Turnover intention and coronaphobia among frontline nurses during the second surge of COVID-19: The mediating role of social support and coping skills
Dennis C. Fronda RN, MAN
Sultan Qaboos University, Muscat, Sultanate of Oman
Search for more papers by this authorCorresponding Author
Leodoro J. Labrague DM, PhD, CNE
St. Paul University Philippines, Tuguegarao, Philippines
Correspondence
Leodoro J. Labrague, St. Paul University Philippines, Tuguegarao, Philippines.
Email: [email protected]
Search for more papers by this authorDennis C. Fronda RN, MAN
Sultan Qaboos University, Muscat, Sultanate of Oman
Search for more papers by this authorCorresponding Author
Leodoro J. Labrague DM, PhD, CNE
St. Paul University Philippines, Tuguegarao, Philippines
Correspondence
Leodoro J. Labrague, St. Paul University Philippines, Tuguegarao, Philippines.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Turnover among frontline health care workers, particularly nurses, reached an alarming rate during the COVID-19 pandemic. This turnover has been attributed, in part, to excessive fear of the virus (a condition called coronaphobia). Studies have not yet been conducted examining whether social support and coping skills could act as buffers between coronaphobia and the intention to leave.
Aim
To examine the relationship between coronaphobia and frontline nurses' organisational and professional turnover intention and to assess whether social support and coping skills can buffer this relationship.
Methods
A correlational research design was used to collect responses through an online questionnaire from a convenience sample of 687 frontline nurses from the Central Philippines. Data were analyzed using descriptive (mean, standard deviation and percentages) and inferential statistics (t test, Pearson r correlation coefficient, ANOVA and multiple linear regression).
Results
More than half of the frontline nurses experienced coronaphobia, while 25.8% reported a desire to leave their job and 20.7% reported a desire to leave their profession. Coronaphobia had direct significant effects on nurses' organisational (β = .424, p < .001) and professional turnover intention (β = .316, p < .001). Social support and coping skills partially mediated the relationship between organisational (β = .365, p < .001; β = .362, p < .001) and professional turnover intention (β = .279, p < .001; β = .289, p < .001).
Conclusion
Frontline nurses who experienced coronaphobia were more likely to quit their job and the nursing profession. Increasing nurses' social support and enhancing their coping skills reduced the negative effects of coronaphobia, resulting in improved nurse retention.
Implications for Nursing Management
Institutional approaches to reduce coronaphobia and turnover intention during the pandemic can be facilitated by improving social support through innovative approaches (e.g., use of technology and social media) and equipping nurses with positive coping skills through coping skills training and other empirically based coping skill-building interventions.
CONFLICT OF INTEREST
All authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
- Al Maqbali, M., Al Sinani, M., & Al-Lenjawi, B. (2021). Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Psychosomatic Research, 141, 110343. Ahead of Print
- Ariapooran, S., Ahadi, B., & Khezeli, M. (2021). Depression, anxiety, and suicidal ideation in nurses with and without symptoms of secondary traumatic stress during the COVID-19 outbreak. Archives of Psychiatric Nursing. Ahead of Print. https://doi.org/10.1016/j.apnu.2021.05.005
- Arnetz, J. E., Goetz, C. M., Sudan, S., Arble, E., Janisse, J., & Arnetz, B. B. (2020). Personal protective equipment and mental health symptoms among nurses during the COVID-19 pandemic. Journal of Occupational and Environmental Medicine, 62(11), 892–897. https://doi.org/10.1097/JOM.0000000000001999
- Blanco-Donoso, L. M., Moreno-Jiménez, J., Amutio, A., Gallego-Alberto, L., Moreno-Jiménez, B., & Garrosa, E. (2021). Stressors, job resources, fear of contagion, and secondary traumatic stress among nursing home workers in face of the COVID-19: The case of Spain. Journal of Applied Gerontology, 40(3), 244–256. https://doi.org/10.1177/0733464820964153
- Chew, Q. H., Wei, K. C., Vasoo, S., & Sim, K. (2020). Psychological and coping responses of health care workers toward emerging infectious disease outbreaks: A rapid review and practical implications for the COVID-19 pandemic. The Journal of Clinical Psychiatry, 81(6), 0–0, DOI: https://doi.org/10.4088/JCP.20r13450
- Chorwe-Sungani, G. (2020). Assessing COVID-19 related anxiety among nurses in Malawi. Research Square, 1–11. https://doi.org/10.21203/rs.3.rs-79619/v1
- Cordero, D. A. Jr. (2021). Saving our healthcare workers again during the COVID-19 pandemic in the Philippines. Journal of Preventive Medicine and Public Health, 54(5), 380–381. https://doi.org/10.3961/jpmph.21.482
- Dy, L. F., & Rabajante, J. F. (2020). A COVID-19 infection risk model for frontline health care workers. Network Modeling Analysis in Health Informatics and Bioinformatics, 9(1), 1–13.
