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Research Article Critique
Jessie Heller
Liberty University
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Part I. Comprehension
Introduction
All of the authors are nurses with advanced degrees, and several are professors of nursing
at a prominent medical university. The authors who are not professors of nursing hold senior
level nursing titles at a medical center in Taiwan. The difference of qualifications allows more
than one perspective when constructing this material.
The title of the article does state the content of the article, as each part is evaluated and
explained throughout. The article may be better summarized as work related fatigue and intent to
leave for new nurses, as the other parts did not directly influence intent to leave. Due to multiple
variables being evaluated, the flow of article is harder to follow and seems to make the
hypothesis weaker. The abstract addresses the main points of the articles and includes the
overview, along with the design, the basic findings, and clinical relevance. The methods,
findings, and conclusion could be expanded upon to make the article more clear.
Problem/Purpose
This article aims to address concerns regarding high turnover rate among new nurses in
the nursing workforce. Several statistics included are that turnover among nurses is 30% within a
year of nursing, and 57% within two years. Reasons for high turnover listed are work related
fatigue, and lack of ability for adequate recovery. Work conditions, personal characteristics and
health of nurses are also evaluated as potential sources of stress leading to intent to leave a
nursing practice. The aims of the study is listed to determine how much the factors of personal
characteristics, work conditions and work-related fatigue will affect the intent to leave among
new nurses (Liu et al., 2016).
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Literature Review
Despite more than 30 articles listed in the references, only 14 of the articles were within the
past 10 years, and none were within the past five years. Some articles were over 30 years old,
and while some articles may still be relevant to current events, authors should be cautious with
using references greater than ten years. The authors do include some limitations of their study,
to include that it being a cross sectional study and only measuring fatigue levels at one point in
time.
Framework/Theoretical Perspective
The authors used a conceptual framework with a hypothesized model for testing.
According to Gray et al., states that a conceptual framework “describes phenomena of interest,
expresses assumptions, and reflects a philosophical stance” (2016, pg. 139). The structural
equation model (SEM) is used to evaluate the data. The paths from work conditions to fatigue,
from fatigue to intent to leave, and from work conditions to intent to leave are demonstrated
using the SEM.
While there is a conceptual framework, a specific nursing theory is not mentioned. A theory that
seems to apply is the nursing cognitive theory. Cognitive theory deals with the interaction of
people, environment and behavior. Since the study desires to look at ways to reduce turnover, it
is evaluating elements that play a role in turnover, in this case personal characteristics, work
conditions and health.
List the Research Question(s) or Hypotheses
To what extent do personal characteristics, work conditions, and work related fatigue
predict intent to leave among new nurses?
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Identify and Define Variables
The latent variables being evaluated in this study include personal characteristics, work
conditions, and work related fatigue. The study is evaluating nurses with less than 12 months
of experience, so only nurses that met that criteria were contacted. Of the 200 contacted, 171
met the inclusion criteria. The final number of cases included in the study was 162 for analysis.
The dependent variable or “effect” being evaluated is intent to leave among new nurses.
Demographics of Sample
The study sample included 162 nurses who had more than one month of experience, but
not more than 12 months of experience. All were clinical nurses working in medical center or
hospital setting, and had graduated within one year. Of the 162 nurses, the majority were female
(96.3%) and ages of participants raged from 20 to 35 years. All but one of the participants was
unmarried. 99 of the nurses who participated were from two medical centers, and 63 were from
three regional hospitals. 122 of the nurses worked a rotating shift, while 40 of them worked a
fixed shift.
Research Design
The authors used a quantitative research design into order to answer their research
question. A cross section design was utilized by a questionnaire survey.
Sample/Setting
Nurses were selected using the convenience sampling method, and had to meet the
criteria of having between 1-12 months of experience. The study received approval from the
Institutional Review Board before recruiting nurses to participate. Personnel went to units with
new nurses at the medical centers and regional hospitals to find volunteers for the study.
Consent was obtained and the participants received a questionnaire to fill out at their
convenience. After the questionnaire was completed, participants placed it in a sealed envelope
on their unit. One to
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two weeks was given to complete the questionnaires after distribution, and then the envelope was
collected by the research personnel. Each participant received a small gift for their participation.
Measurement, Methods, and Instruments
According to a priori sample size calculation (Soper 2015), given 10 observed variables
and three latent variables, with an anticipated effect size at .10, the probability at .05, and power
level of .80, the minimum sample size needed was 156. The final data set of 162 nurses meets
that requirement. A conceptual framework with hypothesized model was used, and the
structural equation model (SEM) was used for data analysis. The authors use the likert scale to
to measure self-rated health status (SRHS), and point out that this single-item measurement has
good reliability and validity (Liu et al., 2016).
Data Collection
Researchers used the convenience sampling method to select their participants. Research
personnel sough units with new nurses at the medical centers and regional hospitals in order to
find volunteers. The study was cross sectional in design and used a questionnaire to collect data.
Research personnel obtained consent and left questionnaires to be completed by participants at
their convenience. Once completed, the questionnaires were placed in a sealed envelope on the
unit until picked up by research personnel. Data was collected between January to May 2014,
and only collected at one point in time.
Statistical Analyses
All data was analyzed using SPSS version 19.0 for Windows (IBM corp., Armonk,
NY, USA) and AMOS version 21.0 (SPSS Inc., Chicago IL, USA). Structural equations
modeling (SEM) was used to test model fit. Model fit is examined used chi-square (x^2),
goodness-of-fit index (TLI), and the root mean square error of approximation (RMSEAR).
