Turnover of Nurses in Australia - Research Paper Example

NURSING TURNOVER: STATISTICS, CAUSES, CONSEQUENCES AND POSSIBLE SOLUTIONS Name Course Tutor Date of Submission Part A: Data Collection from Hospital to Investigate Nurses Turnover Rate of Nurses Turnover for the Last Two years Table 1: Turnover rates of Nurses in Australian Northern Territory (NT) Hospital between 2004 and 2010 (Rickard et al., 2012). Table 2: Number of Australian Nurses by State in 2012 (Nursing and Midwifery Board of Australia, 2015). Table 3: Number of Australian Nurses by State in 2013 (Nursing and Midwifery Board of Australia, 2015). The above statistics indicate that the rate of turnover of nurses in Australia has been reducing significantly. In the period between 2012 and 2013, there was a negative turnover rate as shown by the statistics recorded above. Causes behind Nurses Turnover in the Above Hospitals The major causes of nurse turnover as per the original research conducted in NT hospital are many. They include poor compensation or remuneration, occupational stress, ageing and retirement, lack of job satisfaction, high levels of education, poor policies, tight schedule and lack of autonomy in decision making. Part B: Literature Review Introduction Nurses play an integral role within the healthcare settings. In fact, the health care organizations require stable, skilled, fully engaged and well trained nursing staff, to realize the vision of providing effective services to the patients. However, in the recent past, the issue of nurse’s turnover has received ascendancy in both professional and the scholarly domains (Heinen et al., 2013). The growth of shortage in qualified nursing staff further worsen the situations with predictions indicating the growth of the healthcare industry that is likely to surpass the supply of the qualified nurses. Nurses turnover like any other form of turnover refers to either voluntary or involuntary termination or quitting thereof, as well as external and internal transfers within the health care organizations (Heinen et al., 2013). Voluntary termination occurs when a nurse transfers from one department to another while still serving in the same organization (Heinen et al., 2013). It can also mean a nurse voluntary leaving or transferring from one employment position to the other. Involuntary termination on the other hand refers to a scenario where the employment of a nurse is terminated by the management of an organization (Heinen et al., 2013). This review looks at the matter of nurses’ turnover in-depth, exploring the causes, consequences and the possible remedies to the situation that is likely to heavily impact the global health care industry. Causes of Nurses Turnover The causes of nurses’ turnover has formed a whole new area of research with most studies classifying the causes of turnover under organizational, individual and economic factors. There are various organizational factors that can be attributed to high turnover rates include work load, management styles, autonomy, promotional opportunities, work schedules and empowerment in the organization (Tachibana, Takahashi & Sakurayama, 2010). Consistent and heavy workload on part of the nurses increases tension and job related stress as well as decreases job satisfaction of the nurses (Brewer, Kovner, Greene, Tukov-Shuser & Djukic, 2011). Consequently, the nurses are more likely to quit either voluntarily or request for transfer to other departments (Hayes et al., 2006). Recent studies have suggested that addition of an extra patient to a nurse is likely to cause a 23% increase in the odds of a nurse’s burnout. Additionally, the same could also elevate the odds of a nurse being dissatisfied by 15% (Hayes et al., 2006). The types of patient is also directly related to the burnout of the nurses. Psychiatric patients’ care is demanding and often involve psychological, emotional and physical risks on part of the nurse causing high levels of burnout and stress and thus a likelihood of increased turnover behaviour. Leadership also influence on the rate of nurses turnover in healthcare institutions. Management styles that lack the inclusion and participation of the nurses exacerbates the chances of turnover and intent to leave the job (Hayes et al., 2006). Lack of proper leadership means that the roles of the nurses are not clearly communicated and thus the nurses feel a low sense of control over their performance. Consequently, a nurse is likely to quit or ask for transfer to departments where leadership and self-development is enhanced (Tachibana, Takahashi & Sakurayama, 2010). Poor leadership and management is also likely to make the nurses feel that they are not being valued and the only option is to quit (Brewer, Kovner, Greene, Tukov-Shuser & Djukic, 2011). Empowerment is directly related to job satisfaction, when it lacks