Exploring Nurse Turnover Factors
Added on 2020-03-16
12 Pages4543 Words123 Views
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Qualitative Research in PublicHealth1
Background:It has been observed that , in emergency department staff retention is very less due to stressas result of transforming and dynamic nature of the department. Lower rate of staff retentionis also due to the non-cooperation from the management and dissatisfaction in pay scale.Identifying reasons behind poor morale and higher turnover is helpful in finding solutions toprevent higher turnover and to avoid higher burnout of experienced staff members. Poormorale and higher staff turnover directly affects patient care. Incompetent nurses andhandling of critical patients are important factors responsible for the higher turnover rate inthe emergency and accident department1. Sequential events can occur from poor morale tonurses burnout to the effect on the management of organisation. Nurses burnout lead tonurses turnover to adverse effects on the patient care and finally effect on the management ofthe hospital. There are varied dimensions for nurse burnout like physical, personal andsocial2. Physical environment of the organisation can adversely affects perceived stress and jobsatisfaction. Environmental aspects in the facility like noise, air quality, light, toxicexposures, temperature, humidity, and aesthetics can affect nurse turnover and patient care3, 4.Physical factors also affects social factors for nurses. Accommodative physical environmentgives nurses satisfaction of social support in caring patients. Leadership and collaborativework are the important aspects of the social factors of nurse turnover. Leadership aspectswhich can lead to poor morale include work scheduling, staffing and promotionopportunities. Collaborative work include support from the all the stakeholders in thehospital. Work/home interface, age and pay scale can be considered as the personal factorsresponsible for the poor morale and higher nurse turnover5. It has been observed that oldernurse leave job more in number as compared to the younger nurses. It has been establishedthat in nursing, professional reasons are predominant than personal reasons for poor moraleand higher turnover. In the literature, following are the reasons mentioned with highfrequency for nurse turnover in emergency and accident: higher patient-to-nurse ratios, jobdissatisfaction, reduced patient safety and adverse perception of the nursing profession.Factors mentioned with comparatively less frequency are : severe sickness of older patients,rude behaviour of patients, low morale, management problems, augmented workload andmore amount of work nor related to the nursing profession. 2
Management should give more focus on improving morale of nurses and stopping nurseturnover because replacement of one nurse can cost huge financial impact on themanagement. It has been observed that replacement of one nurse can cost managementapproximately 2.5 % salary of one nurse. Higher turnover can adversely affect patientoutcome. There is possibility of increased medical procedure error and medicationadministration error. Injury may also occur due to falls of the elderly patients. Higher patient-to-nurse ratio can lead to longer duration of wait period and inefficiency of the nurses toprovide adequate care to the patients6. Nurse burnout is one of the prominent reason for poor morale and higher nurse turnover.Burnout may be due to emotional exhaustion, decreased personal accomplishment anddepersonalization. Burnout can lead to reduced morale, raised absenteeism as result ofsickness, reduced efficiency and productivity, inadequate job performance and patient care.In emergency and accident department, approximately 50 % nurses reach clinical levelburnout7. Needs of the department should be identified. More number of full-time nurses should berecruited as compared to the travel nurses. Orientation strategies should be identified andareas should be identified with requirements of change. Nurses should be given opportunityto develop professionally. Financial aspects, time, management perceptions and staff stigmashould be considered in assessing reasons behind poor morale and higher nurse turnover.Staff can reduce turnover by accepting change and working in co-ordination withmanagement, by understanding qualities of good and bad preceptor, by identifyingrequirements of the department, by making efforts to reduce fatigue, by working in co-operation with other staff members and by not forgetting willingness to help patients toimprove their quality of life8,9,10. Research questions:Phenomenological approach will be implemented in identifying reasons behind reducedmorale of staff. This approach establishes precise, complete, and clear description andunderstanding of the experiences of the persons11. In this qualitative study, experiences ofstaff members in the emergency department need to be understood. In this approach, findingsemerge from the participants and not imposed by the investigator. It has been well establishedthat emergency department is affected due to high turnover rate of staff members. Gaps needto be understood, in retaining staff members in the emergency department. It is evident that3
low morale can result in reduced staff retention. Qualitative research based on identificationof high turnover rate, will focus on following research questions :What are the experiences of staff members in the emergency and accident department?What are the perceptions of staff members ? What are the perceptions of nurses about facility and management ?By raising these questions, we aim to know the reasons behind poor morale of the staffmembers in the emergency department which is responsible for the high turnover. Along withthis we aim to identify correlation between poor morale of staff and patient outcome andmanagement role in poor morale. Physical, social and personal reasons are responsible for thelow morale of the staff members. It will be helpful in identifying solutions for low moraleand higher turnover. Effective training and orientation can be developed to address issue ofhigher turnover. Population and sampling method : In qualitative research, population is a group of people from which data need to be collected.People in the participant population should meet the criteria of the study12. This study will beconducted in the urban hospital comprising of emergency and accident department. Thisemergency and accident department comprising of 200 beds. This study will be specificallyfocused on the nurses. This study will incorporate nurses of all age group and both the sexes.In this study, nurses in the emergency department will be specifically focused because it hasbeen observed that nurses in the emergency department experiences more turnover due topoor morale. Hence, relevant data can be obtained from the nurses in the emergencydepartment. In this study, purposeful sampling method will be implemented for the data collection. Inpurposeful sampling, data can be collected from all the selected participants and these will beselected based on the inclusion criteria13. This is the most common method of sampling in thequalitative research. Maximum variation sampling is one of the methods of the purposefulsampling and it will be used in this qualitative research of staff of emergency department.Maximum variation sampling can collect data from varied insights of phenomenon byconsidering varied angles14,15. In this study, 30 nurses will be enrolled. Number of nurses inthis hospital are less than standard ratio of 1 : 3 ; nurse : patient ratio in the emergencydepartment. This number participants may vary slightly based on the turnover of the staff. In4
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