10.1007/s13721-020-00258-3 Google Scholar
- Enea, V., Candel, O. S., Zancu, S. A., Scrumeda, A., Bărbuşelu, M., Largu, A. M., & Manciuc, C. (2021). Death anxiety and burnout in intensive care unit specialists facing the COVID-19 outbreak: The mediating role of obsession with COVID-19 and coronaphobia. Death Studies. Ahead of Print.
- Falatah, R. (2021). The impact of the coronavirus disease (COVID-19) pandemic on Nurses' turnover intention: An integrative review. Nursing Reports, 11(4), 787–810. https://doi.org/10.3390/nursrep11040075
- Goh, Y. S., Ow Yong, Q. Y. J., Chen, T. H. M., Ho, S. H. C., Chee, Y. I. C., & Chee, T. T. (2021). The impact of COVID-19 on nurses working in a university health system in Singapore: A qualitative descriptive study. International Journal of Mental Health Nursing, 30(3), 643–652. https://doi.org/10.1111/inm.12826
- Gonzalez, A., Cervoni, C., Lochner, M., Marangio, J., Stanley, C., & Marriott, S. (2020). Supporting health care workers during the COVID-19 pandemic: Mental health support initiatives and lessons learned from an academic medical center. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S168–S170. https://doi.org/10.1037/tra0000893
- Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. bmj, 368. https://doi.org/10.1136/bmj.m1211
- Gross, C. T., & Canteras, N. S. (2012). The many paths to fear. Nature Reviews Neuroscience, 13(9), 651–658. https://doi.org/10.1038/nrn3301
- Hou, T., Zhang, T., Cai, W., Song, X., Chen, A., Deng, G., & Ni, C. (2020). Social support and mental health among health care workers during coronavirus disease 2019 outbreak: A moderated mediation model. PLoS ONE, 15(5), e0233831. https://doi.org/10.1371/journal.pone.0233831
- International Council of Nurses. (2021). The global nursing shortage and nurse retention, access date: December 1, 2021, access from: https://www.icn.ch/system/files/2021-07/ICN%20Policy%20Brief_Nurse%20Shortage%20and%20Retention.pdf.
- Irshad, M., Khattak, S. A., Hassan, M. M., Majeed, M., & Bashir, S. (2020). How perceived threat of Covid-19 causes turnover intention among Pakistani nurses: A moderation and mediation analysis. International Journal of Mental Health Nursing. Ahead of Print
- Jang, Y., You, M., Lee, S., & Lee, W. (2020). Factors associated with the work intention of hospital Workers' in South Korea during the early stages of the COVID-19 outbreak. Disaster Medicine and Public Health Preparedness, 15(3), e23–e30. https://doi.org/10.1017/dmp.2020.221
- Jung, S. (2021). Factors influencing the turnover Intention of COVID-19 ward and general ward nurses in public hospitals. Korean Journal of Occupational Health Nursing, 30(2), 46–56.
