Nurses' Turnover and Its Related Factors in a Medical Center

Aim: The supply of nurse human resource has been an important topic for the health care community, government, and the general public. The establishment of universal health insurance has enable the rise of health consumerism. This increase in health care demand, together with the aging population, increasing disease severity, and the need of long-term care have drastically increase the demand of clinical care and nurse human resource. The long-term care program was established by the Taiwan Union of Nurses Association (TUNA) in 2014. The statistical analysis from this program indicated that the nursing practice rate have decreased from 60.07 % to 58.40 % (1.67 % decrease) from 2009 to 2016, respectively. In the current rapidly changing health care system, the nurses have to balance between patient care outcomes and achieving the patient families' demand. The nurses' self-demand, and the demand of nursing care quality can lower their confidence in their work. These factors can lead to the resignation of the nurses and impact the health care quality of a medical institution. This study aimed to investigate turnover status and its related factors among nursing staffs in a medical center.

Methods: In a cross-sectional designed study, we enrolled nurses with full-time employment for more than three months in a medical center. A total of 126 questionnaires were distributed by convenience sampling, and 123 valid questionnaires were returned, resulting in a recovery rate of 97.6%.

Results: The resigned nurses were mainly female (95.9%), with an average age of 29.9±6.3 years. Among them, 68.3% were unmarried. The average seniority at the time of resignation was 6.9±6.1 years. The ward staff accounted for 43.1%, and staff in emergency and critical care units accounted for 35.8%. Among all causes of turnover, the highest score was due to "work characteristics of nursing", with an average score of 2.98 (SD = 1.1).

In this study, we exhibited significant differences of baseline characteristics in age, marital status, child-bearing, shift status, work unit, contract retention fee, salary, place of residence, “salary and welfare factors”, “work characteristics factors”, “interpersonal factors”, “development factors” "organization factors" and "environmental factors" between resigned nurses and retaining nurses (all p <0.05).

The important factors of turnover for nursing staff were: “They experienced physical and mental exhaustion caused by excessive clinical nursing works”, “They felt their health was getting worse”, “the bonuses and allowances outside the salary were too small”, “the paperwork was too much”, and “the work pressure was high.

Conclusion: In order to reduce staff turnover rate and to stabilize nursing manpower, the managers should continue to reduce nurse-to-patient ratio, make human resource management to be more flexible, divide the works according to specifications, simplify work processes, and increase salary and welfare.