Voluntary nurse turnover

Résumé fourni par la source

FigureThe nursing workforce is the largest among all healthcare professions and provides the majority of patient-care services within and across the acute care setting.1 Nurses are considered the backbone of healthcare systems, and nursing is ranked as the most trusted profession.2 Ensuring nurse retention is essential for healthcare systems globally, as frequent turnover negatively impacts patient care and safety.3 Nurses face difficult experiences, such as death, ethical challenges in practice, unpredictable changes in work routine, staff shortages, and extreme stress on a daily basis.4,5 The psychological demands and complexity of being a nurse often lead to traumatic stress, emotional exhaustion, burnout, and turnover.6,7 Nurses' experiences during the COVID-19 pandemic resulted in a mass exodus of nurses from acute care settings and from the profession overall.4,8,9 This widespread departure exacerbated existing staffing shortages and contributed to increasingly challenging work environments.8,10 Furthermore, high turnover rates have been linked to ineffective nursing leadership and decreased nurse job satisfaction.11 Globally, nursing turnover rates are 15.2%, with 38.4% of nurses intending to leave their jobs and/or the profession.12,13 Recent research indicates turnover among newly licensed RNs is primarily driven by personal health status and work environment factors.14 A rise in nurse turnover significantly impacts the healthcare system in multiple ways, leading to high economic costs and unhealthy work environments and negatively impacting nurse allocation and job satisfaction.13,15,16 An organization's average cost for turnover of an RN is $46,100 in hiring, training, and retention, resulting in annual financial losses between $5.2 million and $9 million per hospital for all nurse turnovers. Additionally, a decline in experienced professional nurses exacerbates staff shortages and increases the workload for remaining nurses.17-19 Exit surveys are commonly provided postemployment to individuals who have voluntarily resigned from a position and are widely used in healthcare organizations. Surveys help to identify reasons why employees are leaving the organization and what may have encouraged them to stay with the organization. Feedback provided on exit surveys provides evidence to inform strategies to mitigate future turnover.20 Thus, exit surveys can be used to improve understanding of voluntary nurse turnover. Despite well-documented prior investigations of nurse turnover, a research gap remains related to using exit survey data to investigate aspects of voluntary nurse turnover. In this study, voluntary exit surveys were obtained from a Level 1, Magnet®-recognized, quaternary academic hospital and analyzed to determine reasons for voluntary turnover. The aims of this study were to identify: 1) common characteristics and themes related to voluntary turnover of nurses from exit survey data, and 2) opportunities for organizational improvements and interventions that can address these factors and reduce voluntary nurse turnover. Theoretical framework The study design was guided by Kanter's structural empowerment theory, which focuses on how social and cultural factors facilitate or undermine an individual's sense of autonomy and initiative, in addition to their well-being.21 This theory defines structural empowerment as the existence of social structures in a workplace that enable individuals to achieve their work goals, such as access to opportunities, relevant information, support, and resources.21 For nurses, support includes effective teamwork among colleagues, appropriate resources and staffing, adequate workload levels, and a climate that promotes success and innovation and encourages nurses to have a voice.22,23 Kanter's theory has been broadly applied to studies of professional nursing practice, showing that access to resources and information can empower nurses to accomplish their work in ways that are more meaningful and can help them to fulfill role expectations.24,25 Studies have also shown that empowered work environments can positively influence nurses' experiences and significantly lower the risk of poor patient outcomes.22,26,27 Recent studies have reported associations between job satisfaction among nurses and workplace conditions, and noted that structural empowerment is positively associated with work engagement, job satisfaction, and intention to remain in an organization and the profession.22,23 METHODS Study design, setting, and sample This retrospective descriptive study used data made available to the hospital via standardized exit surveys distributed to RNs who voluntarily departed from the organization. The surveys were distributed via email by a third-party vendor within 45 days of the nurse's departure date. Reminders were emailed to former employees who hadn't returned an exit survey within 3 weeks of the initial email request. Return of the survey implied consent for the vendor to summarize the data for reporting and improvement purposes. Prior to the return of exit survey data to the healthcare organization, the third-party vendor anonymized and aggregated the survey results to ensure the confidentiality of respondents. Prior to accessing the data for this study, institutional review board approval was obtained from Washington University in St. Louis, Missouri. Exit survey data from staff RNs with voluntary departure dates from January 1 through December 31, 2023, were eligible for inclusion in this study. Nurses participating in the study were employed across 14 acute care units at a 1,300-bed quaternary academic hospital. Exit survey data from nurse leaders, assistant nurse leaders, and RNs who had been involuntarily terminated were excluded from analyses. Survey instrument The academic hospital participating in this study used an external agency to distribute and maintain proprietary exit survey data focused on employer-related and employee-influenced factors affecting turnover. The first section of the survey evaluated employer-influenced factors that contributed to the employee's resignation. Respondents selected all factors that applied from a list and could provide narrative comments to elaborate on their experiences. The second section of the survey asked respondents to identify what they considered to be the most important employer-related reason for their resignation. The exit survey also collected employee factors that contributed to their resignation, compliance or other concerns, perception of diversity and inclusion, and future employment status posthospital resignation. This exit survey approach combined structured and unstructured response options to generate more complete exit findings. Procedure Anonymized exit survey data were obtained from 139 staff RNs. Respondent data were collated by question and provided in Microsoft Word, yielding 46 pages of written comments. Transcripts were paginated and lines were numbered to facilitate independent evaluation by the research team and for ease of reference during subsequent team discussions. Analysis Themes and characteristics in exit survey data were evaluated using Template Analysis, a specific method of thematic analysis focused on hierarchical coding, which can be adapted to meet the needs of the study and ongoing analyses.28 Initial codes were developed a priori based on Kanter's Structural Empowerment Theory. An inductive-deductive hybrid approach was used to expand upon and add to these codes and to develop new codes. The research team, including three PhD-prepared clinical nurse researchers and one PhD-prepared research scientist, held ongoing discussions during analyses to ensure that participant experiences and perceptions were reflected in code and theme development to reduce researcher bias. RESULTS Demographic analyses showed that the cohort of 139 nurses consisted of 122 (88%) female and 17 (12%) male participants. Participants self-i

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