- Khattak, S. R., Saeed, I., Rehman, S. U., & Fayaz, M. (2020). Impact of fear of COVID-19 pandemic on the mental health of nurses in Pakistan. Journal of Loss and Trauma, 26(5), 421–435. https://doi.org/10.1080/15325024.2020.1814580
- Kim, Y. J., Lee, S. Y., & Cho, J. H. (2020). A study on the job retention intention of nurses based on social support in the Covid-19 situation. Sustainability, 12(18), 7276. https://doi.org/10.3390/su12187276
- Labrague, L. J. (2021). Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies. Journal of Nursing Managemen, 29(7), 1893–1905. https://doi.org/10.1111/jonm.13336
10.1111/jonm.13336 Google Scholar
- Labrague, L. J., & de Los Santos, J. A. A. (2021a). Fear of Covid-19, psychological distress, work satisfaction and turnover intention among frontline nurses. Journal of Nursing Management, 29(3), 395–403. https://doi.org/10.1111/jonm.13168
- Labrague, L. J., & De Los Santos, J. A. A. (2021b). Prevalence and predictors of coronaphobia among frontline hospital and public health nurses. Public Health Nursing, 38(3), 382–389. https://doi.org/10.1111/phn.12841
- Labrague, L. J., de Los Santos, J. A. A., & Fronda, D. C. (2021). Factors associated with missed nursing care and nurse-assessed quality of care during the COVID-19 pandemic. Journal of Nursing Management. Ahead of Print.
- Langford, C. P. H., Bowsher, J., Maloney, J. P., & Lillis, P. P. (1997). Social support: A conceptual analysis. Journal of Advanced Nursing, 25(1), 95–100.
- Lavoie-Tremblay, M., Gélinas, C., Aubé, T., Tchouaket, E., Tremblay, D., Gagnon, M. P., & Côté, J. (2021). Influence of caring for COVID-19 patients on nurse's turnover, work satisfaction and quality of care. Journal of Nursing Management. Ahead of Print
- Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
- Lee, S. A. (2020). Coronavirus anxiety scale: A brief mental health screener for COVID-19 related anxiety. Death Studies, 44(7), 393–401. https://doi.org/10.1080/07481187.2020.1748481
- Leng, M., Wei, L., Shi, X., Cao, G., Wei, Y., Xu, H., … Wei, H. (2021). Mental distress and influencing factors in nurses caring for patients with COVID-19. Nursing in Critical Care, 26(2), 94–101. https://doi.org/10.1111/nicc.12528
- Li, J., Li, P., Chen, J., Ruan, L., Zeng, Q., & Gong, Y. (2020). Intention to response, emergency preparedness and intention to leave among nurses during COVID-19. Nursing Open, 7(6), 1867–1875. https://doi.org/10.1002/nop2.576
- Li, Y., Scherer, N., Felix, L., & Kuper, H. (2021). Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PloS one, 16(3), e0246454.
- Lin, M., Hirschfeld, G., & Margraf, J. (2019). Brief form of the Perceived Social Support Questionnaire (F-SozU K-6): Validation, norms, and cross-cultural measurement invariance in the USA, Germany, Russia, and China. Psychological Assessment, 31(5), 609–621.
