https://doi.org/10.4081/ecj.2023.11644
A systematic review of the factors influencing retention or turnover intention among emergency personnel in epidemics
Submitted: 8 August 2023
Accepted: 13 October 2023
Published: 20 October 2023
Accepted: 13 October 2023
Abstract Views: 812
PDF: 233
Supplementary Materials: 141
Supplementary Materials: 141
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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To maintain the performance of emergency personnel who are at disproportionate risk of infection on the front lines of outbreaks, it is beneficial to understand the factors that promote their willingness to stay or leave their job. This study aims to identify key factors related to emergency workers' willingness to retain. This study identifies key factors related to emergency workers' willingness to be retained or turnover intention during infectious disease pandemics. Following the PRISMA guidelines, a systematic review of the literature was conducted. To obtain the results, three databases, Scopus, PubMed Web of Science, and Google Scholar, were searched for English-speaking studies up to March 2022 that met the established inclusion criteria and were of high quality. Given the heterogeneity of the results, a qualitative synthesis of the results was also undertaken. A narrative synthesis was performed on 34 studies of high and medium quality. The studies examined different and multifaceted factors in three categories: retention, turnover decision, and factors that mediate between turnover intention and retention. The retention of frontline emergency workers during an epidemic is dependent on essential factors such as job satisfaction, organizational commitment, managerial support, psychological well-being, and resilience.
Piret J, Boivin G. Pandemics throughout history. Front Microbiol. 2021;11:631736.
DOI: https://doi.org/10.3389/fmicb.2020.631736
Wilkason C, Lee C, Sauer LM, Nuzzo J, McClelland A. Assessing and reducing risk to healthcare workers in outbreaks. Health Secur. 2020;18(3):205–11.
DOI: https://doi.org/10.1089/hs.2019.0131
Organization WH. Health worker Ebola infections in Guinea, Liberia and Sierra Leone: a preliminary report 21 May 2015. World Health Organization; 2015.
Chowell G, Abdirizak F, Lee S, Lee J, Jung E, Nishiura H, et al. Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med. 2015;13(1):1–12.
DOI: https://doi.org/10.1186/s12916-015-0450-0
Lietz J, Westermann C, Nienhaus A, Schablon A. The occupational risk of influenza A (H1N1) infection among healthcare personnel during the 2009 pandemic: a systematic review and meta-analysis of observational studies. PloS One. 2016;11(8):e0162061.
DOI: https://doi.org/10.1371/journal.pone.0162061
Alshamrani MM, El-Saed A, Al Zunitan M, Almulhem R, Almohrij S. Risk of COVID-19 morbidity and mortality among healthcare workers working in a Large Tertiary Care Hospital. Int J Infect Dis. 2021;109:238–43.
DOI: https://doi.org/10.1016/j.ijid.2021.07.009
Mukherjee A, Parashar R. Impact of the COVID-19 pandemic on the human resources for health in India and key policy areas to build a resilient health workforce. Gates Open Res. 2020;4.
DOI: https://doi.org/10.12688/gatesopenres.13196.1
Cornish S, Klim S, Kelly A. Is COVID‐19 the straw that broke the back of the emergency nursing workforce? Emerg Med Australas. 2021 Dec;33(6):1095–9.
DOI: https://doi.org/10.1111/1742-6723.13843
Willis K, Ezer P, Lewis S, Bismark M, Smallwood N. “Covid just amplified the cracks of the system”: working as a frontline health worker during the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(19):10178.
DOI: https://doi.org/10.3390/ijerph181910178
Namin BH, Øgaard T, Røislien J. Workplace incivility and turnover intention in organizations: A meta-analytic review. Int J Environ Res Public Health. 2021;19(1):25.
DOI: https://doi.org/10.3390/ijerph19010025
Waldman JD, Kelly F, Arora S, Smith HL. The shocking cost of turnover in health care. Health Care Manage Rev. 2010;35(3):206–11.
DOI: https://doi.org/10.1097/HMR.0b013e3181e3940e
Hou H, Pei Y, Yang Y, Lu L, Yan W, Gao X, et al. Factors Associated with Turnover Intention Among Healthcare Workers During the Coronavirus Disease 2019 (COVID-19) Pandemic in China. Risk Manag Healthc Policy. 2021 Dec 31;14:4953–65.
