Determinants of turnover among nursing department employees

Testing the Revised Stress-Response Sequence Model in Pediatric Oncology Nurses

In a series of five studies, the research team tested components of the stress-response sequence (SRS) model to determine the relationships between role-related stress, coping, and work consequences in pediatric oncology nurses. The combined outcomes indicated that the model required revision to include role-related meaning; this study tested the revised model. Eighty-nine pediatric oncology nurses from one setting completed seven study questionnaires. The new scale, the Role-Related Meaning Scale, created for this study achieved a Cronbach's alpha of .83 and significant positive correlations with other study variables. Descriptive findings indicate that the nurses are moderately to highly stressed; use coping strategies frequently and effectively; have high levels of job satisfaction, organizational commitment, and group cohesion; and exhibit low intent to leave the organization. Importantly, the stress and coping components of the model did not predict role consequences. These outcomes suggest that the revised SRS model does not adequately predict role consequences in pediatric oncology nurses. A new model is proposed.

Thirty years of nursing turnover research: looking back to move forward

Despite the substantial amount of useful prior work on turnover among nurses, our understanding of the causal mechanisms explaining why nurses voluntarily leave their jobs is limited. The purpose of this article is to promote the development of stronger conceptual models of the causes of voluntary turnover among nurses. The author compares the nursing-specific literature to research on voluntary turnover from the general management field over the past 30 years and examines the evolution of key theories used in the nursing literature. Results of this review comparing nursing research with that in the broader field suggest that, over time, nursing research has not kept pace with conceptualizations from general management explaining why people either remain at or quit their jobs. The author argues that conceptual models of turnover among nurses can benefit significantly from drawing more effectively on particular models and concepts available in general management studies of turnover.

Job embeddedness and nurse retention

BACKGROUND

Nurse retention is a different way of conceptualizing the employer-employee relationship when compared with turnover. Job embeddedness (JE), a construct based on retention, represents the sum of reasons why employees remain at their jobs. However, JE has not been investigated in relation to locale (urban or rural) or exclusively with a sample of registered nurses (RNs). The purpose of this study was to determine what factors (JE, age, gender, locale, and income) help predict nurse retention.

METHODS

A cross-sectional mailed survey design was used with RNs in different locales (urban or rural). Job embeddedness was measured by the score on the composite, standardized instrument. Nurse retention was measured by self-report items concerning intent to stay.

RESULTS

A response rate of 49.3% was obtained. The typical respondent was female (96.1%), white, non-Hispanic (87.4%), and married (74.9%). Age and JE were predictive of nurse retention and accounted for 26% of the explained variance in intent to stay. Although age was a significant predictor of intent to stay, it accounted for only 1.4% of the variance while JE accounted for 24.6% of the variance of nurse retention (as measured by intent to stay).

CONCLUSIONS

Older, more "embedded" nurses are more likely to remain employed in their current organization. Based on these findings, JE may form the basis for the development of an effective nurse retention program.

Addressing the turnover issue among new nurses from a generational viewpoint

AIM

To investigate the relationship between dimensions of the psychosocial work environment and the intent to quit among a new generation of nurses.

BACKGROUND

As a new generation of nurses enters the workforce, we know little about their perception of their current work environment and its impact on their intent to stay.

METHOD

A self-administered questionnaire was distributed to 1002 nurses.

RESULTS

The nurses who intended to quit their positions perceived a significant effort/reward imbalance as well as a lack of social support. The nurses who intended to quit the profession perceived a significant effort/reward imbalance, high psychological demands and elevated job strain.

CONCLUSION

The balance between the level of effort expended and reward received plays an important role in young nurses' intent to leave.

IMPLICATIONS FOR NURSING MANAGERS

Nurse Managers must offer Nexters, from the beginning of their career, a meaningful work and supportive environment. Without the efforts of the organization to improve the work environment and support nurses, this generation may not feel valued and move to another organization that will support them or another career that will offer fulfilment.

