Aspects Prioritized by Nursing Undergraduates During Choosing a Position in Grassroots Medical Institutions Analyzed Based on the Discrete Choice Experiment

Abstract

Background: Hierarchical medical system is the top task among the five key tasks of China′s healthcare reform during the 13th Five-Year Plan period. However, the unsatisfied qualification and professional capabilities in primary healthcare providers have become the major obstacles in implementing the hierarchical medical system efficiently. So how to attract and retain high-quality healthcare providers is a significant issue that needs to be resolved during the implementation of the system.

Objective: To investigate and analyze the aspects prioritized by nursing undergraduates during choosing a position in grassroots medical institutions, and based on this, to propose relevant intervening measures.

Methods: We conducted a survey in 164 eligible nursing undergraduates who took internship in a tertiary grade A hospital in Tangshan, China with a discrete choice experiment questionnaire in March 2017. The data of the survey were analyzed with mixed-effects logistic regression models.

Results: Of the 164 questionnaires handed out, 153 (93.3%) were responsive, the other 11 were irresponsive assessed by logical error correction. The results of the survey showed that, the aspects prioritized by nursing undergraduates during choosing a position in grassroots medical institutions were as follows in the descending order: monthly income, children′s educational conditions, staffing, working place, working conditions, time needed to get the personal promotion in professional and technical title and systematic training opportunity (P＜0.05). When given the premises that included: monthly income of 2 000 yuan, working in rural areas, no staffing, poor educational conditions for children, 5 years needed to get the personal promotion in professional and technical title, no systematic training opportunities, inadequate equipments and facilities, 75% of the nursing undergraduates were reluctant to work at the grassroots medical institutions, but if the educational conditions for children were improved, then the percentage slumped to 38%.

Conclusion: Discrete selection experiment is a method suitable for analyzing the working preference of nursing undergraduates. The factors that affect nursing undergraduates′ intentions to work in grassroots medical institutions consist of both economic and noneconomic factors. Therefore, an effective package of policy interventions should be developed aiming at this population.