Analysis of the inhibitory effect of a refined human resources salary system on job transfer and transfer tendency of nurses

Abstract

To evaluate the impact of a refined human resources salary system on job transfer and transfer tendency. From January 2019 to December 2019, a refined human resources salary system reform was implemented at the Tangshan Workers’ Hospital in Hebei Province, and the job transfer and transfer tendency of clinical nurses was assessed using the nurse job transfer tendency scale before and 1 year after the intervention. A total of 640 nurses completed the intervention and evaluation. The results showed that the job transfer rate following the intervention reduced to 0.22%. The total score of clinical nurse job transfer tendency was (10.80 ± 3.23) before the intervention and (9.66 ± 3.58) after 1 year of intervention, which was substantially lower (P < .001). The satisfaction scores of nurses on performance-based salary increased significantly from (67.83 ± 18.54) before the intervention to (80.66 ± 15.87) after intervention, with varying degrees of increase observed in each dimension (P < .001). The refined human resources salary system effectively reduced job transfer and transfer tendency of clinical nurses in hospital nursing management, and can be widely promoted and applied.

1. Introduction

The nurse turnover and job transfer rate among nurses is a major concern for global health organizations,^[1] with a nurse turnover rate of 15.1%, 19.9%, 26.8%, and 44.3%, in Australia, Canada, the United States, New Zealand, and other countries, respectively.^[2] High nurse turnover and job transfer rates result in a shortage of clinical front-line nurses, which is detrimental to the stability of the nursing team and the enhancement of nursing quality.^[3] In particular, during the novel coronavirus pandemic in 2020, the shortage of nurses and the overburdened workload became more apparent, which has become the focus of medical management in several countries. Currently, most studies are focusing on the factors that influence nurse turnover or job transfer. Different working hours, professional titles, work pressure, occupational fatigue, job satisfaction, and other factors influence nurse turnover and job transfer, and hospital managers are continuously looking for solutions.^[4–6] Studies have shown that refined performance management produces positive outcomes in the management of intensive care units (ICU), pediatric wards, and operating rooms in hospitals.^[7,8] A retrospective analysis of nurses in the Tangshan Workers’ Hospital showed that clinical nurses transferring to nonclinical departments had become a serious problem with 72 nurses transferred from 2014 to 2018, it is urgent to take effective intervention to reverse the tendency. The study received significant support and policy support from hospital executives, it intended to evaluate the influencing factors, build a new model of a performance-based nursing salary system, and assess its effect on inhibiting job transfer tendency among clinical nurses. The results are reported as follows:

2. Participants and methods

2.1. Research participants

A total of 645 nurses working in front-line departments at Tangshan Workers’ Hospital in Hebei Province from January to December 2019, were selected as research participants. Inclusion criteria: Regular employees; new nurses who were employed for over a year. Exclusion criteria: Nurses who asked for leave for over a month during the intervention; nurses who left for further studies during the intervention. Oral informed consent was obtained from each participant, no ethical issues/procedures applied to this research, and no ethics approval was required for this study.

2.2. Research methods

This was a quasi-experimental study with a control group to compare the before and after intervention status of the nurses. The control group included nurses before the intervention. The intervention methods are as follows:

2.2.1. Theoretical basis of intervention framework

In sociologist Taylor’s “Principles of Scientific Management,” modern scientific management has 3 levels: standardization, refinement, and personalization. Based on the second level of refinement, we uncovered the key difficulties and weak links, implemented operations, and eventually integrated the results to build the final framework.

2.2.2. Preintervention preparation

The 645 nurses in clinical wards were surveyed prior to intervention using the Nurse Job Transfer Tendency Scale, Performance-based salary satisfaction scale, and General information questionnaire. It was determined that the following elements influence job transfer tendency among nurses: performance-based salary satisfaction, night shifts, work intensity, job satisfaction, and family support, with salary satisfaction being the key influencing factor. As a result, we developed a human resource salary structure for nurses in our hospital that is primarily focused on salary satisfaction. Night shifts and workload are fundamental elements of nurses’ work that cannot be intervened. However, the night shift element can be included in salary management to produce a refined salary system management model.

