New insights on a recurring theme: A secondary analysis of nurse turnover using the National Sample Survey of Registered Nurses

BACKGROUND

Registered nurse (RN) turnover is a recurring phenomenon that accelerated during COVID-19 and heightened concerns about contributing factors.

PURPOSE

Provide baseline RN turnover data to which pandemic and future RN workforce turnover behaviors can be compared.

METHODS

A cross-sectional, secondary analysis of RN turnover using U.S. National Sample Survey of Registered Nurses 2018 data. Responses from 41,428 RNs (weighted N = 3,092,991) across the United States were analyzed. Sociodemographic, professional, employment, and economic data and weighting techniques were used to model prepandemic RN turnover behaviors.

DISCUSSION

About 17% of the sample reported a job turnover, with 6.2% reporting internal and 10.8% reporting external turnover. The factors common across both internal and external turnover experiences included education, employment settings, and years of nursing experience.

CONCLUSIONS

Baseline RN turnover data can help employers and policymakers understand new and recurring nursing workforce trends and develop targeted actions to reduce nurse turnover.

2022 Emory Business Case for Nursing Summit: What has changed in the past year

This commentary paper concludes the Business Case for Nursing special edition. The special edition covered major areas of dialogue from the 2022 Emory Business Case for Nursing Summit. The 2022 summit, led by Emory School of Nursing in partnership with Emory School of Business, convened national nursing, health care, and business leaders. Its aim was to explore possible solutions to nursing workforce crises, including nursing shortages. Each of the summit's four panels authored a paper in this special edition on their respective topic(s) of discussion. This paper is written by the summit's hosting deans and closing speaker in response to those discussions. It shares major policy and regulatory reforms that have taken place since the summit and highlights workforce needs that will require continued attention in 2023 and beyond. Topics include issues driving nurse turnover and workforce distribution, the relationship(s) between working conditions and nursing retention, the importance of competitive nursing salaries, and the need for systems to protect resilience in nursing.

Maximizing the potential value of the nursing workforce

This panel paper is the fifth installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic, and this panel paper focuses on maximizing the potential value of the nursing workforce. It addresses topics including the need to create a nursing-inclusive federal health care billing system improve nursing salaries by designing/testing nurse-informed compensation models, and strengthen nursing's national professional infrastructure.

Design health care systems to protect resilience in nursing

This panel paper is the fourth installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage. Each of the summit's four panels authored a paper in this special edition on their respective topic(s) of discussion, and this panel paper is focused on resilience in nursing. It addresses the importance of organizational culture in nursing retention, the role of leadership in reducing nurse turnover, and strategies for how to build resilience systems that counteract or eliminate sources of moral distress. Cost rationales are discussed as part of 'the busienss case' for investing in resilience systems.

The Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health

OBJECTIVE

Nurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides.

DESIGN

A retrospective, cross-sectional analysis.

SETTING AND PARTICIPANTS

The study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018.

METHODS

We used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0-16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution).

RESULTS

Across state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses.

CONCLUSION AND IMPLICATIONS

The ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health.

Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia

Background

Despite the inevitable growing rate of nurse turnover worldwide and its consequences, limited empirical data has been published in Indonesia. This study aims to describe the nurse turnover pattern at private hospitals, its causes and consequences as perceived by the hospitals' managers.

Methods

A survey method was used to obtain secondary and primary data from five private general hospitals in three administrative regions in East Java, Indonesia. The data of nurse turnover and demographic characteristics were collected. Mann Whitney test and relative risk analysis was performed to explore the role of nurse characteristics on nurses' decision to leave their job. To explore the causes and consequences of nurse turnover, an online survey was conducted to twelve hospital managers. The data was then classified based on similar themes.

Results

The data show that nurse turnover is between 12 and 34%. Being up to thirty years old, single, and having worked in the hospital up to three years significantly increase the risk of turnover. Personal reasons, external attractions and unsuitable working conditions are the three common nurse turnover reasons revealed by hospital managers. Hospital managers admitted that nurse turnover disturbs hospital operations, further impacting the hospital's revenue and costs.

Conclusions

The nurse turnover is higher than the acceptable level which is significantly predicted by age, marital status and job tenure. Further research is needed to develop nurse retention strategy in their early years of employment, based on the nurse's point of view.

The Job Embeddedness instrument: an evaluation of validity and reliability

A cross sectional correlational mailed survey was used to assess the validity and reliability of the Job Embeddedness (JE) instrument for predicting nurse retention. A regression model using the variables of JE and age were predictive of nurse retention in a sample of Registered Nurses (RNs) working in long term care (LTC) settings. This study supports the multi-dimensionality, validity and reliability of the underlying JE construct. However a different factor structure was suggested that better fit the data. Long term care organizations (LTC) may benefit from a strategy of increasing the embeddedness of their existing employees in order to increase nurse retention. Job embbededness could be used as a foundation to provide effective nurse retention strategies in LTC settings.

Models for predicting turnover of residential aged care nurses: a structural equation modelling analysis of secondary data

BACKGROUND

Nurse turnover in the residential aged care industry is a pressing issue. Researchers have shown ongoing interest in exploring how the factors that are amendable to change in aged care policy, regulation and funding and in organizational procedures (e.g. job demands, coping resources and psychological health of nurses) impact on turnover. However, the findings are mixed.

OBJECTIVE

This study tested two theoretical models of turnover to examine the structural relationships among job demands, coping resources, psychological health and turnover of residential aged care nurses. Although many previous studies operationalized turnover as intention to leave, the present study investigated actual turnover by following up with the same individuals over time, and thus provided more accurate predictive models of turnover behaviour.

DESIGN AND METHODS

The sample, 239 Australian residential aged care nurses, came from the Nurses and Midwives e-cohort Study. Job demands, coping resources, and psychological health were measured using standardized instruments. Structural equation modelling was used to test the measurement and structural models.

RESULTS

Controlling for a number of workforce and individual characteristics, coping resources (measured by job control, supervisor support, and co-worker support) were negatively and directly associated with turnover. Additionally, the findings supported the Job Demand-Control-Support model in that higher coping resources and lower job demands (indicated by psychological demands, physical demands, and effort) were related to better psychological health (measured by vitality, social functioning, role emotional, and mental health), and higher job demands were related to lower coping resources.

CONCLUSIONS

Findings suggest that aged care policy makers and service providers might consider increasing coping resources available to nurses and minimizing job demands of care work to reduce turnover and improve nurses' psychological health. Moreover, findings from this Australian study may provide valuable practical and policy implications for other developed countries.