Nursing Turnover and Job Satisfaction: Why Do Nurses Leave?

Nursing Turnover and Job Satisfaction: Why do nurses leave?

Melissa Carlson

Samuel Merritt University

Significance of the problem

        High nursing turnover has been observed around the globe and continues to contribute to the nursing shortage (Cowden and Cummings, 2011;Aiken et al, 2011;Cranley et al, 2013;Ritter, 2010;Aiken et al, 2011;Brunetto & Shacklock, 2011). Nursing turnover rates are 10-21% per year globally, with some countries averaging even higher (Cowden & Cummings, 2011; Ritter, 2011). Opinions differ on exactly how large the shortage is, but nurse shortages are projected to grow across the United States between 2009 and 2030, with California and Texas being the most affected. (Juraschek, Ranganathan, Vernon, & Zhang, 2012) Shortage on staff has been linked to contributing to sentinel events, increased hospital readmission, patient mortality, decreased patient satisfaction and decreased nursing retention (ANA, 2012; Moneke & Umeh, 2013). Nursing turnover impacts the healthcare system negatively both on the operations level of the hospital and the patient care level (Ritter, 2010; ANA, 2015).Hospitals feel the financial burden of having to pay overtime, accrue training costs of new nurses and the inability to maximize their census (Brunetto & Shacklock, 2011; Ritter, 2011) The impact is also felt on the remaining staff as they endure heavier workloads and a decreased morale ( Cranley et al, 2013; Bonner, Hayes, & Pryor, 2010). Lastly, the patients are at risk of receiving decreased quality of care and are at risk of an increase in errors leading to adverse outcomes (Cranley et al, 2013; Buffington et al, 2012; Kuehn, 2007). As previously mentioned, some studies have reported there is not a nursing shortage or there may be a smaller shortage then previously reported and that the past economic climate has altered projections (Spertz, 2015). It has been argued that the recession of 2009 kept mature nurses in their jobs rather than retiring, hence reducing the number of positions needing to be filled (American Nurses Association, 2015; Ritter, 2011). While the demand of nurses was decreased by the recession, a supply of new nurses were in the making and await for jobs to open. If the economy continues to stabilize, mature nurses will retire and the new graduates will fill their shoes (Ritter, 2011) However, it is suggested that with the increasing age of the nursing workforce, increase in healthcare insurance recipients, increase in nurses leaving their positions, the changing demographics of patients, the decrease in enrollment in nursing schools and the decrease in retaining nursing teaching faculty there may be an increase demand for nurses once again (American Nurses Association,2015; Ritter, 2011). The increase for demand and the decrease in supply along with the cost and safety issues concerning nurse turnover justifies the need to investigate causes of nurse turnover and interventions aimed to increase nurse retention (Brunetto & Shacklock, 2011; Ritter, 2011).

Statement of purpose

        The purpose of this literature review is to examine the prevalence of nurse turnover and its causes. In addition, potential strategies to improve nurse retention are described. Pub med was searched using the criteria ACUTE CARE NURSES and RETENTION and PERSONNEL TURNOVER. Filters used were Humans, 5 years and English language. This resulted in approximately 40 relevant articles. Additional articles were obtained by using the similar article link located under relevant articles and by searching references used by articles found.

Critique of the literature

        A search of the literature resulted in thousands of articles examining nurse retention over and fewer articles looking at possible strategies to prevent nursing turnover over the last forty years. It is suggested that job satisfaction is associated with a nurses intent to stay and that job satisfaction is found to be dependent on many variables (Bonner, Hayes, & Pryor, 2010; Dotson & Dave, 2014; Hairr, Johannsson, Redfern-Vance, 2014). The factors that have been found to have an effect on nurse job satisfaction and thus nurse turnover include but are not limited to: recognition/rewards, professional nursing role, mentorship, schedule flexibility, stressors, management/leadership practices, organizational commitment, professional opportunity, pay, group cohesion, trust, perceived supervisor support, praise, access to resources and information as needed to succeed in the role, perceived manager position and power (Bonner, Hayes, & Pryor, 2010; Dotson & Dave, 2014).  In the attempt to organize these factors, however some do overlap, four main categories have been adapted from the "Conceptual model of intent to stay" developed by Boyle, Bott, Hansen, Taunton, & Woods (1999). These are manager characteristics, organizational characteristics, nurse characteristics, and work characteristics.