Linda O'Brien-Pallas

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.

Nursing staffing, nursing workload, the work environment and patient outcomes

Nurse staffing (fewer RNs), increased workload, and unstable nursing unit environments were linked to negative patient outcomes including falls and medication errors on medical/surgical units in a mixed method study combining longitudinal data (5 years) and primary data collection.

Who will be there to nurse? Retention of nurses nearing retirement

Aims: To determine the impact on nursing work-force supply of delaying retirement. Background Data: The nursing workforce is aging, and the Baby Boomer generation is nearing retirement age. This potential loss of experienced nurses is likely to exacerbate current nursing shortages. Methods: An analysis of loss rates of nurses in New South Wales (Australia) is provided using 2 different retirement ages—58 and 65 years. Supply numbers were used and then “aged” to determine the impact of retirement on workforce numbers. The impact of potential retention strategies on the numbers who could be retained were determined if 100% of 50- to 55-year-old nurses was retained, 75% of those 56 to 60 years, and 50% of those 61 to 65 years. Results: By the year 2004, approximately 4139 nurses (registered and enrolled) will be lost through retirement at age 65 years. However, retirement at age 58 years sees 7328 lost by 2004. Potentially 2139 nurses in this age spectrum could be retained if strategies are focused on delaying retirement. Conclusions: Delaying the retirement of nurses could provide a significant human resource, not only in terms of absolute numbers but more importantly, in terms of experience and expertise. However, retention of this portion of the workforce may require different strategies than for younger members of the workforce. The needs of this segment of the nursing workforce may require nurse administrators to consider different approaches to nursing work and work allocation.

Human Resources Planning and the Production of Health: A Needs-Based Analytical Framework

Traditional approaches to health human resources planning emphasize the effects of demographic change on the needs for health human resources. Planning requirements are largely based on the size and demographic mix of the population applied to simple population-provider or population-utilization ratios. We develop an extended analytical framework based on the production of health-care services and the multiple determinants of health human resource requirements. The requirements for human resources are shown to depend on four separate elements: demography, epidemiology, standards of care, and provider productivity. The application of the framework is illustrated using hypothetical scenarios for the population of the combined provinces of Atlantic Canada.

A strategy to promote research‐based nursing care: Effects on childbirth outcomes

Studies at area hospitals revealed many gaps between research evidence and intrapartum nursing practices. A randomized controlled trial involving 20 hospitals was used to evaluate the effectiveness of a marketing strategy to promote research-based nursing care. It was hypothesized that the strategy would result in lower rates of epidural analgesia, through increasing the amount of support nurses provided to their patients. Other outcomes included rates of narcotic analgesia, episiotomy, and operative delivery. The marketing strategy was unsuccessful in improving intrapartum nursing care. Much more research is needed about the factors that facilitate improvements in nursing practice.

Nursing: A stepping stone to future careers

Objective: To identify the range of positions to which registered nurses moved when they left the profession and to explore the perceptions of respondents about the skills and experiences gained from performing nursing work. Background Data: Many nurses do not remain employed in nursing positions for the duration of their working life. This pattern of career change has been seen in many countries, including Australia, the United Kingdom, the United States, and Canada. Methods: A mailed questionnaire was completed by respondents who had left nursing. This questionnaire covered demographic information, the industry and role in which respondents were currently working, ease of adjustment to the current industry and role, perceptions of the skills they had gained from nursing, reasons for becoming a nurse, and reasons they left nursing. Results: Many respondents moved to management positions outside the health industry, and most undertook additional study after leaving nursing. In addition, few identified difficulties in adapting to non-nursing employment, and most agreed that their nursing skills and experiences had assisted them in attaining these positions. Conclusions: The findings are reassuring that employment as a nurse provides invaluable skills for a range of employment prospects should an individual wish to change careers.

Beyond Demographic Change in Human Resources Planning: An Extended Framework and Application to Nursing

Objectives: To introduce health care production functions into human resources planning and to apply the approach to analysing the need for registered nurses in Ontario during a period of major reduction in inpatient capacity. Methods: Measurement of changes in services delivered by acute care hospitals in Ontario between 1994/95 and 1998/99, and comparison with changes in the mix of human resources, non-human resources and patient needs. Results: Inpatient episodes per nurse fell by almost 2%. At the same time the number of beds was cut by over 20%. As a result, the number of patients per bed increased by 12%. Allowing for severity, there was a 20% reduction in beds per episode and a 3.7% reduction in nurses per episode. Conclusions: The demands on nurses in acute care hospitals have increased as an increasing number of severity-adjusted episodes are served using fewer beds by a reduced number of nurses. Human resources planning traditionally only considers the effects of demographic change on the need for and supply of health care. Failure to recognize the variable and endogenous nature of other health care inputs leads to false impressions about the adequacy of existing supplies of human resources. Consideration of human resources in the context of the production function for health services provides a meaningful way of improving the effectiveness and efficiency of human resources planning.

Job satisfaction and intentions to leave of new nurses

Turnover of newly graduated nurses is of significant concern. There are continuing reports that new graduates struggle during the transition to the work setting. The purpose of this study was to examine the effects of perceived demands, control, social support and self-efficacy on the job satisfaction and intention to leave of new nurses utilising Karaseks Job Demands-Control-Support model. A cross-sectional mailed survey was used to gather data. The sample comprised 232 new nurses working in acute care in Canada. Job demands, social support from both supervisors and coworkers and self-efficacy were significantly related to job dissatisfaction, while demands and support from coworkers were related to intention to leave the job. Identifying factors that contribute to the job satisfaction and intentions to leave of new nurses is a first step in developing interventions to assist nurses who are just beginning their careers.

Media Portrayal of Nurses' Perspectives and Concerns in the SARS Crisis in Toronto

Purpose: To describe nursing work life issues as portrayed in the media during the SARS crisis in Toronto. Methods: Content analysis of local and national news media documents in Canada. Media articles were sorted and classified by topic, and themes were identified. Findings: Themes were: (a) changing schemas of nursing practice: the new normal; (b) barriers to relational nursing work; (c) work life concerns: retention and recruitment; (d) nursing virtue: nurses as heroes and professionals; (e) paradoxical responses to nurses from the community; and (f) leadership in nursing during the SARS crisis. Conclusions: This analysis enhanced understanding of how nurses are portrayed in the media, but it indicated the significance of quality of work life and issues about work‐home life. Some descriptions of the care and caring of nurses have made nursing seem like an important and influential profession to potential applicants who might previously have dismissed nursing as a career.

Different systems, different costs? An examination of the comparability of workload measurement systems.

This study examines the equivalence of the hours of care estimates of four patient classification/workload measurement systems. Although the hours of care estimates of the systems were similar, differences between the estimates could be as great as 4.53 hours per day for the same patient. The researchers developed relational statements that made hours of care estimates equivalent for all systems studied. System differences can have a profound impact on nursing unit and department budgets, if not adjusted.