Influence of basic attributes and attitudes of nurses toward death on nurse turnover: A prospective study

Background: Facing patient death is an unavoidable aspect of work for nurses working in healthcare settings. The attitudes of nurses toward death, however, can exert a negative psychological impact on themselves that can even cause them to quit this occupation. Aim: The objective of this study was to explore the attitudes of nurses toward death, the factors influencing said attitudes, and whether nurses basic attributes and attitudes toward death were associated with their future turnover behavior. Method: A prospective study design was adopted. The recruitment period ran from October 2017 to March 2018. A total of 323 nurses completed a basic attributes survey as well as the Death Attitude Profile-Revised questionnaire and were followed until May 30, 2021. The factors influencing turnover were then analyzed using the Cox proportional hazard model. The STROBE checklist was used for reporting in this study. Results: Age was found to be significantly associated with fear of death and death avoidance. Compared with nurses with no religion, nurses who were Buddhists/Taoists were more inclined toward neutral acceptance in their attitude toward death, whereas those who were Christians/Catholics were more inclined toward escape acceptance. Nurses with less than three years of work experience were more likely to resign earlier than those with more than 3 years of work experience. Fear of death and approach acceptance could be used to predict turnover. Conclusions: Younger nurses were more likely to exhibit fear of death and escape behavior, and those with less work experience or a greater fear of death were more likely to resign. Nurses with religious beliefs could accept patient death more positively, whereas those who faced death with positive approach acceptance displayed reductions in turnover. Implication for nursing and health policy: Younger nurses should receive more education regarding death early in their training. Hospitals should also offer more education from a religious aspect in order to reduce turnover.