title: The impact of safety and quality of health care on Chinese nursing career decision-making.
abstract: OBJECTIVE
  The aim of the study was to understand why nurses leave nursing practice in China by exploring the process from recruitment to final exit. This report examines the impact of safety and quality of health care on nursing career decision-making from the leavers' perspective.
  
  
  BACKGROUND
  The nursing shortage in China is more serious than in most developed countries, but the loss of nurses through voluntarily leaving nursing practice has not attracted much attention.
  
  
  METHODS
  This qualitative study draws on a grounded theory approach. In-depth interviews with 19 nurses who have left nursing practice and were theoretically sampled from one provincial capital city in Mainland China.
  
  
  RESULTS
  'Loss of confidence in the safety and quality of health care' became one of the main categories from all leavers' accounts of their decision to leave nursing practice. It emerged from three themes 'Perceiving risk in clinical practice', 'Recognising organisational barriers to safety' and 'Failing to meet expectations of patients'.
  
  
  CONCLUSIONS
  The findings indicate that the essential work value of nursing to the leavers is the safety and quality of care for their patients. When nurses perceived that they could not fulfil this essential work value in their nursing practice, some of them could not accept the compromise to their value of nursing and left voluntarily to get away from the physical and mental stress. However, some nurses had to stay and accept the limitations on the safety and quality of health care.
  
  
  CONCLUSIONS
  The study suggests that well-qualified nurses voluntarily leaving nursing practice is a danger signal for patients and hospitals, and has caused deterioration in nursing morale for both current and potential nursing workforces. It suggests that safety and quality of health care could be improved when individual nurses are empowered to exercise nursing autonomy with organisational and managerial support.
  
  
  CONCLUSIONS
  The priority retention strategies need to remove organisational barriers to the safety and quality of health care. Under the current nursing shortage, Chinese hospital managers might consider recruiting nurses and care assistants of different educational levels, which would effectively improve nursing team work and support nurses' to stay and actively achieve their work values for the safety and quality of health care.
authors.affiliation: Nursing Studies, School of Medicine, Hangzhou Normal University, Hangzhou, PR, China.
authors.forename: Junhong
authors.initials: J
authors.lastname: Zhu
authors.forename: Sheila
authors.initials: S
authors.lastname: Rodgers
authors.forename: Kath M
authors.initials: KM
authors.lastname: Melia
mesh_terms: D002321:Career Choice; D002681:China; D006801:Humans; D009726:Nurses / Q000523:psychology* / Q000600:supply & distribution; D061214:Patient Safety; D017060:Patient Satisfaction; D010563:Personnel Turnover; D011787:Quality of Health Care
keywords: China; nursing; quality; safety; voluntary leaving; work value