in the healthcare settings, the nurses feel demotivated and demoralized, thus low job satisfaction. Lack of autonomy of the nurses over resources, their relationships and decision making has also been reflected in most literature as a possible cause of increased nurses’ turnover and low levels of job satisfaction as well (Tachibana, Takahashi & Sakurayama, 2010). Dissatisfaction with the training programs and promotional programs within the healthcare systems is also directly linked with high rates of turnover (Hayes et al., 2006). Multivariate analysis in most literature have indicated that poor promotional and personal development opportunities have higher influence on nurse turnover compared to other factors combined. Too tight work schedules that do not offer a well-balanced life-work relationship are likely to affect the morale and well-being of the nurses. Tight schedules affect how the nurses manage their personal as well as family responsibilities (Hayes et al., 2006). Long shifts, overtime, night-shifts, prolonged holidays, weekend overtime and weekend are likely to influence high turnover rates since the nurses do not have time to take care of their personal duties. At the individual level, there are a plethora of socio-demographic attributes of the nurses that elevates their chances to quite or leave the job and thus high turnover rates (Takase, Maude & Manias, 2005). The tenure of the nurses also have an influence on the turnover rates (Heinen et al., 2013). Novice nurses under training as well as less experienced nurses who are young in age and have no responsibilities have been shown to have high turnover rates due to their view of the job as being too demanding (Hayes et al., 2006). In the first year of work, most of the nurses quit the job due to burnout and stress (Tachibana, Takahashi & Sakurayama, 2010). Additionally, lack of autonomy when one is less experienced and poor promotional strategies are some of the factors that have exacerbated the turnover rates of the nurses. Part-time married nurses are also likely to quit and leave the job compared to the married and experienced nurses. Additionally, when the kinship responsibilities are more demanding, a nurse is likely to leave the job (Heinen et al., 2013). The other reason of elevated turnover rates is individual level of education and qualifications of the nurse (Tachibana, Takahashi & Sakurayama, 2010). Highly educated nurses are more likely to quit in order to grab opportunities for advancement either in their current or other healthcare organizations (Takase, Maude & Manias, 2005). The other cause of high turnover is the minimum requirements that have with most of the older nurses who do not met such qualifications leaving the job (Heinen et al., 2013). Age therefore, plays an integral role in turnover because the older also retire voluntarily. The last category of the cause of increased turnover rate is the economic factors. Remuneration plays an important role in defining job satisfaction. Compensation has both direct and indirect influence on the rates of nurse turnover (Brewer, Kovner, Greene, Tukov-Shuser & Djukic, 2011). The growth of population and the wider economy also has a contribution to nurse turnover rates as there is a relative increase in the number of alternative opportunities making nurses to quit an organization for another that has lucrative opportunities (Tachibana, Takahashi & Sakurayama, 2010). Consequences of Nurses Turnover There are a myriad of underlying consequences of nurse turnover rates that have and are still escalating. First off, high turnover rates automatically lead to gaps within the positions in the healthcare environments (Hayes et al., 2006). Consequently, the provision of healthcare services in the hospitals is hampered leading to the dominance of certain diseases and deterioration of the conditions of the patients (Heinen et al., 2013). The consequences include decreased quality of patient care, increase in hospital acquired illnesses and long patient stays in hospitals (Hayes et al., 2006). Additionally, loss of nursing staff can be attributed to the continued loss of patients to other healthcare facilities due to turnover. Consequently, there is the flocking of other healthcare institutions’ facilities and reduced health care. High rates of turnover also create pressure on the nurses who are left at work to have more workload. Consequently, the nurses also quit due to burnout and work related stress thus further increase in the rate of turnover or what is termed as artificial turnover in some literature (Heinen et al., 2013). High turnover rates also have direct and indirect economic impacts on the healthcare organizations (Rickard et al., 2012). First off, the direct costs are those that are incurred during the processes of re-staffing, such as advertising the