Reviewer #1
This manuscript uses an interesting methodology to examine the retention strategies for mid-career critical care nurses. The background for the study is well developed, up to date, and develops the rationale for the study. The author(s) do not develop a theoretical framework, per se, for the study. Explained on page 6, para 2, last 4 lines
The Q-Method is explained well, and is appropriate for the purpose of this study. Additionally, this presentation may encourage other researchers to use the Q-Method for similar studies with different populations. The use of focus groups and the literature to develop the statements used in the study is appropriate. The process of Q-sorting with a 45-call grid (Figure 1) could be explained in more detail and used to explain the data analysis. The statistical analysis using principal component analysis and varimax rotation seems appropriate.
-Additional details added on page 8 (last 2 lines)
-Page 9, para 1, lines 1-3 and para 2, lines 5-6
-Page 13, para 3, lines 14-19
The explanation of the results seems complete and helps to develop a framework to justify the four salient viewpoints related to The Healthy Workplace and Respect Seeker, The Flexibility and Reward Seeker, The Professional Development and Teamwork Seeker, and The Lifestyle Seeker. However, additional analysis would be helpful. Forty-five statements were included in the Q-sorting (page 7), but only 22 of those statements are listed in the Factors 1, 2, 3, and 4 (Tables 1, 2, 3, and 4).
* What happened to the other 23 statements? What were these statements?
-Added explanation on page 13, para 3, lines 11-13
* The discussion states (page 14) that "all of the mid-career critical care nurses were in agreement that they were content to accompany transport patients to other hospitals." The rationale for including such statement is given, but that statement is not included in the text. Is that statement one of the 23 statements that I referenced earlier?
-Added on page 13, para 2, lines 8-9
* Inclusion of a table that depicts which statement occur in which factors and whether the statement was seen as a high value strategy or least effective strategy for that factor. This visual presentation would help the reader and administrators implementing the strategies to determine for which group of critical care nurses the strategy could be most (or least) effective. For example, Statement 19 ("I would remain in my current position if rotation to other ICUs than my own was done of a fair basis?) would not be an effective strategy for either The Healthy Workplace and Respect Seekers (Factor 1) OR The Lifestyle Seekers (Factor 4).
-Added (Table 5) and referenced on page 13, para 3, line 14
The manuscript has some difficulties with clarity of presentation and use of APA style. For example * Be careful with use of pronouns (i.e., it, there, these, this) without clear antecedents
CHANGED
-p. 6, para 2, line 9 (“these” removed)
-p. 10, para 3, lines 19-22 (combined two sentences removing “these results”)
-p. 19, para 1, line 9 (removed “this variety of” following “nevertheless”)
* Not using the phrase "in order" unless the author(s) is actually putting items in order (e.g., p. 1, 2nd para; p. 9, line 6; p. 15, 3rd line to the end of the limitations para.).
CHANGED
-p. 1, para 1, line 19 – removed “in order to begin…”
-p. 10, para 3, line 19 - removed
-p. 11, para 1, line 1 – removed
-p. 19, para 1, line 12 - removed
* In the text, the date does not need to be repeated for references used more than once in the same paragraph (page 1, last line; and page 2, 3rd line, 8th line, 18th line).
-Page 2, para 1, line 1 (Strachota et al date removed)
-Page 2, para 1, line 5 (Cartledge date removed)
-Page 2, para 1, line 10 (Stone et al date removed)
-Page 2, para 3, line 19 (Jones date removed)
* Use the word for numbers, rather than the Arabic number, for numbers less than 10 (pages 8, 9, and 10).
