title: Does moonlighting influence South African nurses' intention to leave their primary jobs?
abstract: BACKGROUND
  Staff retention and turnover have risen in prominence in the global discourse on the health workforce. Moonlighting, having a second job in addition to a primary job, has not featured in debates on turnover.
  
  
  OBJECTIVE
  This paper examines whether moonlighting is a determinant of South African nurses' intention to leave their primary jobs.
  
  
  METHODS
  During 2010, a one-stage cluster random sample of 80 hospitals was selected in four South African provinces. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information and information on moonlighting, the questionnaire obtained information on the participants' intention to leave their primary jobs in the 12 months following the survey. A weighted analysis of the survey data was done using STATA(®) 13.
  
  
  RESULTS
  Survey participants (n=3,784) were predominantly middle-aged with a mean age of 41.5 (SD±10.4) years. Almost one-third of survey participants (30.9%) indicated that they planned to leave their jobs within 12 months. Intention to leave was higher among the moonlighters (39.5%) compared to non-moonlighters (27.9%; p<0.001). Predictors of intention to leave in a multiple logistic regression were moonlighting in the preceding year, nursing category, sector of primary employment, period working at the primary job, and number of children. The odds of intention to leave was 1.40 (95% CI: 1.16-1.69) times higher for moonlighters than for non-moonlighters. The odds ratio of intention to leave was 0.53 (95% CI: 0.42-0.66) for nursing assistants compared to professional nurses and 2.09 (95% CI: 1.49-2.94) for nurses working for a commercial nursing agency compared to those working in the public sector.
  
  
  CONCLUSIONS
  Moonlighting is a predictor of intention to leave. Both individual and organisational strategies are needed to manage moonlighting and to enhance retention among South African nurses.
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; laetitia.rispel@wits.ac.za.
authors.forename: Laetitia C
authors.initials: LC
authors.lastname: Rispel
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Tobias
authors.initials: T
authors.lastname: Chirwa
authors.affiliation: Centre for Health Policy & Medical Research Council Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Duane
authors.initials: D
authors.lastname: Blaauw
mesh_terms: D000328:Adult; D002322:Career Mobility; D004651:Employment; D005260:Female; D006801:Humans; D033182:Intention; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D016017:Odds Ratio; D010558:Personnel Loyalty; D013019:South Africa; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: South Africa; intention to leave; moonlighting; nurses; turnover