Exploring the Influence of the Regulatory Survey Process on Nursing Home Administrator Job Satisfaction and Job Seeking

Nursing home administrators’ retention rate continues to be a serious problem. One factor potentially affecting administrator turnover that has received minimal research attention is the nursing home regulatory process. Using a random start systematic sample of 135 nursing home administrators, this study explores whether regulatory process perceptions, survey performance (number of deficiency citations on last survey), and demographic or facility variables are associated with job satisfaction and job seeking. Multivariate analyses revealed three main findings: (a) an overall positive perception of the survey process was a significant predictor of administrator job satisfaction and job seeking, (b) survey performance outcomes were not related to administrator job satisfaction, and (c) administrator job seeking was associated with perception of the survey process, performance outcomes, and four factors identified in prior research on staff turnover (type of facility, job tenure, salary, and job satisfaction). Results reinforce ongoing initiatives on retaining quality nursing home leadership.

Organizational commitment as a predictor variable in nursing turnover research: literature review

AIM

This paper is a report of a literature review to (1) demonstrate the predictability of organizational commitment as a variable, (2) compare organizational commitment and job satisfaction as predictor variables and (3) determine the usefulness of organizational commitment in nursing turnover research.

BACKGROUND

Organizational commitment is not routinely selected as a predictor variable in nursing studies, although the evidence suggests that it is a reliable predictor. Findings from turnover studies can help determine the previous performance of organizational commitment, and be compared to those of studies using the more conventional variable of job satisfaction.

METHODS

Published research studies in English were accessed for the period 1960-2006 using the CINAHL, EBSCOHealthsource Nursing, ERIC, PROQUEST, Journals@OVID, PubMed, PsychINFO, Health and Psychosocial Instruments (HAPI) and COCHRANE library databases and Business Source Premier. The search terms included nursing turnover, organizational commitment or job satisfaction. Only studies reporting mean comparisons, R(2) or beta values related to organizational commitment and turnover or turnover antecedents were included in the review.

RESULTS

There were 25 studies in the final data set, with a subset of 23 studies generated to compare the variables of organizational commitment and job satisfaction. Results indicated robust indirect predictability of organizational commitment overall, with greater predictability by organizational commitment vs job satisfaction.

CONCLUSION

Organizational commitment is a useful predictor of turnover in nursing research, and effective as a variable with the most direct impact on antecedents of turnover such as intent to stay. The organizational commitment variable should be routinely employed in nursing turnover research studies.

Impact of management development on nurse retention

PURPOSE

Nurse retention is essential to maintain quality healthcare organizations. In an effort to mitigate the loss of nurse managers, a management education program was created for new and transitioning nurse managers that included scholarships for nurses from long-term and rural acute care settings. Program evaluation was based upon the outcomes of anticipated turnover and employee satisfaction.

DESIGN AND METHODS

Using a preprogram and postprogram evaluation, the Index of Work Satisfaction (IWS) and the Anticipated Turnover Scale (ATS) were used to survey participants. Descriptive statistics as well as Wilcoxon statistics for group comparisons were used for analysis.

FINDINGS

ATS scores were significantly reduced (P < .05) for all program participants. Further analysis of scholarship recipients indicated that the management program significantly increased their intent to stay (P < .08) in their current positions. However, because of a large rate of attrition, findings can only be considered preliminary.

CONCLUSIONS

While the high level of attrition among the scholarship recipients is disappointing, potential attendance barriers are discussed, particularly from long-term care settings. Management development programs may improve the satisfaction and retention of critically needed managers and enhance development of future nursing leaders.

Why do nurses at a university hospital want to quit their jobs?

The aim of the study was to investigate to what extent the registered nurses at a university hospital intend to quit their present jobs and the reasons for this. A total of 833 nurses at a university hospital responded to two mailed, work-environment questionnaires (Quality Work Competence and Huddinge University Hospital Model Questionnaire). About 54% (n = 449) intended to quit and 35% (n = 155) had already taken steps to do so. Main reasons were dissatisfaction with the salary (65%), psychologically strenuous and stressful work (32%), a wish to 'try something new' (28%) and limited opportunities to make a professional career (19%). Nurses who intended to quit ('quitters') rated a higher work tempo (P < 0.001), experienced an increased work-related exhaustion (P < 0.001) and a lower quality of patient care (P < 0.01). They also perceived to a lower degree that their competence was made good use of (P < 0.001) and that they had fewer opportunities of developing their own competence (P < 0.001) and making a professional career. They were less satisfied with the support from their superiors for participating in nursing research and developing projects (P < 0.001). Finally, the 'quitters' knew to a significantly lesser extent (P < 0.001) why they had the actual salary they had, what the salary was based on and what to do to improve it. However, it was found that the hospital still had a 'core group' of highly motivated and dedicated nurses with an unusually high amount of mental energy left. All findings regarding the 'quitters' are factors amenable to interventions.