2.2.3. Refined human resource salary system framework

As per refined management theory, the salary system is divided into 2 categories: performance-based salary incentives and other refined measures (Fig. 1).

Figure 1.

Management model of refined human resources salary system.

2.2.4. Specific implementation plan

(1) Set up special funds for nursing: 70% of the total income of the hospital’s clinical nursing level was used as special nursing funds, which were generally allocated by the nursing department. The special fund was specifically allocated to nurses who work in environments with a high workload, high pressure, and high risk. It was allocated based on the department’s risk level and the number of patients admitted. A second-level allocation was performed by the head nurse based on the academic qualifications, working years, professional title, grade, and work scale of the nurses. (2) Department risk classification: Referring to research on ward classification methods of other general hospitals of the same scale, the ward classification scheme was preliminatively drawn up, and the nursing workload survey was carried out in 65 wards of the whole hospital, Delphi method was applied. The weight of each risk index was determined and nursing workload was calculated, the risk classification score of each ward was determined by multiplying the index with workload. The result showed ICU earned the highest risk classification score, so the ICU nurses should be paid more. (3) Set up special post allowance for ICU nurses: ICU nurses were provided a special post allowance of RenMinBi (Chinese currency) 1000 per month to increase their income, reflecting the policy of allocating bonuses to departments with high work intensity and high risk. (4) Refine the classification of night shift allowance and improve the treatment of nurses on night shifts: The night shift allowance was distributed based on academic credentials, working years, professional title, grade, number of patients, and degree of risks, using different coefficients for each condition. For example, the working years were separated into levels of 4 years, with a 2-point difference between each level; different professional title was entitled different coefficients, nurses with the same title were divided into 2 levels of ≤2 years and >2 years. (5) Performance-based incentive management for clinical front-line nurses in case of job transfer: If the nurses transferred from a clinical to a nonclinical department, they did not receive performance bonuses in the first year, received 20% in the second year, 30% in the third year, and so on. If nurses transferred from a nonclinical to a clinical department, they immediately received the preferential incentives of the clinical department. (6) Granting of professional titles and evaluation of exceptional nurses: The granting of various titles necessitates a specified number of night shifts. Priority was given to individuals who worked more night shifts under the same conditions. In the evaluation of exceptional nurses, the quota distributions were 25% for the nurses in ICUs and emergency rooms; 18% for the nurses in each clinical ward, and 10% for the nurses in nonclinical departments.

2.3. Assessment method

The clinical nurses were evaluated using the nurse job transfer tendency scale before and after the intervention. (1) Nurse Job Transfer Tendency Scale: The original job transfer tendency scale for nurses was altered to generate a questionnaire with 4 items and 2 dimensions of the job transfer possibility dimension and job transfer motivation dimension in this study^.[9] Cronbach α was 0.847. The reverse 4-scale scoring method was used. The higher the scores, the stronger the job transfer tendency. (2) Performance-based salary satisfaction scale: The original scale was compiled by Yuzhen Zhang in 2011, altered and modified by Chen Jie in 2016.^[10] It has been largely used in nursing salary satisfaction surveys in China. The scale has 3 dimensions and 26 components, with a total score ranging from 46 to 110 points. The higher the scores, the higher the level of satisfaction with performance-based salary. Cronbach α coefficient was 0.958.

2.4. Statistical method

SPSS22.0 software was used for statistical analysis. The measurement data were analyzed using an independent samples t test, and the results are presented as mean ± standard deviation. P < .05 indicates a statistically significant difference.

3. Results

3.1. General data

The number of nurses who participated in the survey prior to the intervention was 645, with 5 of them dropping out due to resignation, no participants were allowed to enter the study during the year. At the end, 640 nurses completed the intervention. There were 625 (97.7%) females and 15 (2.3%) males among them, and the average age was (34.79 ± 6.92) years.

