., Runesdotter, S., Alenius, L. S., & Tishelman, C. (2016). Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: A multi-country, multilevel study, International Journal of Nursing Studies 58: 47-58. doi: https://doi.org/10.1016/j.ijnurstu.2016.02.003
Loft, M. I., & Jensen, C. S. (2020). What makes experienced nurses stay in their position? A qualitative interview study, Journal of Nursing Management 28(6): 1305-1316. doi: https://doi.org/10.1111/jonm.13082
Lyons, P., & Bandura, R (2022). Coaching to enhance learning and engagement and reduce turnover, Journal of Workplace Learning 34(1): 295-307. doi: https://doi.org/10.1108/JWL-08-2021-0106
Lögde, A., Rudolfsson, G., Runeson-Broberg, R., Rask-Andersen, A., Wålinder, R., & Arakelian, E. (2018). I am quitting my job. Specialist nurses in perioperative context and their experiences of the process and reasons to quit their job, International Journal for Quality in Health Care 30(4): 313-320. doi: https://doi.org/10.1093/intqhc/mzy023
Martinussen, P. E., Magnussen, J., Vrangbæk, K., & Frich, J. C. (2020). Should I stay or should I go? The role of leadership and organisational context for hospital physicians’ intention to leave their current job, BMC Health Services Research 20:400. doi: https://doi.org/10.1186/s12913-020-05285-4
NOU/Norges offentlige utredninger (2023). Tid för handling. Personellet i en bærektaftig helse- og omsorgstjenste [Time for action. The personnel in a sustainable health and care services], Rapport 2023:4. https://www.regjeringen.no/contentassets/337fef958f2148bebd326f0749a1213d/no/pdfs/nou202320230004000dddpdfs.pdf
OECD/European Observatory on Health Systems and Policies (2021a). Norway: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris. doi: https://doi.org/10.1787/6871e6c4-en
OECD/European Observatory on Health Systems and Policies (2021b). Finland: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris. doi: https://doi.org/10.1787/2e74e317-en
OECD/European Observatory on Health Systems and Policies (2021c). Sweden: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris. doi: https://doi.org/10.1787/b9027e42-en
OECD/European Observatory on Health Systems and Policies (2021d). Iceland: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris. doi: https://doi.org/10.1787/5341c87c-en
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan - a web and mobile app for systematic reviews, Systematic Reviews 5(1): 210. doi: https://doi.org/10.1186/s13643-016-0384-4
Norwegian Government (2023). Gjennomgang av allmennlegetjenesten [Review of the general practitioner service], Ekspertutvalgets rapport 18:2023. https://www.regjeringen.no/contentassets/092e9ca0af5e49f39b55c6aded2cf18d/no/pdfs/gjennomgang-av-allmennlegetjenesten.pdf
Parding, K., Lindberg, L., & Ejdemo, T. (2022). Kompetensförsörjningsanalys arbetsmarknadsregionen Boden-Luleå [Skills supply analysis of the labour market region Boden-Luleå], Luleå: Luleå University of Technology
Puhakka, I. J. A, Nokelainen, P., & Pylväs, L. (2021). Learning or leaving? Individual and environmental factors related to job satisfaction and turnover intention, Vocations and Learning 14(3): 481-510. doi: https://doi.org/10.1007/s12186-021-09275-3
Suadicani, P., Bonde, J. P., Olesen, K., & Gyntelberg, F. (2013). Job satisfaction and intention to quit the job, Occupational Medicine 63(2): 96-102. doi: https://doi.org/10.1093/occmed/kqs233
Salminen, H., & Miettinen, M. (2019). The role of perceived development opportunities on affective organisational commitment of older and younger nurses, International Studies of Management & Organisation 49(1): 63-78. doi: https://doi.org/10.1080/00208825.2019.1565094
Sejbeak, C. S., Nexo, M. A., & Borg, V. (2012). Work-related factors and early retirement intention: a study of the Danish eldercare sector, European Journal of Public Health 23(4): 611-616. doi: https://doi.org/10.1093/eurpub/cks117
Slater, P., Roos, M., Eskola, S., McCormack, B., Hahtela, N., Kurjenluoma, K., & Suominen, T. (2020). Challenging and redesigning a new model to explain intention to leave nursing, Scandinavian Journal of Caring Sciences 35(2): 626–635. doi: https://doi.org/10.1111/scs.12884
Statistics Sweden (2022). Vilka utbildningar ger jobb? Arbetskraftsbarometern 2022 [Which educations lead to jobs? Labor force barometer 2022]. https://www.scb.se/contentassets/a12b37a263104dca9f9b1f69107f7b00/uf0505_2022a01_am78br2203.pdf
Susskind, R., & Susskind, D. (2015). The Future of the Professions: How Technology will Transform the Work of Human Experts, Oxford: Oxford University Press.
Swedish Association of Health Professionals (2022). Yrken för livet kräver bättre villkor [Professions for life require better conditions], Stockholm: Vårdförbundet. https://www.vardforbundet.se/contentassets/72292c2ff26847228f36d876236745ae/yrken-for-livet-kraver-battre-villkor-arbetsmiljorapport2022.pdf
Swedish National Board of Health and Welfare (2022). Bedömning av tillgång och efterfrågan på legitimerad personal i hälso- och sjukvård samt tandvård [Assessment of supply and demand for licensed personnel in health care and dental care]. Nationella planeringsstödet 2022, Stockholm: National Board of Health and Welfare. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2022-2-7759.pdf
Swedish National Board of Health and Welfare (2023). Riktvärden för beläggningsgrad och vårdplatser: Delredovisning av uppdraget att stödja och stärka regionernas produktions- och kapacitetsplanering [Guideline values for occupancy rate and care places: Partial report of the mission to support and strengthen the regions' production and capacity planning], Stockholm: National Board of Health and Welfare. https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2023-5-8573.pdf
Theorell, T. (2020). COVID-19 and working conditions in health care, Psychotherapy and Psychosomatics 89(4): 193–194. doi: https://doi.org/10.1159/000507765
The Swedish Agency for Work Environment Expertise (2022). Arbetsmiljö och hälsa i organisationer vid epidemier och pandemier orsakade av coronavirus [Work environment and health in organizations during epidemics and pandemics caused by the coronavirus]. Kunskapssammanställning 2022:5. https://mynak.se/wp-content/uploads/2022/03/Arbetsmiljo_och_halsa_i_organisationer_digital.pdf
Wålinder, R., Runeson-Broberg, R., Arakelian, E., Runeson, A., & Rask-Andersen, A. (2018). A supportive climate and low strain promote well-being and sustainable working life in the operation theatre, Upsala Journal of Medical Sciences 123(3): 183-190. doi: https://doi.org/10.1080/03009734.2018.1483451
Woodward, K. F., & Willgerodt, M. (2022). A systematic review of registered nurse turnover and retention in the United States, Nursing Outlook 70(4): 664-678. doi: https://doi.org/10.1016/j.outlook.2022.04.005
Zwysen, W. (2023). Labour shortages – Turning away from bad jobs, ETUI Policy Brief, 2023.03. https://www.etui.org/publications/labour-shortages-turning-away-bad-jobs
Öhman, A., Keisu, B-I., & Enberg, B. (2017). Team social cohesion, professionalism, and patient-centeredness: Gendered care work, with special reference to elderly care - A mixed methods study, BMC Health Services Research 17:381. doi: https://doi.org/10.1186/s12913-017-2326-9
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