- Lorente, L., Vera, M., & Peiró, T. (2021). Nurses stressors and psychological distress during the COVID-19 pandemic: The mediating role of coping and resilience. Journal of Advanced Nursing, 77(3), 1335–1344. https://doi.org/10.1111/jan.14695
- Mi, T., Yang, X., Sun, S., Li, X., Tam, C. C., Zhou, Y., & Shen, Z. (2020). Mental health problems of HIV healthcare providers during the COVID-19 pandemic: The interactive effects of stressors and coping. AIDS and Behavior, 25(1), 18–27. https://doi.org/10.1007/s10461-020-03073-z
- Mirzaei, A., Rezakhani Moghaddam, H., & Habibi Soola, A. (2021). Identifying the predictors of turnover intention based on psychosocial factors of nurses during the COVID-19 outbreak. Nursing Open. Ahead of Print, 8, 3469–3476. https://doi.org/10.1002/nop2.896
- Mokhtari, R., Moayedi, S., & Golitaleb, M. (2020). COVID-19 pandemic and health anxiety among nurses of intensive care units. International Journal of Mental Health Nursing, 29(6), 1275–1277. https://doi.org/10.1111/inm.12800
- Mora-Magaña, I., Lee, S. A., Maldonado-Castellanos, I., Jiménez-Gutierrez, C., Mendez-Venegas, J., Maya-Del-Moral, A., Rosas-Munive, M. D., Mathis, A. A., & Jobe, M. C. (2020). Coronaphobia among healthcare professionals in Mexico: A psychometric analysis. Death Studies. Advance online publication. https://doi.org/10.1080/07481187.2020.1808762
- Murat, M., Köse, S., & Savaşer, S. (2021). Determination of stress, depression and burnout levels of front-line nurses during the COVID-19 pandemic. International Journal of Mental Health Nursing, 30(2), 533–543.
- Punsalan, M. L. D. (2021). Give what is due: The need to prioritize healthcare workers in response to COVID-19 pandemic. Journal of Public Health, 43(2), e283–e284. https://doi.org/10.1093/pubmed/fdaa265
- Said, R. M., & El-Shafei, D. A. (2021). Occupational stress, job satisfaction, and intent to leave: Nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt. Environmental Science and Pollution Research, 28(7), 8791–8801. https://doi.org/10.1007/s11356-020-11235-8
- Sampaio, F., Sequeira, C., & Teixeira, L. (2021). Impact of COVID-19 outbreak on nurses’ mental health: A prospective cohort study. Environmental Research, 194, 110620. https://doi.org/10.1097/JOM.0000000000001987
- Saricam, M. (2020). COVID-19-related anxiety in nurses working on front lines in Turkey. Nursing and Midwifery Studies, 9(3), 178–181. https://doi.org/10.4103/nms.nms_40_20
- Schierberl Scherr, A. E., Ayotte, B. J., & Kellogg, M. B. (2021). Moderating roles of resilience and social support on psychiatric and practice outcomes in nurses working during the COVID-19 pandemic. SAGE Open Nursing, 7, 23779608211024213.
- Searle, B. J., & Lee, L. (2015). Proactive coping as a personal resource in the expanded job demands–resources model. International Journal of Stress Management, 22(1), 46–69. https://doi.org/10.1037/a0038439
- Shahrour, G., & Dardas, L. A. (2020). Acute stress disorder, coping self-efficacy and subsequent psychological distress among nurses amid COVID-19. Journal of Nursing Management, 28(7), 1686–1695. https://doi.org/10.1111/jonm.13124
- Shechter, A., Diaz, F., Moise, N., Anstey, D. E., Ye, S., Agarwal, S., … Abdalla, M. (2020). Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. General Hospital Psychiatry, 66, 1–8. https://doi.org/10.1016/j.genhosppsych.2020.06.007
- Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194–200. https://doi.org/10.1080/10705500802222972
- Song, J., & McDonald, C. (2021). Experiences of New Zealand registered nurses of Chinese ethnicity during the COVID-19 pandemic. Journal of Clinical Nursing, 30(5–6), 757–764. https://doi.org/10.1111/jocn.15607
- Soper. (2021). A-priori sample size calculator for multiple regression. Retrieved from http://www.danielsoper.com/statcalc/calculator.aspx?id=1.
- Stelnicki, A. M., Carleton, R. N., & Reichert, C. (2020). Nurses' mental health and well-being: COVID-19 impacts. Canadian Journal of Nursing Research, 52(3), 237–239. https://doi.org/10.1177/0844562120931623
- Takase, M. (2010). A concept analysis of turnover intention: Implications for nursing management. Collegian, 17(1), 3–12.
