Laureen Hayes

Nurse turnover: A literature review - An update

BACKGROUND Concerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of inter-related factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations. OBJECTIVES The objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies. DESIGN A comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years. DATA SOURCES Electronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications. REVIEW METHODS Keyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies. RESULTS From about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations. CONCLUSIONS Nursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.

The Patient Care Delivery Model--an open system framework: conceptualisation, literature review and analytical strategy.

AIMS AND OBJECTIVES This paper presents the Patient Care Delivery Model to illustrate interrelationships between model components and to support its application in research using advanced analytical techniques, including structural equation modelling. BACKGROUND Many complex factors contribute to the nature of healthcare environments and to nurse, patient and system outcomes. A better understanding of these factors and their interrelationships would provide insight for decision-makers to develop strategies to improve outcomes. DESIGN A literature review approach was used to address the objectives. METHOD A threefold approach used existing theory to explicate a comprehensive conceptual framework, reviewed empirical studies of the proposed relationships and considered the application of advanced analytical techniques to inform future research directions. RESULTS As per general system theory, inputs (patient, nurse and system characteristics) to the Patient Care Delivery Model interact with throughputs (nursing interventions, work environments and environmental complexity) to produce intermediate (staffing levels) and distal outputs (patient, nurse and system outcomes). Application of the model in research and its relevance for healthcare settings is supported in the current literature. Statistical techniques that allow model testing and the investigation of multiple relationships simultaneously have demonstrated the interconnections among the model components. CONCLUSIONS Development of the Patient Care Delivery Model is a step towards understanding work environments and providing healthcare managers with evidence-based management tools. Formal testing of comprehensive, multilevel conceptual models will provide empirical linkages between inputs and outputs and will identify potential mediators between predictors and outcomes to offer new insight into organisational practices. RELEVANCE TO CLINICAL PRACTICE A better understanding of how factors in the work environment impact clinical outcomes can facilitate care processes in the nursing unit. Future studies using comprehensive conceptual frameworks and sophisticated analytical approaches will enhance professional nursing practice and improve clinical outcomes in healthcare organisations.

Implementation of the National Nursing Quality Report Initiative in Canada: Insights From Pilot Participants

A qualitative study was undertaken to explore the perceptions and experiences of nurse leaders associated with their participation in the pilot testing of a national nursing database. Interviews with 18 participants were conducted and analyzed using a direct content analysis approach. Three themes emerged including selecting, accessing, and uploading indicators; using indicators and monitoring tools for improvement; and perceiving involvement as a catalyst. Study findings may inform quality improvement efforts in health care organizations.