3.2. Comparison of job transfer tendency scores of ward nurses before and after the intervention

3.2.1. Comparison of job transfer tendency scores before and after the intervention

The total score of job transfer tendency of clinical ward nurses was (10.80 ± 3.23) before the intervention and (9.66 ± 3.58) after 1 year of intervention, which was considerably lower (P < .001). The scores of the probability and motivation dimensions of job transfer both reduced significantly (P < .001) (Table 1).

Table 1.

Comparison of scores prior to and after intervention ($\overline{\mathit{x}}\mathbf{\pm }\mathit{s}$).

Scale	Dimensions	Clinical nurses		t value	P value
		Before intervention	After intervention
Job transfer tendency	Probability dimension of job transfer	5.70 ± 1.68	5.01 ± 1.78	−7.897	<.001
	Motivation dimension of job transfer	5.10 ± 1.67	4.65 ± 1.80	−6.233	<.001
	Total points	10.80 ± 3.23	9.66 ± 3.58	−7.491	<.001
Satisfaction score on performance-based salary	Allocation fairness dimension	23.16 ± 6.01	26.45 ± 4.31	18.724	.000
	Procedure fairness dimension	34.03 ± 10.86	41.63 ± 10.45	18.243	.000
	Interaction fairness dimension	10.64 ± 2.78	12.58 ± 2.34	20.180	.000
	Total points	67.83 ± 18.54	80.66 ± 15.87	20.155	.000

3.3. Changes in the job transfer trend of the ward nurses before and after the intervention

In 2014, 10 clinical ward nurses transferred jobs, with a job transfer rate of 1.12%. The number of nurses who transferred jobs and the transfer rates more than doubled in 2016, when compared to 2014, when the hospital stopped recruitment and workload of clinical ward increased and it started to be trendy to transfer jobs. In 2018, the job transfer rate of nurses rose to 2.07%. In 2019, after the performance-based nursing management model of refined human resources salary system was implemented in the hospital, the transfer rate dropped to 0.22% and showed an evident downward trend (X² = 5.212, P < .05) (Fig. 2).

Figure 2.

Trend of job transfer of nurses before and after intervention.

3.4. Comparison of the satisfaction scores of nurses on performance-based salary

The results revealed that the satisfaction scores of nurses on performance-based salary increased significantly from (67.83 ± 18.54) before the intervention to (80.66 ± 15.87) after the intervention, with varying degrees of improvement observed in each dimension, with a statistically significant difference (P < .001) (Table 1).

4. Discussion

Unlike other intervention models for nurse turnover and job transfer, in this study, we identified factors that could be intervened on based on the influencing factors of job transfer tendency among nurses demonstrated in previous research, to construct a novel refined salary system for nurses based on salary satisfaction. The night shift factor was included in the salary management to develop a refined human resources salary system management model.

The results revealed that the overall scores of job transfer tendency of nurses were (10.80 ± 3.23) before the intervention and (9.66 ± 3.58) after 1 year of intervention, which was considerably lower than before the intervention. This study happened to be conducted before the year of the coronavirus pandemic(2019), and the following pandemic years approved how valuable clinical nurses are, especially the ICU nurses, they deserve higher payment for their work. In the intervention plan, the hospital first provided special funding for nursing and established specific post allowances for ICU nurses, which directly boosted the salaries of nurses in special positions. Salary is a significant influencing factor in job satisfaction among nurses.^[11] The higher the wage levels of nurses, the more satisfied they are with their jobs.^[12] Additionally, special funds and post allowances were allocated to positions with high work intensity and high risk, leading nurses to believe that their pay was matched with the effort they put in, minimizing the chance of nurses changing jobs. In departments such as the ICU, operating room, and special care units, the risks are high, the working hours are irregular, the nurses have a large workload and heavy job responsibilities, and they have to constantly pay attention to the patients’ conditions, which requires tremendous focus.^[13] Nurses sometimes stay up late due to overtime, and frequently neglect their families due to work, resulting in notable family problems. However, in departments such as Ear–Nose–Throat, outpatient, logistics, and so on, the risks are modest, and the job intensity and pressure are less. Nurses are frequently able to balance job and family life. Monthly subsidies are given to nurses in high-intensity and high-risk departments to improve their overall income level, thus nurses in the ICU and special care units become the group making the most among nurses in the hospital, neutralizing the perception of low wages with high work pressure and high work intensity.^[14] This fully reflects the distribution principle of more labor and more reward to achieve equitable income distribution, which can boost job satisfaction among nurses and lower their temptation to transfer jobs.^[1] The night shift allowance was allocated based on academic qualifications, working years, professional title, grade, number of patients looked after, degree of risk, and other factors. Furthermore, nurses working night shifts were prioritized in being granted professional titles and awards, which decreased negative feelings and made their work input proportional to the return. The higher the rank of the nurse, the more money the nurse could make. As a result, personal and professional values can be realized, and professional identity can be enhanced.^[15] This also encourages nurses to continually enhance their professional abilities and improve the quality of the nursing team, which prevents job transfers of nurses on night shifts to departments that do not require night shifts, such as outpatient counseling.