DOI: https://doi.org/10.2147/RMHP.S318106
Liu JX, Goryakin Y, Maeda A, Bruckner T, Scheffler R. Global health workforce labor market projections for 2030. Hum Resour Health. 2017;15(1):1–12.
DOI: https://doi.org/10.1186/s12960-017-0187-2
Deng D, Naslund JA. Psychological Impact of COVID-19 Pandemic on Frontline Health Workers in Low- and Middle-Income Countries. Harv Public Health Rev Camb Mass. 2020;28:http://harvardpublichealthreview.org/wp-content/uploads/2020/10/Deng-and-Naslund-2020-28.pdf.
DOI: https://doi.org/10.54111/0001/Z1
Imai H, Matsuishi K, Ito A, Mouri K, Kitamura N, Akimoto K, et al. Factors associated with motivation and hesitation to work among health professionals during a public crisis: a cross sectional study of hospital workers in Japan during the pandemic (H1N1) 2009. BMC Public Health. 2010 Nov 4;10(1):672.
DOI: https://doi.org/10.1186/1471-2458-10-672
Rafiq M, Shahzad F, Farrukh M, Khan I. The psychological mechanism linking life satisfaction and turnover intention among healthcare workers during the COVID-19 pandemic. Work. 2022 Mar 25;71(3):505–14.
DOI: https://doi.org/10.3233/WOR-210995
Irshad M, Khattak SA, Hassan MM, Majeed M, Bashir S. How perceived threat of Covid-19 causes turnover intention among Pakistani nurses: A moderation and mediation analysis. Int J Ment Health Nurs. 2020;30(1):350.
DOI: https://doi.org/10.1111/inm.12775
Mirzaei A, Rezakhani Moghaddam H, Habibi Soola A. Identifying the predictors of turnover intention based on psychosocial factors of nurses during the COVID‐19 outbreak. Nurs Open. 2021 Nov;8(6):3469–76.
DOI: https://doi.org/10.1002/nop2.896
Chang J, Ray JM, Joseph D, Evans LV, Joseph M. Burnout and Post-traumatic Stress Disorder Symptoms Among Emergency Medicine Resident Physicians During the COVID-19 Pandemic. West J Emerg Med. 2022 Mar;23(2):251–7.
DOI: https://doi.org/10.5811/westjem.2021.11.53186
Wibowo A, Paramita W. Resilience and turnover intention: the role of mindful leadership, empathetic leadership, and self-regulation. J Leadersh Organ Stud. 2022;29(3):325–41.
DOI: https://doi.org/10.1177/15480518211068735
Simard K, Parent-Lamarche A. Abusive leadership, psychological well-being, and intention to quit during the COVID-19 pandemic: a moderated mediation analysis among Quebec’s healthcare system workers. Int Arch Occup Environ Health. 2022 Mar 1;95(2):437–50.
DOI: https://doi.org/10.1007/s00420-021-01790-z
Yücel İ. Transformational leadership and turnover intentions: the mediating role of employee performance during the COVID-19 pandemic. Adm Sci. 2021;11(3):81.
DOI: https://doi.org/10.3390/admsci11030081
Yang Y, Wang P, Kelifa MO, Wang B, Liu M, Lu L, et al. How workplace violence correlates turnover intention among Chinese health care workers in COVID‐19 context: The mediating role of perceived social support and mental health. J Nurs Manag. 2021 Apr 22;10.1111/jonm.13325.
DOI: https://doi.org/10.1111/jonm.13325
Yildiz B, Yildiz H, Ayaz Arda O. Relationship between work–family conflict and turnover intention in nurses: A meta-analytic review. J Adv Nurs. 2021;77(8):3317–30.
DOI: https://doi.org/10.1111/jan.14846
Shayestehazar M, Heydarian S, Gharib M, Ghaffari S, Fateh S, Ghadiri A, et al. Influential factors in job retention and organizational commitment among the nurses working in COVID-19 outbreak. J Nurs Midwifery Sci. 2022;9(1):58.
DOI: https://doi.org/10.4103/jnms.jnms_166_20
Du C nan, Liu B xue, Ma Q fang, Yang M fei. The effect of tranexamic acid in patients with TBI: a systematic review and meta-analysis of randomized controlled trials. Chin Neurosurg J. 2020;6(03):171–7.
DOI: https://doi.org/10.1186/s41016-020-00196-z
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021 Apr 1;88:105906.
DOI: https://doi.org/10.1016/j.ijsu.2021.105906
Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. 2016;6(12):e011458.
