Nicola North

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 Impact of Nurse Turnover on Patient, Nurse, and System Outcomes: A Pilot Study and Focus for a Multicenter International Study:

Research about the economic impact of nurse turnover has been compromised by a lack of consistent definitions and measurement. This article describes a study that was designed to refine a methodology to examine the costs associated with nurse turnover. Nursing unit managers responded to a survey that contained items relating to budgeted full-time equivalents, new hires, and turnover, as well as direct and indirect costs. The highest mean direct cost was incurred through temporary replacements, whereas the highest indirect cost was decreased initial productivity of the new hire. The study allowed the identification of the availability of data and where further refinement of data definition of variables is needed. The results provided significant evidence to justify increased emphasis on nurse retention strategies and the creation of healthy work environments for nurses.

Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes

AIMS To determine the rates and costs of nurse turnover, the relationships with staffing practises, and the impacts on outcomes for nurses and patients. BACKGROUND In the context of nursing shortages, information on the rates and costs of nursing turnover can improve nursing staff management and quality of care. METHODS Quantitative and qualitative data were collected prospectively for 12 months. A re-analysis of these data used descriptive statistics and correlational analysis techniques. RESULTS The cost per registered nurse turnover represents half an average salary. The highest costs were related to temporary cover, followed by productivity loss. Both are associated with adverse patient events. Flexible management of nursing resources (staffing below budgeted levels and reliance on temporary cover), and a reliance on new graduates and international recruitment to replace nurses who left, contributed to turnover and costs. CONCLUSIONS Nurse turnover is embedded in staffing levels and practises, with costs attributable to both. A culture of turnover was found that is inconsistent with nursing as a knowledge workforce. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers did not challenge flexible staffing practices and high turnover rates. Information on turnover and costs is needed to develop strategies that retain nurses as knowledge-based workers.

Sustaining and Creating Migration Chains Among Skilled Immigrant Groups: Chinese, Indians and South Africans in New Zealand

The concept of chain migration has played a central role in the study of international migration over several decades. Recent developments in the ease of movement and international transmission of information may have made the social networks that are at the heart of such migration redundant, especially for skilled individuals and their households. To investigate this claim, a small panel study of recent migrants to New Zealand from China, India and South Africa is used to explore both the importance of social networks in promoting their moves and their subsequent involvement in encouraging and assisting family and friends to join them. The findings show that most of their moves did not involve the typical chain migration process, but the participants who remained in the study for the full five years assisted on average 1.25 others to move to New Zealand also.

Employment Status, Duration of Residence and Mental Health Among Skilled Migrants To New Zealand: Results of a Longitudinal Study

Aims: To report findings on employment, duration of residence and mental health from a longitudinal study of 107 skilled immigrants to New Zealand from the Peoples Republic of China, India and South Africa. Methods: Demographic and employment data were collected by face-to-face interviews using a structured questionnaire that included (as the mental health instrument) the General Health Questionnaire 12 (GHQ-12). The initial interview took place after the immigrants had been resident in New Zealand for an average of five months. Four subsequent interviews were conducted annually (1999—2002) on or about the anniversary of the first interview. Results and Conclusion: Rather than an initial euphoric period followed by a mental health crisis, the results indicated poor mental health status in the first two years irrespective of employment status. Thereafter, mental health slightly improved as did employment rates. A surprising result was that although the South Africans had the highest employment rate, there were neither substantial mental health differences among the three groups nor was there a significant improvement during the course of the longitudinal study.

Decentralisation of Health Services in Fiji: A Decision Space Analysis

BACKGROUND Decentralisation aims to bring services closer to the community and has been advocated in the health sector to improve quality, access and equity, and to empower local agencies, increase innovation and efficiency and bring healthcare and decision-making as close as possible to where people live and work. Fiji has attempted two approaches to decentralisation. The current approach reflects a model of deconcentration of outpatient services from the tertiary level hospital to the peripheral health centres in the Suva subdivision. METHODS Using a modified decision space approach developed by Bossert, this study measures decision space created in five broad categories (finance, service organisation, human resources, access rules, and governance rules) within the decentralised services. RESULTS Fijis centrally managed historical-based allocation of financial resources and management of human resources resulted in no decision space for decentralised agents. Narrow decision space was created in the service organisation category where, with limited decision space created over access rules, Fiji has seen greater usage of its decentralised health centres. There remains limited decision space in governance. CONCLUSION The current wave of decentralisation reveals that, whilst the workload has shifted from the tertiary hospital to the peripheral health centres, it has been accompanied by limited transfer of administrative authority, suggesting that Fijis deconcentration reflects the transfer of workload only with decision-making in the five functional areas remaining largely centralised. As such, the benefits of decentralisation for users and providers are likely to be limited.

