[Turnover intentions of public health nurses after responding to COVID-19: A comparison with 10 years ago (A report of the Committee on Public Health Nursing 2022/2023 survey)].

Abstract

Objectives　This study aimed to determine how turnover intentions among public health nurses have changed following their coronavirus disease 2019 (COVID-19) response compared to 10 years ago, using propensity score matching.Methods　As part of the Committee on Public Health Nursing's 2022/2023 activities, we conducted a repeated cross-sectional survey among public health nurses based on the Job Demands-Resources Model, a theoretical framework for turnover intentions. We collected cross-sectional observational data from periods before and after the COVID-19 outbreak. Pre-pandemic data came from a 2013 survey ("2013 survey"), while post-pandemic data were collected between December 2022 and February 2023 ("2023 survey"). For the 2023 survey, we created a self-administered questionnaire similar to the 2013 instrument. We stratified and sampled 4,000 full-time public health nurses for distribution, ensuring the proportion of full-time public health nurses matched that of employees in established administrative organizations nationwide. After adjusting for 11 covariates-including sex and administrative classification of respondents' municipalities-through propensity scores, we extracted data for analysis. We compared turnover intentions using the χ² test and compared burnout and work engagement, as mediating variables for turnover intention, using t-tests.Results　The 2023 survey yielded 2,127 valid responses (53.2% valid response rate), and the 2013 survey provided 1,798 responses. After propensity score matching, 2,492 responses (1,246 per group) were used for analysis. Compared to the survey conducted ten years ago, the 2023 survey included more respondents who were staff members or chiefs in health sectors, prefectures, and local governments with jurisdictions exceeding 300,000 people. However, after propensity score matching adjustment, standardized differences for all adjustment variables fell below 0.1, confirming homogenized distributions and composition ratios between groups. Compared to 2013, significantly more public health nurses in the 2023 survey reported turnover intentions. Additionally, public health nurses experienced greater burnout and lower work engagement than 10 years ago.Conclusion　These findings suggest that the COVID-19 response may have exhausted public health nurses and increased their turnover intentions. Further analysis of job demands and resources as factors influencing burnout and work engagement is needed to ensure the career continuity of public health nurses.