Monday, November 3, 2003

This presentation is part of : An International Examination of the Cost of Turnover and Its Impact on Patient Safety and Nurse Outcomes

Methodological and Measurement Challenges in Conducting an International Study of Nursing Turnover – Lessons from the Pilot Study

Linda L. O'Brien-Pallas, RN, PhD, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada, Christine Duffield, RN, BScN, MHP, PhD, FACHSE, Centre for Health Services Management, University of Technology, Sydney, New South Wales, Australia, Pat Griffin, RN, PhD, Office of Nursing Policy, Health Policy and Communications Branch, Health Canada, Ottawa, ON, Canada, Patricia Hinton Walker, PhD, RN, FAAN, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, USA, Heather K. S. Laschinger, RN, PhD, School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada, Judith Shamian, RN, PhD, Health Canada, Nursing Policy, Ottawa, ON, Canada, and Patricia W. Stone, PhD, MPH, RN, Columbia University, New York, NY, USA.

Purpose: The purpose of this paper is to report on the measurement and methodological challenges in conducting an international study on nursing turnover.

Design: A purposive cross section of medical and surgical units was selected from one province or state in each of the countries studied.

Population, Setting, and Sample: Unit Managers from two medical and two surgical units from each country were asked to participate in the pilot study. Surveys were distributed in Australia, Canada, New Zealand, the United Kingdom, the United States, and Scotland.

Methods: The survey used in the pilot study was adapted from Buchan’s (1999) earlier work and included a series of questions related to budgeted full-time equivalents, new hires, turnover, and direct and indirect costs of turnover on the nursing unit in the last six months. Respondents indicated actual responses to the questions and availability of data for the study.

Results: Most Unit Managers were able to provide data to determine occupancy and turnover rates and termination replacement costs. Some difficulties were experienced in isolating other direct costs per hire including recruitment costs and administrative time per new employee. Costs associated with training new employees and with productivity losses (while new employees learn new jobs) were challenging to collect. Unit Managers’ access to financial and utilization data bases in the organizations in which they are employed need to be improved.

Conclusion: In completing the main study on nursing turnover, many data holders beyond the Unit Manager will have to be approached. The researchers plan to send all surveys well in advance of interviews so that all data sources and data holders are consulted prior to site visits.

Implications: The degree of time spent in understanding each institution’s reporting practices prior to completing data collection will enhance the response rate and quality of data provided.

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