A theoretical model of job retention for home health care nurses

BACKGROUND

Predicted severe nursing shortages and an increasing demand for home health care services have made the retention of experienced, qualified nursing staff a priority for health care organizations.

AIMS

The purpose of this paper is to describe a theoretical model of job retention for home health care nurses.

METHODS

The theoretical model is an integration of the findings of empirical research related to intent to stay and retention, components of Neal's theory of home health care nursing practice and findings from earlier work to develop an instrument to measure home health care nurses' job satisfaction.

DISCUSSION

The theoretical model identifies antecedents to job satisfaction of home health care nurses. The antecedents are intrinsic and extrinsic job characteristics. The model also proposes that job satisfaction is directly related to retention and indirectly related to retention though intent to stay. Individual nurse characteristics are indirectly related to retention through intent to stay. The individual characteristic of tenure is indirectly related to retention through autonomy, as an intrinsic characteristic of job satisfaction, and intent to stay.

CONCLUSIONS

The proposed model can be used to guide research that explores gaps in knowledge about intent to stay and retention among home health care nurses.

Development and testing of the Role-related Meaning Scale for Staff in Pediatric Oncology

The purpose of this study was to develop and test the Role-Related Meaning Scale for Staff in Pediatric Oncology (RRMS) to determine the internal consistency and the content and construct validity of this two-phase instrument. During phase 1 (item generation, content validation, and initial field testing), 23 nurses from two cancer centers participated, and during phase 2 (instrument testing), 89 nurses from one pediatric research center participated. The nurses completed either the RRMS only (phase 1) or six instruments including the RRMS (phase 2) to assess the following research variables: role-related meaning, group cohesion, organizational commitment, work satisfaction, and intent to leave. The RRMS was revised after phase 1 because the results yielded a ceiling effect and three overlapping items. The Cronbach alpha for the phase 2 total RRMS was.83, and four of the five hypothesized relations were confirmed (P =.04). Therefore, the RRMS was concluded to be an internally consistent instrument that has content validity and beginning construct validity. Future studies will examine whether the RRMS adequately measures the change in meaning brought about by interventions designed to increase role-related meaning among nurses.

Organization specific predictors of job satisfaction: findings from a Canadian multi-site quality of work life cross-sectional survey

BACKGROUND

Organizational features can affect how staff view their quality of work life. Determining staff perceptions about quality of work life is an important consideration for employers interested in improving employee job satisfaction. The purpose of this study was to identify organization specific predictors of job satisfaction within a health care system that consisted of six independent health care organizations.

METHODS

5,486 full, part and causal time (non-physician) staff on active payroll within six organizations (2 community hospitals, 1 community hospital/long-term care facility, 1 long-term care facility, 1 tertiary care/community health centre, and 1 visiting nursing agency) located in five communities in Central West Ontario, Canada were asked to complete a 65-item quality of work life survey. The self-administered questionnaires collected staff perceptions of: co-worker and supervisor support; teamwork and communication; job demands and decision authority; organization characteristics; patient/resident care; compensation and benefits; staff training and development; and impressions of the organization. Socio-demographic data were also collected.

RESULTS

Depending on the organization, between 15 and 30 (of the 40 potential predictor) variables were found to be statistically associated with job satisfaction (univariate analyses). Logistic regression analyses identified the best predictors of job satisfaction and these are presented for each of the six organizations and for all organizations combined.

CONCLUSIONS

The findings indicate that job satisfaction is a multidimensional construct and although there appear to be some commonalities across organizations, some predictors of job satisfaction appear to be organization and context specific.