International Nurse Migration: Impacts on New Zealand

As a source and destination country, nurse flows in and out of New Zealand (NZ) are examined to determine impacts and regional contexts. A descriptive statistics method was used to analyze secondary data on nurses added to the register, NZ nurse qualifications verified by overseas authorities, nursing workforce data, and census data. It found that international movement of nurses was minimal during the 1990s, but from 2001 a sharp jump in the verification of NZ-registered nurses (RNs) by overseas authorities coincided with an equivalent increase in international RNs (IRNs) added to the NZ nursing register—a pattern that has been sustained to the present. Movement of NZ RNs to Australia is expedited by the Trans-Tasman Agreement, whereas entry of IRNs to NZ is facilitated by nursing being an identified Priority Occupation. Future research needs to consider health system and nurse workforce contexts and take a regional perspective on migration patterns.

Towards a systemic understanding of a hospital waiting list

Hospital waiting lists are a feature of publicly funded health services that result when demand appears to exceed supply. While much has been written about surgical waiting lists, little is known about the dynamics of radiology waiting lists, which is surprising given that rational treatment, and indeed the medical professions claim to expertise, rests on establishing a diagnosis. This paper reports the findings of a case study of a problematic ultrasound waiting list. In particular, this paper highlights how the management of the ultrasound waiting list served to subordinate the needs of waiting patients and their general practitioners to the interests and values of radiologists. Radiologist concern to protect specialist expertise from encroachment by outpatient clinicians and sonographers is implicated in the growth of the ultrasound waiting list. It is argued that an adequate understanding of ultrasound waiting lists depends on grasping how radiologists are successful in structuring problems of access in ways that enhance radiologist control over ultrasound imaging. The case study reported helps to shed light on why increasing funding to clear waiting lists proves ineffective.

Housing experience and settlement satisfaction: recent Chinese, Indian and South African skilled immigrants to New Zealand

Relatively little work has been done on the housing experience of recent migrants from cultural backgrounds different to that of their host society. This absence is particularly marked for relatively high socio-economic status skilled migrants, many of whom have to negotiate housing markets significantly different from those in their countries of origin. Data obtained from a panel study of recent immigrants from three separate sources—China, India and South Africa—to New Zealands main cities (primarily Auckland) are used to explore the nature of their housing experiences. Over a four-year period these migrants moved towards the New Zealand norm of owner occupied, detached dwellings, although more rapidly in some cases than others; the pace of movement reflected not only cultural differences among the three groups, relative to the New Zealand norms, but also experiences in the labour market. These differences are reflected in levels of satisfaction with the decision to move to New Zealand.

New graduate separations from New Zealand's nursing workforce in the first 5 years after registration: a retrospective cohort analysis of a national administrative data set 2005–2010

AIM To describe workforce separation rates and its relationship with demographic and work characteristics in the 2005 new graduate cohorts first 5 years as practising RNs in NZ. BACKGROUND Retaining new graduate RNs is critical to nursing workforce sustainability; one study showed that if an RN is still employed in a hospital setting 5 years after graduation, he/she tends to remain active in the health industry. DESIGN Retrospective analysis using the Nursing Council of New Zealands registration data set for years 2005-2010. METHODS All newly registered NZ graduates practising in NZ in 2005 (n = 1236) were tracked for 5 years. RESULTS Within 5 years of graduation, 26% of the cohort had separated from the NZ nursing workforce, 18% in the first year. The under-25s (n = 517), 42% of the cohort, had the highest loss, 32%, in 5 years. Separations were significantly lower for graduates in their 30s vs. their 20s and for those who gained postgraduate tertiary qualifications post-registration (10%) vs. those who did not (29%). Hospitals were the most frequent employment setting over 5 years, the largest increase being community settings. Five-year retention rates in the four largest practice areas were surgical 26%, medical 16%, mental health 60% and continuing care 10%. After 5 years, 24% of those still practising (n = 920) worked in a different health board region. CONCLUSIONS New graduate RN losses were higher than in previous research, with younger RNs at most risk, threatening future sustainability of the nursing workforce and highlighting the need for evidence-based targeted strategies to retain them.