positions, recruitment, selection, orientation and training and development of the new staff (Hayes et al., 2006). Indirect costs on the other hand include the increased rate of costs associated with training and induction of the contingent staff such as the nurses hired on contract as the new ones are being trained. The contract nurses are always costly to acquire and motivate as they are operation in a completely new environment. Additionally due to pressure and increased workload, other medical staff are also likely to leave the healthcare organizations for greener pastures following the trend of the nurses (Hayes et al., 2006). This further elevates the costs that are associated with returning normalcy into such healthcare settings through contingent measures. To its worse within the public institutions, high turnover rate may compel the government to stretch its budget further leading to increased taxation rates in the country (Rickard et al., 2012). The worst case scenario is where the nurses leave the country for other countries with lucrative healthcare policies leading to brain drain that affects the wider economy of a country. Recent observational and cross-sectional studies have indicated high levels of absenteeism and accidents as there is no time for the remaining nurses to rest. At a personal level, the nurses who remain are also affected (Hayes et al., 2006). First off, they experience emotional exhaustion due to longer working periods in the complex environment as long as extended shifts with no adequate time being allotted for resting (Rickard et al., 2012). Some of the nurses also develop illnesses and other work related illnesses such as musculo-skeletal ailments (Takase, Maude & Manias, 2005). Consequently, the nurses in this state are likely to make unwise decisions as well as cause accidents such as needlestick injuries and such related injuries when attending to the patients. Job Satisfaction and Nurse Turnover Organizational studies have always focused on job satisfaction as a human resource factor that determines the level of retention and organizational development. Studies have explored and determined a positive relationship between job satisfaction and the rates of nurse turnover. A significant body of literature have linked job satisfaction with high turnover rates (Hayes et al., 2006). Job satisfaction measuring instruments in most of the studies include work-family balance, safety in the workplace, scheduling, extrinsic rewards, promotion, recognition, involvement and engagement, co-workers, teams and responsibilities (Hayes et al., 2006). When all the above mentioned factors are lacking in a healthcare environment the nurses get dissatisfied with their job and are less committed to the healthcare organization in question. Low levels of satisfaction among nurses have been recorded on new entrants into the profession, however the older nurses who have experienced and high tenure in organization show high levels of job satisfaction (Rickard et al., 2012). Therefore, the new nurses are likely to quit due to low levels of job satisfaction (Moseley, Jeffers & Paterson, 2008). The trend was also consistent with educated nurses who view the opportunities at the other work places other than their organization and thus have low levels of job satisfaction. Proper management and leadership in the healthcare organizations also determine the levels of job satisfaction of the nurses. So does, job security and the amount of time spent on hospital, clinical or patient related duties. Psychological stress, emotional exhaustion, overtime, lack of proper equipment and skills, occupational stress and low job security are some of the factors that lead to job dissatisfaction and thus elevated levels of turnover (Hayes et al., 2006). Possible Solutions and Recommendations to Reduce the Rate of Nurses Turnover There are many reasons why nurses are attracted to the profession and similarly many reasons that make the quit their jobs. There is no single solution that has been tailored for reducing turnover rates of nurses. However, a number of solutions that have worked well in some situations have been revealed (Kunic & Jackson, 2013). First off, the healthcare organizations and the academic institutions should lay much focus in increasing the number of qualified nurses as well as nursing candidates (Hayes et al., 2006). This can effectively be done through educational as well as community outreach programs so as to raise awareness on nursing as a profession (Hayes et al., 2006). Secondly, the nursing students should be supported through organizational and government scholarships. Thirdly, the existing nurses should have educational re-imbursement programs so that their qualifications are raised. Thirdly, nurses from foreign countries should be recruited and the government should also raise