Registered Nurse Turnover: Lessons Learned From Organizational Culture in Select Private Hospitals in Kenya

Globally, healthcare settings are facing registered nursing staff shortages, and experiencing difficulties in recruitment and retention of registered nursing staff. The International Council of Nurses and others have suggested this situation constitutes a global crisis, predicting a 2.8 million deficit in nurses by 2015 primarily in developing contexts (Keith, 2016). Kenya is among the countries with critical shortage of registered nurses at 0.48 RN per 1,000 population (Wakaba, et al 2014). This situation has led to a call for national and international ethical human resource planning and retention strategies. Although a plethora of publications exists on causes of registered nurse turnover in developed countries, this pattern is not mirrored in most developing nations, including Kenya. Organizational factors that undermine registered nurses’ morale are known to contribute to high turnover rates in developed countries (Toh, et al 2012); however, it is unclear whether this is mirrored in developing contexts. Therefore, the purpose of this study was to consider the organizational culture(s) prevalent in a small sample of private hospitals in Kenya, and to explore and describe known and unknown factors impacting on the work environment and RN turnover.

A qualitative phenomenological approach was utilized as there was little known about the experiences of RNs in private hospitals in Kenya. Ethical approval was sought from the Kenyan National Council for Science and Technology. Eight RNs, who had previously worked in two private hospitals in Kenya consented to participate in the study. Eight individual interviews were conducted and data analyzed using content thematic analysis.

The research data revealed three themes and seven sub-themes, respecting organizational culture of select private hospitals in Kenya. The themes included: restrictive work environment as constrictive to nursing practice; top-down leadership topples down nursing autonomy; and normalizing the abnormal in team dynamics and professionalism. The sub-themes included: experiencing restrictive work practices; being denied opportunities; being ordered to do; adopting an unquestioning approach and attitude; learning the unwritten rules; normalizing professional bullying; normalizing lack of professional support. A key factor influencing these cultural attributes according to the participants is nursing leadership.

Within developing contexts, the issues of organizational culture and RN retention have not been as widely studied; however, a few recent publications have reflected increasing awareness of this relationship (Edoho, Bamidele, Neji, & Frank, 2015; Lemu, 2015). Therefore, these findings inform the current literature regarding turnover in developing countries, and the role that organizational culture plays in RNs turnover.