- Tayyib, N. A., & Alsolami, F. J. (2020). Measuring the extent of stress and fear among registered nurses in KSA during the COVID-19 outbreak. Journal of Taibah University Medical Sciences, 15(5), 410–416. https://doi.org/10.1016/j.jtumed.2020.07.012
- ÜNver, S., & YenÍĞÜN, S. C. (2021). COVID-19 fear level of surgical nurses working in pandemic and surgical units (Vol. 36) (pp. 711–716). Journal of PeriAnesthesia Nursing. https://doi.org/10.1016/j.jopan.2021.04.014
- Vagni, M., Maiorano, T., Giostra, V., & Pajardi, D. (2020). Coping with COVID-19: Emergency stress, secondary trauma and self-efficacy in healthcare and emergency workers in Italy. Frontiers in Psychology, 11, 2294. https://doi.org/10.3389/fpsyg.2020.566912
- Vallejo, B. M. Jr., & Ong, R. A. C. (2020). Policy responses and government science advice for the COVID 19 pandemic in the Philippines: January to April 2020. Progress in Disaster Science, 7, 100115. https://doi.org/10.1016/j.pdisas.2020.100115
- Varghese, A., George, G., Kondaguli, S. V., Naser, A. Y., Khakha, D. C., & Chatterji, R. (2021). Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis. Journal of Global Health. Ahead of Print.
- von Vogelsang, A. C., Göransson, K. E., Falk, A. C., & Nymark, C. (2021). Missed nursing care during the COVID-19 pandemic: A comparative observational study. Journal of Nursing Management. Ahead of Print
- Warchoł-Biedermann, K., Daroszewski, P., Bączyk, G., Greberski, K., Bugajski, P., Karoń, J., … Samborski, W. (2021). Dysfunctional coping mediates the relationship between stress and mental health in health care staff working amid COVID-19 pandemic. Medical Principles and Practice, 30, 395–400. https://doi.org/10.1159/000516181
- Weiner, L., Berna, F., Nourry, N., Severac, F., Vidailhet, P., & Mengin, A. C. (2020). Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: The REduction of STress (REST) study protocol for a randomized controlled trial. Trials, 21(1), 1–10. https://doi.org/10.1186/s13063-020-04772-7
- Yáñez, J. A., Jahanshahi, A. A., Alvarez-Risco, A., Li, J., & Zhang, S. X. (2020). Anxiety, distress, and turnover intention of healthcare workers in Peru by their distance to the epicenter during the COVID-19 crisis. The American Journal of Tropical Medicine and Hygiene, 103(4), 1614–1620. https://doi.org/10.4269/ajtmh.20-0800
- Zhang, S. X., Chen, J., Jahanshahi, A. A., Alvarez-Risco, A., Dai, H., Li, J., & Patty-Tito, R. M. (2021). Succumbing to the COVID-19 pandemic—Healthcare workers not satisfied and intend to leave their jobs. International Journal of Mental Health and Addiction, 1–10. https://doi.org/10.1007/s11469-020-00418-6
- Zhang, X., Jiang, X., Ni, P., Li, H., Li, C., Zhou, Q., Qu, Z., Guo, Y., & Cao, J. (2021). Association between resilience and burnout of front-line nurses at the peak of the COVID-19 pandemic: Positive and negative affect as mediators in Wuhan. International Journal of Mental Health Nursing, 30(4), 939–954. https://doi.org/10.1111/inm.12847
- Zhu, J., Sun, L., Zhang, L., Wang, H., Fan, A., Yang, B., & Xiao, S. (2020). Prevalence and influencing factors of anxiety and depression symptoms in the first-line medical staff fighting against COVID-19 in Gansu. Frontiers in Psychiatry, 11, 386. https://doi.org/10.3389/fpsyt.2020.00386