The impact of workplace empowerment, organizational trust on staff nurses' work satisfaction and organizational commitment

A predictive, nonexperimental design was used to test Kanter's work empowerment theory in a random sample of 412 staff nurses selected from the professional registry list of a central Canadian province. Kanter argues that work environments that provide access to information, support, resources, and opportunity to learn and develop are empowering and influence employee work attitudes, productivity, and organizational effectiveness. Test results suggest that fostering environments that enhance perceptions of empowerment will have positive effects on organizational members and increase organizational effectiveness.

Administrator turnover and quality of care in nursing homes

PURPOSE OF THE STUDY

In this article, I examine the association between turnover of nursing home administrators and five important quality of care outcomes.

DESIGN AND METHODS

The data came from a survey of 420 nursing facilities and the 1999 On-line Survey, Certification, and Reporting System. Using multivariate logistic regression analyses, I looked at the effects of turnover of administrators in nursing homes belonging to chain organizations and in nursing homes not belonging to chain organizations.

RESULTS

I found the average annual turnover rate of administrators to be 43%. The multivariate logistic regression analyses show that in nursing homes belonging to chains, administrator turnover is associated with a higher than average proportion of residents who were catheterized, had pressure ulcers, and were given psychoactive drugs and with a higher than average number of quality-of-care deficiencies. In nursing homes not belonging to chains I found that turnover of administrators is associated with a higher than average proportion of residents who were restrained, were catheterized, had pressure ulcers, and were given psychoactive drugs.

IMPLICATIONS

There is a need to improve understanding of how and why better outcomes are achieved in some nursing homes. This investigation serves to focus attention on nursing home administrators. I believe this study provides preliminary evidence that the turnover of administrators may have an important association with quality of care in nursing homes.

The antecedents and consequences of empowerment: a gender analysis

Kanter argues that empowerment has many positive consequences. Not only do empowered employees work more effectively, but they are more likely to express positive attitudes toward their organization. Although support for Kanter's model has been found in several studies of nurses, these studies have not explored the possibility of gender differences. Do men in nursing have the same access as women do to structures that lead to empowerment? Moreover, do men and women react differently to empowerment? To answer these questions, we sampled 412 nurses (195 men; 217 women) about their access to empowerment structures and their trust and commitment to their organization. We found no support for the suggestion that male nurses are less empowered because of their "token" status. Also, we found that the model predicted the responses of men and women equally. Our results suggest that empowerment provides an excellent way of enhancing organizational attitudes for both men and women.

Extrinsic and intrinsic determinants of quality of work life

The objective of this research was to test whether extrinsic, intrinsic or “prior” traits best predict satisfaction with quality of work life (QWL) in health care. Extrinsic traits are salaries and other tangible benefits; intrinsic traits include skill levels, autonomy and challenge. Prior traits are those of the individuals involved, such as their gender or employment status. A survey of employees was conducted in seven different health‐care settings located in the south central region of Ontario, Canada. A total of 65 questions were gathered into scales measuring such factors as co‐worker support, supervisor support and teamwork and communication. These were factor‐analyzed into intrinsic and extrinsic variables, and regressed against a satisfaction scale, with socio‐demographic variables included. Based on the results, the following conclusions can be drawn: objectively identifiable traits of an organization – pay, benefits and supervisor style – play the major role in determining QWL satisfaction. Decision‐makers with an interest in improving QWL in a health‐care institution can focus on these traits and pay correspondingly less attention to enhancing staff autonomy or discretion.

Organizational trust and empowerment in restructured healthcare settings. Effects on staff nurse commitment

In today's dramatically restructured healthcare work environments, organizational trust is an increasingly important element in determining employee performance and commitment to the organization. The authors used Kanter's model of workplace empowerment to examine the effects of organizational trust and empowerment on two types of organizational commitment. A predictive, nonexperimental design was used to test Kanter's theory in a random sample of 412 Canadian staff nurses. Empowered nurses reported higher levels of organizational trust, which in turn resulted in higher levels of affective commitment. However, empowerment did not predict continuance commitment--that is, commitment to stay in the organization based on perceived lack of other job opportunities. Because past research has linked affective commitment to employee productivity, these results suggest that fostering environments that enhance perceptions of empowerment and organizational trust will have positive effects on organizational members and increase organizational effectiveness.

