Nurse's Turnover in Acute Clinical Setting

Purpose:

To describe the causes of nurses' resignation, and to compare the demographic, professional and attitudinal characteristics of nurses that resign with those of nurses that choose to remain in two major hospitals in Israel.

Methods:

A matched case control study conducted among 100 resigning nurses and 200 remaining nurses (matching by age, gender and department). Exit interviews to obtain data on reasons for resignation, job satisfaction, burnout, perception of quality of patient care and perception of professional autonomy. A retrospective study to compare demographic and professional characteristics of entire nursing staff (n=1897) with all nurses resigning (n=153) from one hospital during 2012.

Results:

Findings from the case control analysis indicate that resigning nurses are young in terms of age but also years of experience in the organization (23% of the nurses had up to one-year's experience, about 40% had up to 2 years of experience, with 70% of the resignations occurring within the first 5 years of employment in the hospital), have no managerial positions (91%), work part time, and have an academic degree (30% had earned an MSN).

Comparison between the entire population of nurses working and all the nurses resigning from the selected hospital during 2012 indicates that resigning nurses were characterized by young age (30% were under 30 years of age) and a high percentage of male nurses. Distance from place of employment (37%) and working conditions (28%) were given as primary causes of resignation.

Distance from place of employment was the most frequent reason given by young, single women holding no managerial positions, working part time, with seniority of up to 5 years. Working conditions were the most frequent reason given by married men aged 30+ with seniority of over 5 years, holding part-time managerial positions, and having no academic education. Lack of professional advancement was most frequently indicated as another reason for resigning by men with an academic education holding part-time managerial positions.

Nurses having a master degree but no managerial position in the organization were found to be much more likely (2.6 times as much) to resign in comparison to others, or occupying a managerial position in the organization. In addition, less-experienced nurses and nurses working part time were much more likely to resign in comparison to more experienced nurses or nurses working full time.

A significant difference was found between resigning and remaining nurses regarding their perceptions of professional autonomy, with resigning nurses reporting a lower level of autonomy than remaining nurses. In addition, aspirations for professional advancement were found to be higher among resigning than among remaining nurses.

Burnout, job satisfaction and perception of quality of care did not predict resignation.

Conclusion:

Mapping the causes of turnover according to the characteristics of those resigning contributed to our understanding several important aspects of nursing staff retention in hospitals. Such understanding is crucial for decision makers when identifying the weaknesses and strengths of their organization's efforts to retain employees and making informed decisions regarding future modes of operation and organizational strategies.

Findings that nurses resigning differed from those remaining by demographic variables and professional skills, not attitudes, indicate low organizational commitment among young nurses working part time. In light of the current findings and a survey of the research literature, we believe it important that interventions aimed at new nursing staff retention focus on developing professional career paths/professional autonomy, especially among nurses having a master degree and working part time in departments having a large nursing staff and male gender. Professional advancement among nurses has been found to contribute to organizational commitment, with a decline in commitment found to motivate the taking of pre-resignation actions and ultimately to the act of resignation.