DOI: https://doi.org/10.1136/bmjopen-2016-011458
Long HA, French DP, Brooks JM. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res Methods Med Health Sci. 2020;1(1):31–42.
DOI: https://doi.org/10.1177/2632084320947559
Shiao JSC, Koh D, Lo LH, Lim MK, Guo YL. Factors Predicting Nurses’ Consideration of Leaving their Job During the Sars Outbreak. Nurs Ethics. 2007 Jan;14(1):5–17.
DOI: https://doi.org/10.1177/0969733007071350
Chen HM, Liu CC, Yang SY, Wang YR, Hsieh PL. Factors Related to Care Competence, Workplace Stress, and Intention to Stay among Novice Nurses during the Coronavirus Disease (COVID-19) Pandemic. Int J Environ Res Public Health. 2021 Feb 22;18(4):2122.
DOI: https://doi.org/10.3390/ijerph18042122
Li T, Pien L, Kao C, Kubo T, Cheng W. Effects of work conditions and organisational strategies on nurses’ mental health during the COVID‐19 pandemic. J Nurs Manag. 2022 Jan;30(1):71–8.
DOI: https://doi.org/10.1111/jonm.13485
Chang CS, Du PL, Huang IC. Nurses’ perceptions of severe acute respiratory syndrome: relationship between commitment and intention to leave nursing: Nurses’ perceptions of SARS. J Adv Nurs. 2006 Apr;54(2):171–9.
DOI: https://doi.org/10.1111/j.1365-2648.2006.03796.x
Chen SL, Chang SM, Lin HS, Chen CH. Post-SARS knowledge sharing and professional commitment in the nursing profession. J Clin Nurs. 2009 Jun;18(12):1738–45.
DOI: https://doi.org/10.1111/j.1365-2702.2008.02488.x
Chen Y, Wu H, Kuo F, Koh D, Guo YL, Shiao JS. Hospital factors that predict intention of health care workers to leave their job during the COVID ‐19 pandemic. J Nurs Scholarsh. 2022 Sep;54(5):607–12.
DOI: https://doi.org/10.1111/jnu.12771
Sharif Nia H, Arslan G, Naghavi N, Sivarajan Froelicher E, Kaveh O, Pahlevan Sharif S, et al. A model of nurses’ intention to care of patients with COVID‐19: Mediating roles of job satisfaction and organisational commitment. J Clin Nurs. 2021 Jun;30(11–12):1684–93.
DOI: https://doi.org/10.1111/jocn.15723
Poortaghi S, Shahmari M, Ghobadi A. Exploring nursing managers’ perceptions of nursing workforce management during the outbreak of COVID-19: a content analysis study. BMC Nurs. 2021 Dec;20(1):27.
DOI: https://doi.org/10.1186/s12912-021-00546-x
Varasteh S, Esmaeili M, Mazaheri M. Factors affecting Iranian nurses’ intention to leave or stay in the profession during the COVID‐19 pandemic. Int Nurs Rev. 2022 Jun;69(2):139–49.
DOI: https://doi.org/10.1111/inr.12718
Labrague CDPLJ, Santos JDL. Fear of COVID-19, psychological distress, work satisfaction and turnover intention among front line nurses [Internet]. In Review; 2020 Jun [cited 2023 Jul 27]. Available from: https://www.researchsquare.com/article/rs-35366/v1
DOI: https://doi.org/10.21203/rs.3.rs-35366/v1
Labrague LJ, De Los Santos JAA, Fronda DC. Perceived COVID‐19‐associated discrimination, mental health and professional‐turnover intention among frontline clinical nurses: The mediating role of resilience. Int J Ment Health Nurs. 2021 Dec;30(6):1674–83.
DOI: https://doi.org/10.1111/inm.12920
Labrague LJ, De Los Santos JAA. Resilience as a mediator between compassion fatigue, nurses’ work outcomes, and quality of care during the COVID-19 pandemic. Appl Nurs Res. 2021 Oct;61:151476.
DOI: https://doi.org/10.1016/j.apnr.2021.151476
Sinsky CA, Brown RL, Stillman MJ, Linzer M. COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers. Mayo Clin Proc Innov Qual Outcomes. 2021 Dec;5(6):1165–73.
