Growth and challenges of China's nursing workforce from 1998 to 2018: A retrospective data analysis

Zhang, Huijing; Luo, Dan; Lu, Yanhui; Zhu, Hongmei; Zhang, Guangpeng; Li, Mingzi

doi:10.1016/j.ijnurstu.2021.104084

Cited by 21 publications

(15 citation statements)

References 39 publications

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“…Regardless of the sustainable growth in the health workforce, the problem of unreasonable structure between physicians and nurses deserves research attention, which has also been pointed out by previous studies ( 25 , 52 ). The ratio of doctors to nurses was estimated at 1:1.5 in 2019 in China, which was far from the value of 1:3.16 in Korea and 1:4.62 in the United States in the same year based on OECD data.…”

Section: Discussionmentioning

confidence: 83%

“…Moreover, our results also pointed out that the spatial aggregation of physicians and nurses even aggravated in the last decade, as evidenced by a slightly increase of global Moran's I index in HRDI_P and HRDI_N in our study. Similarly, Zhang et al found global Moran's I index of nurse density increased from 0.113 in 1998 to 0.198 in 2018 ( 25 ), and Chen et al observed the HRDI of health personnel increased from 0.055 in 2009 to 0.103 in 2018 through global Moran's I analysis ( 11 ). These figures imply the enlarging spatial heterogeneity in health labor allocation.…”

Section: Discussionmentioning

confidence: 96%

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Finding flaws in the spatial distribution of health workforce and its influential factors: An empirical analysis based on Chinese provincial panel data, 2010–2019

Bai

Huang

et al. 2022

Front. Public Health

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BackgroundThe maldistributions of the health workforce showed great inconsistency when singly measured by population quantity or geographic area in China. Meanwhile, earlier studies mainly employed traditional econometric approaches to investigate determinants for the health workforce, which ignored spillover effects of influential factors on neighboring regions. Therefore, we aimed to analyze health workforce allocation in China from demographic and geographic perspectives simultaneously and then explore the spatial pattern and determinants for health workforce allocation taking account of the spillover effect.MethodsThe health resource density index (HRDI) equals the geometric mean of health resources per 1,000 persons and per square kilometer. First, the HRDI of licensed physicians (HRDI_P) and registered nurses (HRDI_N) was calculated for descriptive analysis. Then, global and local Moran's I indices were employed to explore the spatial features and aggregation clusters of the health workforce. Finally, four types of independent variables were selected: supportive resources (bed density and government health expenditure), healthcare need (proportion of the elderly population), socioeconomic factors (urbanization rate and GDP per capita), and sociocultural factors (education expenditure per pupil and park green area per capita), and then the spatial panel econometric model was used to assess direct associations and intra-region spillover effects between independent variables and HRDI_P and HRDI_N.ResultsGlobal Moran's I index of HRDI_P and HRDI_N increased from 0.2136 (P = 0.0070) to 0.2316 (P = 0.0050), and from 0.1645 (P = 0.0120) to 0.2022 (P = 0.0080), respectively. Local Moran's I suggested spatial aggregation clusters of HRDI_P and HRDI_N. For HRDI_P, bed density, government health expenditure, and GDP had significantly positive associations with local HRDI_P, while the proportion of the elderly population and education expenditure showed opposite spillover effects. More precisely, a 1% increase in the proportion of the elderly population would lead to a 0.4098% increase in HRDI_P of neighboring provinces, while a 1% increase in education expenditure leads to a 0.2688% decline in neighboring HRDI_P. For HRDI_N, the urbanization rate, bed density, and government health expenditure exerted significantly positive impacted local HRDI_N. In addition, the spillover effect was more evident in the urbanization rate, with a 1% increase in the urbanization rate relating to 0.9080% growth of HRDI_N of surrounding provinces. Negative spillover effects of education expenditure, government health expenditure, and elderly proportion were observed in neighboring HRDI_N.ConclusionThere were substantial spatial disparities in health workforce distribution in China; moreover, the health workforce showed positive spatial agglomeration with a strengthening tendency in the last decade. In addition, supportive resources, healthcare needs, and socioeconomic and sociocultural factors would affect the health labor configuration not only in a given province but also in its nearby provinces.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 96%