-Page 8, para 2, line 8 (7 seven)
-Page 8, para 2, line 11 (5 five)
-Page 8, para 3, line 17 (8 eight)
-Page 9, para 2, line 5 (3 three)
-Page 10, para 1, line 4 (4 four)
-Page 11, para 2, line 4 (6 six)
-Page 11, para 2, line 5 (4 four)
-Page 11, para 2, line 6 (3 three)
-Page 11, para 2, line 6 (2 two)
-Page 11, para 4, lines 22 (3 three)
-Page 11, para 4, lines 22 & 23 (2 two)
-Page 12, para 3, line 15 (3 three & 2 two)
-Page 12, para 3, lines 16 (4 four)
-Page 16, para 2, line 8 (8 eight)
* Avoid one sentence paragraphs (page 10, lines 18-19)Made into two sentences, page 13, para 2, lines 8-11
Also addressed in the following places:
-Page 11, para 2, lines 4-5 – combined with paragraph below
-Page 11, para 4, lines 20-22 – combined with paragraph below
* Reference listed in the text as "Bland Jones" is actually "Jones" (page 2 in text and on reference list) Cheryl Bland Jones does not use a hyphenated last name and thus her last name is Jones. The same issue seems to be the case for author "Hamelin Brabant" in the reference "Lavoie-Tremblay et al." (page 3).DONE
JONES:
-Page 2, para 3, line19
BRABANT:
-Page 3, para. 2, line 13
Also done with all (Boychuk) DUCHSCHER references
-Page 14, para. 3, line 19
-Page 16, para. 1, line 3
-Page 16, para. 2, line 13
-Page 16, para. 3, line 21
* Title on reference list should be italicized for International Council of Nurses (2010) reference. Reference changed to Baumann (2010) – in list on page 21
* The "&" is omitted on the reference list for several references with multiple authors (LaPorta et al; Strachota et al.; and Webler et al.)“&” Added – those were the only three found.
Reviewer #2
This is a well written and interesting manuscript. Nursing turnover is a continuing problem, especially within ICUs, and is projected to get worse as the baby boomers age. The proposed solutions usually have, as the authors describe, a one-size fits all approach. This manuscript uses a non-typical analytical approach to determine what retention factors might be attractive to ICU nurses, but assumes that these factors might vary by age/years of experience of the nurse. The authors do a good job of describing the methodology. The results are interesting, since there does appear to be significant differences across the groups of nurses, with some being more interested in team work, others with workplace support, and others in lifestyle amenities (on-site fitness and 24 hour cafes. The manuscript could be strengthened in the following ways:
1. Better explanation of how to interpret the tables
-ADDED – p. 13, para 3, lines 12-19
2. Some discussion of potential applicability to the U.S.
-Added on p. 4, para 2, lines 9-10, para 3, 17-18
-Also on p.17, para 3, lines 17-22
-p. 18, para 1, lines 1-2
-p. 18, para 2, lines 3-8
3. Some discussion of variations in costs and efforts that would be incurred in order to provide some of the retention strategies
-Explained on p. 17, para 3, lines 11-23
-Also on p. 18, para 2, lines 3-13
4. Some discussion of the possible differences that might be documented if more educated nurses or a geographically diverse sample of nurses were completing the Q-sorting exercise.
-ADDED – p. 18, para 3, lines 14-22
-Also suggested for future research on p. 20, para 2, last 3 lines
5. On page 6, the target age group for recruitment seems pretty young, not mid-career (25-44).
-ADDED – p. 7, para 1, lines 9-15
6. Would it be possible to confirm the findings of this Q-sort with a similar sample of nurses?
-ADDED – p. 18, para 3, lines 14-22
CHECKLIST FOR STYLE
TITLE PAGE -- Supply professional title for each author – Provided
Supply running head of less than 50 characters (no abbreviations). ADDED
Provide the complete address for corresponding author –Provided (cover page)
REFERENCES --
Update REFERENCE LIST using APA 6th Ed. format. In particular,
Give surnames and initials for up to and including 7 authors. When authors number eight or more, include the first six authors' names, then insert "..." and add the last author's name (e.g., Stone 2003); check this format for other refs.
-DiMeglio et al (2005)
-Stone et al. (2003)
Other: Check spelling for (1) DiMeglio or DeMeglio? (2) Mosely or Moseley? and (3) Stearley?
-References in list and cited all modified
TABLES -- Please provide Word (instead of TIFF) files with manuscript text; these should not be separate files.
Provided
FIGURES --
Provide sharper image for Figure 1. Current image will not print clearly.
Provided