DOI: https://doi.org/10.1016/j.mayocpiqo.2021.08.007
Cole A, Ali H, Ahmed A, Hamasha M, Jordan S. Identifying Patterns of Turnover Intention Among Alabama Frontline Nurses in Hospital Settings During the COVID-19 Pandemic. J Multidiscip Healthc. 2021 Jul;Volume 14:1783–94.
DOI: https://doi.org/10.2147/JMDH.S308397
Said RM, El-Shafei DA. Occupational stress, job satisfaction, and intent to leave: nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt. Environ Sci Pollut Res. 2021 Feb;28(7):8791–801.
DOI: https://doi.org/10.1007/s11356-020-11235-8
Abd-Ellatif EE, Anwar MM, AlJifri AA, El Dalatony MM. Fear of COVID-19 and its impact on job satisfaction and turnover intention among Egyptian physicians. Saf Health Work. 2021;12(4):490–5.
DOI: https://doi.org/10.1016/j.shaw.2021.07.007
Alameddine M, Bou-Karroum K, Ghalayini W, Abiad F. Resilience of nurses at the epicenter of the COVID-19 pandemic in Lebanon. Int J Nurs Sci. 2021 Oct;8(4):432–8.
DOI: https://doi.org/10.1016/j.ijnss.2021.08.002
Alameddine M, Clinton M, Bou‐Karroum K, Richa N, Doumit MAA. Factors Associated With the Resilience of Nurses During the COVID‐19 Pandemic. Worldviews Evid Based Nurs. 2021 Dec;18(6):320–31.
DOI: https://doi.org/10.1111/wvn.12544
Jung H, Jung SY, Lee MH, Kim MS. Assessing the Presence of Post-Traumatic Stress and Turnover Intention Among Nurses Post–Middle East Respiratory Syndrome Outbreak: The Importance of Supervisor Support. Workplace Health Saf. 2020 Jul;68(7):337–45.
DOI: https://doi.org/10.1177/2165079919897693
Kim YJ, Lee SY, Cho JH. A Study on the Job Retention Intention of Nurses Based on Social Support in the COVID-19 Situation. Sustainability. 2020 Sep 4;12(18):7276.
DOI: https://doi.org/10.3390/su12187276
Khattak SR, Saeed I, Rehman SU, Fayaz M. Impact of Fear of COVID-19 Pandemic on the Mental Health of Nurses in Pakistan. J Loss Trauma. 2021 Jul 4;26(5):421–35.
DOI: https://doi.org/10.1080/15325024.2020.1814580
Sperling D. Ethical dilemmas, perceived risk, and motivation among nurses during the COVID-19 pandemic. Nurs Ethics. 2021 Feb;28(1):9–22.
DOI: https://doi.org/10.1177/0969733020956376
Magnavita N, Soave PM, Antonelli M. Prolonged Stress Causes Depression in Frontline Workers Facing the COVID-19 Pandemic—A Repeated Cross-Sectional Study in a COVID-19 Hub-Hospital in Central Italy. Int J Environ Res Public Health. 2021 Jul 8;18(14):7316.
DOI: https://doi.org/10.3390/ijerph18147316
Gilles I, Mabire C, Perriraz M, Peytremann-Bridevaux I. Workplace Well-Being and Intent to Stay by Health Care Workers Reassigned during the First COVID-19 Wave: Results of a Swiss Survey. Int J Environ Res Public Health. 2021 Aug 26;18(17):8976.
DOI: https://doi.org/10.3390/ijerph18178976
Bayer N, Golbasi Z, Uzuntarla Y, Akarsu K. Job satisfaction, burnout and turnover intention of nurses working in hospital during the pandemic COVID-19 in Turkey. J Clin Med Kazakhstan. 2021 Dec 27;18(6):69–75.
DOI: https://doi.org/10.23950/jcmk/11347
Al-Mansour K. Stress and turnover intention among healthcare workers in Saudi Arabia during the time of COVID-19: Can social support play a role? Mahmoud AB, editor. PLOS ONE. 2021 Oct 7;16(10):e0258101.
DOI: https://doi.org/10.1371/journal.pone.0258101
Nashwan AJ, Abujaber AA, Villar RC, Nazarene A, Al-Jabry MM, Fradelos EC. Comparing the Impact of COVID-19 on Nurses’ Turnover Intentions before and during the Pandemic in Qatar. J Pers Med. 2021 May 24;11(6):456.