Testing the stress-response sequence model in paediatric oncology nursing

The causes and intensity of role-related stress experienced by paediatric oncology nurses, the nurses' ability to respond to the stressors, and the professional and personal consequences of those stressors for the nurses are issues of concern for administrators and staff. The concern evolves from the anticipated relationships among stressors, the ability to cope with role-related stressors, and the expected negative outcomes such as resignation. However, the relationships among these components have not been previously measured concurrently in paediatric oncology nurses. The primary purpose of this study was to test the complete stress-response sequence model in a sample of paediatric oncology nurses by obtaining concurrent measures of the model's individual components: nurses' stressors, reactions, mediators, and consequences. A total of 126 nurses completed six questionnaires (Stressor Scale for Paediatric Oncology Nurses, Perceived Stress Scale, Measure of Job Satisfaction, Organized Commitment Questionnaire, Group Cohesion Scale, and Intent to Leave) and a demographic sheet. The majority of participating nurses were married, worked full-time and had worked 5 or more years in oncology. Qualitative data were analysed using a semantic content analysis technique. Relationships among the components of the model were examined using a two-stage least squares technique. The components were only weakly associated and unable to explain significant variation in each other. The combined qualitative and quantitative data indicate that an important explanatory variable - role-related meaning - is missing in the content model.

Versatility--consequence of changing from mixed to all registered nurse staffing on a surgical ward

BACKGROUND

Pressure on governments to reduce the costs of healthcare whilst improving the quality continue unabated throughout the developed world. As a consequence of budget cuts on a large Swedish University hospital, a decision to change from mixed nurse staffing to all registered nurses (RNs) in one surgical ward was made to evaluate if nursing costs could be reduced.

AIM

This study was developed to gain a deeper understanding of the process of change in a hospital ward when all practical nurses were replaced by registered nurses.

METHODS

A substantive theory was inductively derived, using a modified version of grounded theory methodology.

FINDINGS

The change encouraged the nurses to become versatile. When the nurses adopted a patient focussed philosophy the content of their work changed and individualized care became possible. The versatility fostered a spirit of creativity, permitted a high degree of freedom of choice and increased the competence, but also led to some negative reactions in the form of complaints about weariness, lack of support and vulnerability with regard to the working environment.

CONCLUSION

Versatility can be an opportunity for the nurses to expand their knowledge and develop nursing care but there is a risk that versatility results in weariness.

Job satisfaction and autonomy of Hong Kong registered nurses

This research examines job satisfaction and need for autonomy of 190 registered nurses in Hong Kong using a cross-sectional survey design. The level of job satisfaction towards six job components (autonomy, professional status, pay, interaction, task requirements and organizational policies) was measured using the Index of Work Satisfaction. Results showed that the sample was dissatisfied more than satisfied, they valued the job components of autonomy, professional status and pay more than interaction, task requirements and organizational policies. In addition, comparisons were made between nurses working in different hospitals and also different nursing units within a hospital. The level of need for autonomy was assessed using the autonomy subscale of the Edwards Personal Preference Schedule. Results showed that the level of need for autonomy of this group of nurses was below the mid-score of the sub-scale and there was no significant relationship between their satisfaction with job autonomy and their individual need for autonomy.

Job satisfaction and organizational attachment of nurses holding doctoral degrees

A model explaining job satisfaction and organizational attachment (commitment and intent to leave) was estimated for a national sample of nurses holding doctoral degrees and employed in academic and nonacademic setting. The purpose of the study was (a) to test a model from Price-Mueller that has been used primarily for nurses who do not have their doctorates and (b) to determine if the results of the test were consistent with expectations from the professions literature The results showed that although nursing is categorized as a semiprofession in the professions literature, the satisfaction and attachment of nurses holding doctorate degrees was explained by variables from arguments about numbers of the well-established professions, known as "true" professions.