In the hospital’s refined human resources salary system, if the nurses transfer from a clinical department to a nonclinical department, they would not receive performance bonuses in the first year, and receive only 20% in the second year, 30% in the third year, and so on. If they transferred from a nonclinical to a clinical department, they would immediately receive the clinical department’s preferential incentives. The performance bonuses of nonclinical departments are smaller than those of clinical departments, which have a significant impact on the salary income of nurses who transfer from their jobs. The income earned by nurses is closely tied to their standard of living and life quality. As a result, the likelihood of job transfer among nurses dramatically decreased.

The results of the study also revealed that satisfaction scores of nurses on performance-based salaries increased significantly from (67.83 ± 18.54) before the intervention to (80.66 ± 15.87) after the intervention. In 1 study, nurses were concerned not just with their salary level, but also with the fairness of their salary distribution.^[16] In our study, the hospital established special funds and post allowances that were allocated to departments with high risks, high work intensity, and pressure, which enabled nurses in the ICUs, special care units, and other high-risk departments the group earning the most salary, and improved the fairness dimension of salary distribution among nurses^[1]; the night shift allowance was also distributed based on the nature of the department and the risk degree, and the salary gap between nurses with a relaxed and a more hectic work schedule was widened. When analyzing professional titles and appraising and selecting the most exceptional nurses based on the refined human resources salary system, nurses with more night shifts were preferred under the same conditions. This made nurses feel valued and promoted by their superiors, reduced negative feelings associated with night shifts, and dramatically improved the fairness dimension of salary interaction among nurses. Therefore, the subjective perception of compensation in salary increased among nurses and their salary satisfaction improved.^[17,18] This is also the primary cause of the drop in turnover and job transfer rates.

Economically, the hospital spent about 70,000¥ more on nurses bonuses every month, but, with more nurses willing to stay in clinical nursing work, it reduced the cost of recruitment of new nurses and training spending, and avoided redundant in nonclinical posts. After the reform, nurses income increased markedly in most clinical areas, showed a more rational distribution of payment in the profession.

5. Conclusion

In conclusion, the refined human resources salary system could better reflect fairness of salary distribution and personal value, effectively balance the work–compensation perception of nurses, improve work enthusiasm and satisfaction, and effectively reduce the job transfer tendency of ward nurses. Therefore, this method should be widely adopted.

Author contributions

Conceptualization: Xue-Ming Liu, Zhi-Guo Wang.

Funding acquisition: Xue-Ming Liu, Hong Zhang, Jian-Fei Han.

Writing—original draft: Xue-Ming Liu.

Data curation: Li-Xuan Geng, Hong Zhang.

Formal analysis: Li-Xuan Geng, Jian-Fei Han.

Writing—review & editing: Hong Zhang.

Resources: Jian-Fei Han, Zhi-Guo Wang.

Software: Zhi-Guo Wang.