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To begin, all authors work in Taiwan, which is where the study took place. Two authors
are professors at a School of Nursing in Taiwan, they mold the minds of future nurses. Another is
the Director of Nursing at one of the hospitals in the study and the other is a head nurse that
works with the young nurses. The title of the article although long is fitting. It is the
accumulation of the article. It lets you know exactly what to expect from the study. Although
after the study was complete and the findings showed personal characteristics did not influence a
nurse’s intent to leave they could have changed the title. Continuing with the abstract, it was very
straightforward, broken down into purpose, design/methods, findings, conclusions, and clinical
relevance. It was an exceptional overview, following along with the article. I liked that it had the
clinical relevance in the abstract, telling why this article was important.
The stated problem in the article is the high turnover rate of new nurses in Taiwan. The
authors offer plenty of background information on the problem including where there needs to be
further exploration on. They clearly state the aim of the study even going as far as stating the aim
of this study.
In total there are thirty-three sources used in this article. Twelve of which are not current
meaning they are over 10 years old. Only seven are within the past five years. The most recent
being published in 2014 and the oldest in 1987. The authors recommend further longitudinal
studies since their study only looks at the participants in one part of time. Also, mentioned future
research in “increasing the sample to improve power or choosing another health status
instrument for healthy people” (Liu, Wu, Chou, Chen, Yang, and Hsu, 2015).
The conceptual framework of hypothesized model is clearly stated within the literature
review and is presented in Figure 1 on page 68. The framework is specifically tied to the study
by the variables listed. The latent variables are personal characteristics, work conditions, and
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work-related fatigue. The measured variables include health, age, education, work experience,
work hours, workload, acute fatigue (AF), intershift recovery (IR), chronic fatigue (CF), and
intent to leave.
This study was a cross-sectional survey study, which is classified as a quantitative,
description study. Grove, Burns, and Gray describe a cross-sectional design “examines groups of
subjects in various stages of development, trends, patterns, and changes simultaneously with the
intent to describe changes in the phenomenon across stages” (2013). The authors of the article
did not complete a pilot study before completing their research.
As far as the sampling method, participants were recruited from two different hospitals in
Taiwan using convenience sampling. The inclusion criteria were nurses that had worked for
greater than 1 month but no more than one year and were clinical care nurses. They used the
priori sample size calculation which gave them the minimum sample size of 156 participants. Of
their 200 surveys, 171 met the criteria, and 162 cases were included after the exclusion of
outliers and missing data. Which gave them enough participants to for the study. Some
demographics were included in Table 1 on page 69 of the study which showed 96.3% of
participants were female and 99.4% were single. The authors did not discuss attrition rate only
the response they received. They received approval from the IRB and went to the units of the
hospital were new nurses worked and explained the study. Participation was voluntary, but if a
nurse decided to participate she received a package which included consents, a survey, and
envelope. A larger envelope was left on the unit and the researchers were called when to collect
the questionnaires. If no call was received the envelopes were collected after two weeks’ time.
Questionnaires were collected over five months in 2014. The tools used within the survey were
all developed by someone else and tested. The instruments were as follows for personal
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characteristics the nurses were asked to provide their age, education, work experience, and to
rate their health. To rate their health a five-point Likert scale called the self-rated health status
(SRHS) was used, one being poor and five being excellent. How many hours worked was self-
reported, while overall workload used a 0-10 scale, 10 being the higher workload. The
Occupational Fatigue Exhaustion Recovery scaled was used for fatigue level. It was broken
down into 3 subcategories, chronic fatigue (CF), acute fatigue (AF), and inter-shift recovery (IR).
Each were rated 0-6, six being strongly agree and zero being strongly disagree. This
measurement the authors did discuss was tested and found to have no gender differences and an
acceptable Cronbach’s alpha greater than 0.73. The study showed that work conditions and work
fatigue p < .001 had a direct correlation with intent to leave p< .01.
The authors were very clear when talking about the limitations of their study: fatigue
level only measured once and unable to determine level of change and what might cause the
change. By using the structural equation model (SEM) to test model fit it did not verify
directional causality. Another limitation the authors admit was that they did not use random
sampling. Because the inclusion criteria were so specific to new nurses they had to find them
within the two hospital systems. A third limitation was the use to the self-rated health status
(SRHS) scale not being useful to for healthy workers. Finally, they suggest a study that included
factors as co-worker support or leadership style. I might suggest also maybe a residency program
were all new nurses come together for classes and competencies once a month. They can all
come together and discuss what is going right and what is going wrong and how to correct it. The
authors were not able to generalize this study because their sample was nonrandom sample. The
authors used current APA format and I did not find any grammatical errors. The article was
written very well and clear.
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Part II. Comparison and Analysis
The design for this study was a typical description study design using questionnaires,
which fit this study very well. Considering the study design there are no interventions or
treatments listed. I believe this research design is best for this study because it gives the
participants a chance to answer the survey when convenient for them and with no judgements.
All steps of the research process were met by the authors and everything well explained. They
even adjusted their final model seen on page 70 figure 2, changing personal characteristics to
health. The methods used for this quantitative research study were accurate in examining cause
and effect of the different variables addressed within the article. This study improved the
knowledge that was known at the time of publication in 2016. Finding that personal
characteristics did not affect a nurse intent to leave and confirmed that work fatigue was a major
factor in the intent on new nurse to leave.
After the data was collected it was analyzed using a software package called the SPSS
version 19.0. It is a widely used program for science statistics. The average was used for duration
of time, the mean for overall workload and working hours. The level of significance and alpha
was identified for each variable. Although after the first analysis age, education, and work
experience did not show to be significant to the intent to leave so all were removed from the
model and was replaced with participants health. All data analysis procedures are clearly
explained within the article under the heading data analysis. “A good model fit is indicated by a
non-significant X2 value, GFI, and AGFI greater than .90, TLI greater than .95, and RMSEA less
than .05” (Liu et al., 2015).
All steps of the research process can be seen in this article. The authors showed an
extensive literature review although I would have like to have seen more recent studies used. The
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research question made complete sense based on the literature review and was clear it needed to
be studied. The findings do build on previous studies, and even suggest future studies.
I enjoyed reading this study because I have seen this a lot in my nine years of being a
nurse. Reading this study, I found myself thinking this was redundant. I feel like I have seen this
many times in the United States and in the areas, I have worked. All suggestions that were made
have already been applied within my hospital even before this article was published. Although it
is very nice to see studies suggestions that have already been applied at my hospital.
References
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Grove, S., Burns, N., and Gray, N. (2013). The Practice of Nursing Research: Appraisal,
synthesis, and generation of evidence. St. Louis, MO: Elsevier.
Liu, Y., Wu, L., Chou, P., Chen, M., Yang, L., and Hsu, H. (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). Pages 66-73.
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