Intent to leave
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showed significantly correlation to chronic fatigue (r=.70,p<.001), acute fatigue (r=.60, p<.001),
intershift recovery (r=−.60,p<.001), overall workload (r=.54,p<.001), working hours
(r=.37,p<.001), and SRHS(r=−.33,p<.001). Intent to leave was not significantly correlated to
ago, education, or work experience (Liu et al., 2016).
Implication of Findings
Work conditions, health and work-related fatigue affect new nurses and their intent to
leave the bedside. This study showed that work conditions affect the intent to leave when the
conditions lead to work-related fatigue. Several reasons for this mediating effect are suggested to
include long hours ranging from 10 to 16 hour shifts. The other reason is that nursing is an
extremely demanding profession and nurses will have higher recovery needs. The setting of the
study is Taiwan, where new nurses do not necessarily have the opportunity to “withdraw from
work obligations). New nurses are often expected to complete homework and review literature
based on their preceptors recommendations or situations encountered during their shifts. This can
lead to worsening of fatigue levels, as adequate recovery time is not permitted. Nursing
leadership should be aware of the demands placed on new nurses and help with scheduling for
recovery time, particularly those working shifts of 10 hours or more.
Limitations
Several limitations were identified in this study. The study is a cross-sectional study and
the nurses fatigue levels were only measured at one point in time. The SEM was used to test the
model, but could not confirm direct causality. Because the study was a convenience sample, and
not random sampling, the generalizability of the results is limited. The one item SRHS scale may
also not be sensitive enough for healthy nurses. Larger sample size may be beneficial for future
research. Lastly, the study did not include certain organizational factors such as co-worker
support, leadership style, or other influences which could further the variance of intent to leave.
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Generalization of Findings
The study showed that work-related fatigue, especially among new nurses plays a major
role on intent to leave. While previous literature has shown correlation between work conditions
(work overtime and workload) and intent to leave, this study shows that work conditions only
play a significant role when they cause work related fatigue. The study is limited in that it was
not random and cannot be generalized, but does create some suggestions for nursing managers.
Nursing managers should be aware that new nurses with long overtime hours or long working
hours in general often lack adequate recovery time. Also managers should evaluate the workload
and work related fatigue particularly among new graduates. Adaption strategies could be created
and implemented among nurse mentors to help new nurses increase intention to stay. Increasing
number of breaks and increased support from mentors could have a positive effect on intention to
stay.
Suggestions for Further Study
A longitudinal study that evaluates fatigue trends among nurses would develop a better
analysis of the issues common among the new nurses, as well as experienced nurses. Trends with
work related fatigue could help leaders develop better intervention strategies for healthy work
environments and policies. Future studies might benefit from a larger sample group and
randomization to create stronger results.
Format
The article was written in APA format, and was presented with structure and clarity.
While reading this article, I did not discover any errors in spelling, punctuation, or grammatical
errors.
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Part II. Comparison and Analysis
Design
The design of the study was a quantitative survey, which was appropriate to obtain the
desired data of fatigue and intent to leave among new nurses. The limitations include that it
only measured fatigue at one point in time and is not necessarily generalized to the nursing
population. The design is strong in that it does not include an intervention and is a correlation
design.
Data Analysis
The authors used appropriate data analysis tools and demonstrated how it was evaluated.
The data analysis in this study used and described the appropriate procedures of SPSS version
19.0 for Windows. Structural equation modeling (SEM) was used to test the model fit. The
model fit was examined using chi-square (X2), goodness-of-fit index (GFI), adjusted GFI
(AGFI), Tucker-Lewis index (TLI), and the root means square error of approximation
(RMSEA). A good model fit is indicated by a nonsignificant X2 value, GFI and AGFI greater
than .90, TLI greater than .95, and RMSEA less than .05 (Liu et al., 2016).
Overall Evaluation
This article showed a the link of research steps taken to build on previous research and
answer the research question. Previous studies showed work conditions play a role on intent to
leave among nurses. This study showed how work conditions are linked to intent to leave when
they cause work related fatigue. The study shows that personal characteristics, work conditions,
and work related fatigue are all factors on new nurses intent to leave. The quality of the study
was adequate in that it did answer the research questions on a small scale. The study is
informative and gives valuable insight for nursing leadership. I think that the indications are for
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nursing managers to create better work conditions and supportive environment for new nurses.
Creating a more randomized sample would help generalize results.
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References
Gray, J. R., Grove, S. K., & Sutherland, S. (2016). Burns and Grove's the practice of nursing
research - E-book: Appraisal, synthesis, and generation of evidence. Elsevier Health
Sciences.
Liu, Yi, PhD., R.N., Wu, Li-Min, PhD., R.N., Chou, Pi-Ling, PhD., R.N., Chen, Mei-Hsin,
M.S.N., R.N., Yang, Li-Chien, M.S.N., R.N., & Hsu, Hsin-Tien, PhD., R.N. (2016). The
influence of work-related fatigue, work conditions, and personal characteristics on intent
to leave among new nurses. Journal of Nursing Scholarship, 48(1), 66-73.
doi:http://dx.doi.org.ezproxy.liberty.edu/10.1111/jnu.1218.1...