much focus in establishing nursing schools. The second best solution is making the nursing job or career attractive through relevant interventions (Rickard et al., 2012). The first intervention is creating the right channels of leadership and engagement of the nurses in decision making. Secondly, better compensation mechanisms can be adopted in order to retain the already practising nurses (Kunic & Jackson, 2013). There should also be the integration of the work schedules with work-life balance strategies (Rickard et al., 2012). Fourth, there should also be the improvement of the conditions in the hospital settings so that the motivation levels of the nurses is increased (Hayes et al., 2006). Additionally, there should be flexibility in job scheduling and alteration of job mechanics through job sharing and rotation. Last but not least, the healthcare organizations should also institute career development activities and programs when designing and describing the nursing positions. The other possible recommended intervention is through improving the methods that are used in management of the nurses. The nurses should be trained on leadership skills to be able to enable them be independent in making decisions (Moseley, Jeffers & Paterson, 2008). Secondly, the stressors in the workplace should be assessed and possible stress coping and relieving mechanisms adopted (Moseley, Jeffers & Paterson, 2008). Thirdly, the nurses should be encouraged to embrace teamwork so that they are able to coordinate the tasks and avoid burnout at work (Moseley, Jeffers & Paterson, 2008). The nurses should also be offered better rewards and awards that make them have high levels of job satisfaction (Moseley, Jeffers & Paterson, 2008). The nurses should also be trained through preceptorship programmes that have been linked with reduced turnover rates because the preceptors once trained, model the new nurses further breaking down barriers that elicit high turnover intentions (Kunic & Jackson, 2013). The other best intervention is the introduction of mentoring programmes for the nurses so that they have high levels of job satisfaction, increases chances of retention, and equip the nurses with relevant skills that make them survive in the complex healthcare environments (Rickard et al., 2012). The new nurses should also receive training to enable them cope with stress at the workplace (Kunic & Jackson, 2013). The nurses should also be given an opportunity to research and chip into discussions on how to better their work life. Bibliography Brewer, C., Kovner, C., Greene, W., Tukov-Shuser, M. and Djukic, M. (2011). Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals. Journal of Advanced Nursing, 68(3), pp.521-538. Hayes, L., OBrien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., Spence Laschinger, H., North, N. and Stone, P. (2006). Nurse turnover: A literature review. International Journal of Nursing Studies, 43(2), pp.237-263. Heinen, M., van Achterberg, T., Schwendimann, R., Zander, B., Matthews, A., Kózka, M., Ensio, A., Sjetne, I., Casbas, T., Ball, J. and Schoonhoven, L. (2013). Nurse’s intention to leave their profession: A cross sectional observational study in 10 European countries. International Journal of Nursing Studies, 50(2), pp.174-184. Kunic, R. and Jackson, D. (2013). Transforming Nursing Practice: Barriers and Solutions. AORN Journal, 98(3), pp.235-248. Lee, T., Tzeng, W., Lin, C. and Yeh, M. (2009). Effects of a preceptorship programme on turnover rate, cost, quality and professional development. Journal of Clinical Nursing, 18(8), pp.1217-1225. Moseley, A., Jeffers, L. and Paterson, J. (2008). The retention of the older nursing workforce: A literature review exploring factors that influence the retention and turnover of older nurses. Contemporary Nurse, 30(1), pp.46-56. Nursing and Midwifery Board of Australia, (2015). Nursing and Midwifery Board of Australia - Statistics. [Online] Nursingmidwiferyboard.gov.au. Available at: http://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx [Accessed 14 Oct. 2015]. Rickard, G., Lenthall, S., Dollard, M., Opie, T., Knight, S., Dunn, S., Wakerman, J., MacLeod, M., Seiler, J. and Brewster-Webb, D. (2012). Organisational intervention to reduce occupational stress and turnover in hospital nurses in the Northern Territory, Australia. Collegian, 19(4), pp.211-221. Tachibana, T., Takahashi, K. and Sakurayama, T. (2010). Factors Causing the Rapid Turnover Among Novice Nursing Staff: Analyses of the Survey Conducted in 2006 on the Employment Situation of Nursing Staff in the Tokyo Metropolitan Area. Journals of the National Institute of Public Health, 59(2), pp.178-187. Takase, M., Maude, P. and Manias, E. (2005). Nurses' job dissatisfaction and turnover intention: Methodological myths and an alternative approach. Nurs Health Sci, 7(3), pp.209-217. Read More