DOI: https://doi.org/10.3390/jpm11060456
Ohue T, Togo E, Ohue Y, Mitoku K. Mental health of nurses involved with COVID-19 patients in Japan, intention to resign, and influencing factors. Medicine (Baltimore). 2021 Aug 6;100(31):e26828.
DOI: https://doi.org/10.1097/MD.0000000000026828
Liu X, Ju X, Liu X. The relationship between resilience and intent to stay among Chinese nurses to support Wuhan in managing COVID‐19: The serial mediation effect of post‐traumatic growth and perceived professional benefits. Nurs Open. 2021 Sep;8(5):2866–76.
DOI: https://doi.org/10.1002/nop2.874
Zhang SX, Chen J, Afshar Jahanshahi A, Alvarez-Risco A, Dai H, Li J, et al. Succumbing to the COVID-19 Pandemic—Healthcare Workers Not Satisfied and Intend to Leave Their Jobs. Int J Ment Health Addict. 2022 Apr;20(2):956–65.
DOI: https://doi.org/10.1007/s11469-020-00418-6
Schug C, Geiser F, Hiebel N, Beschoner P, Jerg-Bretzke L, Albus C, et al. Sick Leave and Intention to Quit the Job among Nursing Staff in German Hospitals during the COVID-19 Pandemic. Int J Environ Res Public Health. 2022 Feb 10;19(4):1947.
DOI: https://doi.org/10.3390/ijerph19041947
Yáñez JA, Afshar Jahanshahi A, Alvarez-Risco A, Li J, Zhang SX. Anxiety, Distress, and Turnover Intention of Healthcare Workers in Peru by Their Distance to the Epicenter during the COVID-19 Crisis. Am J Trop Med Hyg. 2020 Oct 7;103(4):1614–20.
DOI: https://doi.org/10.4269/ajtmh.20-0800
Falatah R. The impact of the coronavirus disease (COVID-19) pandemic on nurses’ turnover intention: an integrative review. Nurs Rep. 2021;11(4):787–810.
DOI: https://doi.org/10.3390/nursrep11040075
Moyo N, Bhappu AD, Bhebhe M, Ncube F. Perceived Risk of COVID-19 and Employee Decision-Making: How Psychological Distress during the Pandemic Increases Negative Performance Outcomes among Healthcare Workers. Int J Environ Res Public Health. 2022 Jan;19(11):6762.
DOI: https://doi.org/10.3390/ijerph19116762
Tabur A, Elkefi S, Emhan A, Mengenci C, Bez Y, Asan O. Anxiety, burnout and depression, psychological well-being as predictor of healthcare professionals’ turnover during the COVID-19 pandemic: study in a pandemic hospital. In: Healthcare. MDPI; 2022. p. 525.
DOI: https://doi.org/10.3390/healthcare10030525
Sanner-Stiehr E, Garcia A, Polivka B, Dunton N, Williams JA, Walpitage DL, et al. Support from Work and Intent to Stay Among Nurses During COVID-19. Nurse Lead. 2022 Dec;20(6):594–600.
DOI: https://doi.org/10.1016/j.mnl.2022.04.007
Tabur A, Choudhury A, Emhan A, Mengenci C, Asan O. Clinicians’ social support, job stress, and intent to leave healthcare during COVID-19. In: Healthcare. MDPI; 2022. p. 229.
DOI: https://doi.org/10.3390/healthcare10020229
Shen X, Jiang H, Xu H, Ye J, Lv C, Lu Z, et al. The global prevalence of turnover intention among general practitioners: a systematic review and meta-analysis. BMC Fam Pract. 2020 Nov 30;21(1):246.
DOI: https://doi.org/10.1186/s12875-020-01309-4
Tolksdorf KH, Tischler U, Heinrichs K. Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review. BMC Nurs. 2022 Jul 4;21(1):174.
DOI: https://doi.org/10.1186/s12912-022-00949-4
Nafar H, Tahmazi Aghdam E, Derakhshani N, Sani’ee N, Sharifian S, Goharinezhad S. A systematic mapping review of factors associated with willingness to work under emergency condition. Hum Resour Health. 2021;19(1):1–10.
DOI: https://doi.org/10.1186/s12960-021-00622-y
How to Cite
Rahimi, M. K., Heidari, E., Montazeralfaraj, R., & Farajkhoda, T. (2023). A systematic review of the factors influencing retention or turnover intention among emergency personnel in epidemics. Emergency Care Journal, 19(4). https://doi.org/10.4081/ecj.2023.11644
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