Finding flaws in the spatial distribution of health workforce and its influential factors: An empirical analysis based on Chinese provincial panel data, 2010–2019

Bai

Huang

et al. 2022

Front. Public Health

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“…The widespread nursing shortage and outflow are of great concern in China (Cao et al, 2021; Yang et al, 2021). A recent study shows that the number of nurses per capita in China is below the world average (3.75 nurses per 1000 population) and is far below that of the developed countries (Zhang et al, 2021). The shortage would be exacerbated by the persisting outflow of nurses.…”

Section: Introductionmentioning

confidence: 99%

Stressors, coping strategies and intention to leave the nursing profession: A cross‐sectional nationwide study in China

Wang

Chen

et al. 2022

J Nursing Management

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Aims This study aims to investigate the association between stressors, coping strategies and intention to leave the nursing profession among nurses. Background Job stressors and coping strategies are believed to affect turnover intention among nurses, but no large‐scale study has been conducted on these associations in China yet. Method A cross‐sectional secondary analysis was conducted among 51,406 nurses from 1858 hospitals. Univariable and multivariable logistic regression analyses were carried out, and odds ratios were reported. Results Overall, 49.58% nurses had an intention to leave the profession. It is found that stress from health condition, family, occupational injuries, nurse–patient tension, high job demands, strict leaders and colleague relationships were significantly associated with higher intention to leave. Coping strategies such as talking to family and friends, talking to leaders, doing outdoor activities, engaging in hobbies and attending on‐the‐job training were significantly associated with lower intention, but social gathering, psychological counselling and suffering in silence had an opposite effect. Conclusions Our study provides new insights into the association between stressors, coping strategies and turnover intention among nurses in China. Implications for Nursing Management Evidence from this study indicates that policies promoting a safe and supportive work environment should be developed to help nurses cope with stress.

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“…With the gradual popularization of higher nursing education in China, the academic level of clinical nurses has significantly improved as the number of registered nurses with a master's degree or above increased from 0 in 2002 to 8000 in 2018 (Zhang et al, 2021). However, Hui et al, 2020;Quan et al, 2021), emphasizing the necessity of this scale.…”

Section: Discussionsmentioning

confidence: 99%

Development and psychometric appraisal of Head Nurse Research Leadership Scale

Guo

et al. 2023

Nursing Open

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Aim To develop a Head Nurse Research Leadership Scale and evaluate its reliability and validity. Design A psychometric instrument validation study was conducted in two phases. Methods The item tool was generated based on a literature review, semi‐structured interview and brainstorming. Twenty experts validated the content of the initial version for two rounds. Thirty‐nine clinical nurses conducted the HNRLS‐v3 to test the readability of the items in pilot study I. Items were screened based on the critical ratio, correlation coefficient analysis, Cronbach's α coefficient and factor analysis using the data collected from 265 nurses in pilot study II. A cross‐sectional survey was conducted in six hospitals to evaluate the reliability and validity between 4 January 2022 and 15 January 2022. Three hundred and sixteen nurses participated in this survey, and 60 completed the questionnaire to validate the test–retest reliability between 1 February and 6 February. Results A 15‐item Head Nurse Research Leadership Scale based on 5 dimensions was developed, and the content validity was satisfied. The 15 items accounted for 77.9% of the variance. Confirmatory factor analysis showed acceptable convergent validity and discriminant validity. The Cronbach's α coefficient, split‐half reliability and test–retest reliability of the scale were 0.966, 0.9633 and 0.927, respectively.

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Growth and challenges of China's nursing workforce from 1998 to 2018: A retrospective data analysis

Cited by 21 publications

References 39 publications

Finding flaws in the spatial distribution of health workforce and its influential factors: An empirical analysis based on Chinese provincial panel data, 2010–2019

Finding flaws in the spatial distribution of health workforce and its influential factors: An empirical analysis based on Chinese provincial panel data, 2010–2019

Stressors, coping strategies and intention to leave the nursing profession: A cross‐sectional nationwide study in China

Development and psychometric appraisal of Head Nurse Research Leadership Scale

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