Work group culture, stress, and hostility. Correlations with organizational outcomes

Understanding your organizational culture is necessary if you are to be successful in making and surviving the necessary changes in current environments. Although organizational culture frequently has been studied in the business community, there are fewer studies of organizational or work group culture in hospital settings at the nursing unit level. The existing studies have emphasized the need to understand the individual work group culture before successfully implementing innovation and educational programs, or hiring and orienting new employees on nursing units. This descriptive, correlational study describes the relationships among work group culture, work-place stress, and hostility and nursing unit outcomes, specifically absenteeism and turnover. Implications of the findings include the idea that increasing decision latitude in workers may positively impact absenteeism.

The effect of a professional practice model on staff nurse perception of work groups and nurse leaders

OBJECTIVE

The objective of the study was to measure the effect of an enhanced professional practice model on perception of work groups and nurse leaders.

BACKGROUND

Previous studies of staff nurse perception of work environment and nurse leaders were used to guide development of the professional practice model and the selection of variables. Implementation of the model was expected to result in more favorable perceptions of the work group and a desire for facilitative leadership style.

METHODS

A quasi-experimental design was used to compare change over time in five-hospitals--an urban medical center, two community hospitals, and two rural hospitals.

FINDINGS

Introduction of the model resulted in more favorable perceptions about the work group and a desire for a more facilitative nurse leader.

CONCLUSION

Change in perception of work group and leader rather than job satisfaction may be an early indication of favorable outcome of planned change. Changes in nurse satisfaction may be a late outcome, which may be the reason findings from previous studies are mixed.

The impact of perceived work environment on job satisfaction of hospital staff nurses

The restructuring of health care delivery systems and the redesign of nursing roles is creating dramatic changes in the work environment for nurses. Empirical evidence supports the relationship between work environment and job satisfaction of nurses. However, in order for research to be applicable to practice settings, more information is needed on the specific components of the work environment most salient to nurses. Therefore, the purpose of this study was to determine the effect of the organizational and unit work environment on nurses' job satisfaction. The results of this study indicate the importance of relationships in the work setting. A cohesive peer group may compensate for other frustrations from the work environment, and a supportive manager may buffer nurses from effects of less desirable environments.

Curriculum Issues Related to Nurse Turnover

The problem of turnover rates among registered nurses has implications for nursing curriculum and for continuing education programs. After a brief presentation of turnover issues, curriculum implications will be discussed under three broad areas: (a) content about turnover included in nursing management textbooks; (b) nursing curriculum issues that influence the survivability of graduates of schools of nursing and thereby affect turnover rates; and (c) continuing education needs of registered nurses. This paper is not a summary of solutions for turnover. The problem of turnover is complex and poorly understood. The curricular issues provide challenges to traditional nursing education that would increase the likelihood of the development of "hardy" nurse graduates who have survival skills for the practice environment.

The moderating effects of dispositional affectivity on relationships between job characteristics and nurses' job satisfaction

Using the job satisfaction model embedded in the Price-Mueller nurse turnover model, the moderating effects of positive affectivity (PA) and negative affectivity (NA) on the relationships between the seven independent variables in the model and job satisfaction were examined. Multiple regression procedure was used to analyze data collected from 162 nursing employees of a 327-bed Veterans Administration Medical Center. The major determinants of job satisfaction were found to be routinization, instrumental communication, and PA. The impact of participation, instrumental communication, integration, distributive justice on job satisfaction were found to be moderated by PA. NA moderated the impact of promotional opportunity on job satisfaction. These predictors, in conjunction with demographic variables, explained 45% of the variance of job satisfaction.

The nurse's multiple commitments

Nurses have multiple commitments: organizational, work, professional, job, patient, and personnel. Research has focused almost exclusively on organizational commitment and, to a lesser extent, on professional and job commitment. This fragmented approach to the study of the nurse's commitments neglects the nurse's commitment to patients. The concept of commitment needs to be clarified so that knowledge derived from research on commitment enhances our understanding of how nurses manage these multiple commitments.

The challenge of accountability in nursing

The authors examine the literature on accountability in nursing and analyze the following questions: What is meant by accountability in nursing? To whom are nurses accountable? For what should nurses be held accountable? Finally, the implications of accountability for the nursing profession are explored. In order for nursing to grow and develop as a profession based on sound theoretical foundations, nurses need to examine what it means to be truly accountable. The authors point out that accountability is a complex issue that requires nurses to examine their practice relative to the needs of healthcare consumers, their relationships with other healthcare professional, and the increasingly critical role of nursing in the healthcare system.

Nurses' job satisfaction: are there differences between foreign and U.S.-educated nurses?

This article reports the results of a job satisfaction survey administered to foreign-educated and U.S. nurses at six New York City public hospitals. Although a comparison of results for foreign-educated nurses on temporary visas (N = 322) and U.S. nurses (N = 535) revealed demographic, education and work differences, no differences in level of satisfaction were found between the two groups. Cultural and work status differences that may have affected these results are discussed.

Staff turnover among hospital nurses

Nursing staff turnover remains a financial concern to public as well as private institutions, and it has an impact on staff morale and working practices. Evidence suggests that staff turnover could also have a detrimental effect on patient care. Numerous studies have examined the reasons why staff leave their jobs, but these have often produced conflicting findings and have frequently relied upon bivariate correlation or multiple regression techniques. The availability of analytical techniques such as structural modelling provides an opportunity to examine several aspects of turnover behaviour simultaneously, and overcome some of the methodological difficulties encountered by prior research. This study involved 221 female nurses working full-time in hospitals to examine aspects of the nursing turnover model. Using modelling techniques, this current study found job satisfaction and participation at work to be important variables in the turnover process. This is in keeping with other models of nursing turnover.

Determining nursing retention strategy in a large public teaching hospital

In 1988, the Los Angeles County University of Southern California Medical Center (LAC USC) surveyed 1,102 RNs (75% of its total RN population) to determine factors critical to nursing retention. The Nursing Retention Survey required participants to rank 46 retention factors related to compensation benefits, work environment, amount and type of work, work relationships, availability of support services, management practices, and opportunities for professional growth. This article reports survey responses for the ten most significant and ten least significant retention factors. Survey findings, which guided LAC USC in designing nursing retention strategies, show that RNs who stated that they would leave their jobs were consistently less satisfied with all the top-ranking important elements than those who would stay.

Psychiatric-mental health head nurse management concerns

Psychiatric-mental health head nurses supervise and direct patient care, and therefore, possess a critical, front-line perspective of nursing practice problems. This article explores this perspective by interviewing four head nurses about patient care, staffing, and organizational management concerns. Interestingly, some of the findings of the study, such as head nurse concerns regarding retaining, recruiting, and motivating staff, and increasing patient acuity, already have been supported in the general nursing literature. Other concerns, including the need to clarify the role of the nurse and to define areas of responsibility with other mental health professionals, seem unique to mental health nursing.

Nursing turnover: an integrated model

An integrated model of turnover incorporating personal, organizational, and job experience variables as well as job attitudes and behavioral intentions as predictors of voluntary turnover among staff nurses was tested. Results confirmed the hypothesis that intention to leave would be the most immediate determinant of actual turnover. Personal, organizational, and job experience variables were found to influence voluntary turnover only indirectly through their effects on three attitudinal variables: felt stress, job satisfaction and organizational commitment, and intention to leave. As hypothesized, the strength of the intention-turnover relationship decreased as the time interval between expressed intentions and turnover behavior increased.

Assessing hospital nursing staff retention and turnover. A life table approach

This research applied the life table technique to nursing personnel data in two types of hospitals to illustrate how administrators can examine patterns of continued employment. Although a large proportion of nurses were short-stay employees, the teaching hospital was found to have a higher retention rate than the community hospital corporation. The retention patterns are examined by personal and professional characteristics, as well as by reason for termination. Implications of our findings are discussed with respect to policy concerns related to hiring, retention, productivity, and staff development.

The nurse as the knowledge worker. A management challenge

The purpose of health care institutions is to provide quality patient care. Who renders quality patient care for these institutions? Nurses do. Without nurses, health care institutions would be unable to provide essential services; therefore, administrators need to attract and retain nurses who are knowledge workers and manage their environments effectively.