Improving Nurse Retention in Jordanian Public Hospitals

Mohammed M. Al-Momani, PhD, RN

Disclosures

Topics in Advanced Practice Nursing eJournal. 2008;8(4) 

In This Article

Introduction

The past few decades have witnessed a critical and pervasive shortage of registered nurses (RNs), affecting the delivery of healthcare in Jordan.[1]

The rate at which nurses are leaving the profession, at 18.4% in 1996,[2] is escalating, reaching approximately 40% in 2008.[3] As the largest employer of nurses, the hospital is the institution most affected by the current nursing shortage.[4,5] Appropriate staffing and stability of nursing personnel are challenges for patients, managers, and the nursing profession.[6,7] Although the seeds of strategies to retain nurses in Jordanian public hospitals were planted in the mid-1980s by increasing the number of graduates from nursing programs and focusing on recruitment, these efforts proved futile because retention strategies did not receive equal attention.[8]

Why Do Nurses Leave Their Jobs?

 

Numerous studies examining the question of why staff nurses leave their positions have produced conflicting results. The driving forces behind staff turnover include both demographic and work-related factors.[9,10,11] Factors unique to each individual, such as age, gender, marital status, work experience and tenure, appear to affect nurses' work satisfaction and turnover intentions.[11] Although these attributes are clearly related to staff retention, the nature of the relationship is unclear, and they do not fully explain the job-changing behaviors of RNs.[12]

The nurse's age can influence intent to stay or to leave his or her nursing position. Older nurses form a more stable workgroup and report greater job satisfaction than younger nurses.[13] Older nurses are more likely to remain in their jobs until retirement, because they have invested so much time in their positions. Conversely, younger nurses, seeking a variety of experiences, may decide to leave their jobs or even leave the profession.[14]

Contrasting findings by Diffield and colleagues[15] revealed that younger nurses were more interested than older nurses in opportunities for advancement in the hospital, nurses' week celebrations, control over their schedules, productivity of unlicensed assistive personnel, tuition reimbursement, onsite child care, periodic increases in salary, shift differential, and sign-on hours. Younger nurses considered these factors crucial for staying in their hospital positions.[15]

Level of education is another important variable in nurses' turnover intentions. In Ethical Climates and Registered Nurses' Turnover Intentions, Hart concluded that nurses with more education were better able to actualize their professional roles, had more autonomy at work and therefore, were more likely to stay.[16] However, other investigators found that nurses with more education had higher job turnover rates.[17,18]

Years of experience has been linked to nurses' decisions to stay in or leave their jobs. Shader and colleagues[18] studied the factors that influence job satisfaction and anticipated turnover among nurses, finding that nurses new to the profession often conveyed higher levels of stress and job dissatisfaction than more experienced nurses.[18] The likelihood of leaving one's nursing position is highest in the first year of employment.[18]

Work-related Reasons for Leaving

Work-related factors are instrumental in nurses' employment decisions, and must be addressed if retention is to be improved.[19,20] Research concerning the importance of the nurse's salary to job satisfaction and retention has produced inconsistent results. Some findings suggest that salary does not have as strong an impact as work environment.[21,22] Other studies reveal a strong relationship between salary and intention to leave. Narayanasamy and Narayanasamy,[23] who assessed the impact of certain pay policies on turnover intentions of pediatric nurses, reported that satisfaction with pay had both direct and indirect effects on leaving intentions.[23] Other research indicates that salary or benefits in addition to other factors such as convenience, work schedule and job-related stress were the principal reasons that nurses change jobs.[24] Dissatisfaction with salary was emphasized in many Jordanian studies as a key determinant in the turnover behavior of nurses.[5,6,8]

Promotion opportunities and career development have significant bearing on nurse turnover. Among predictors of intent to leave their nursing positions found by Murrells and colleagues[25] were perception of few promotional opportunities, high routinization, low decision latitude, and poor communication. Educational background, satisfaction with promotion and salary, and the age of the nurse's youngest child were among the predictors of nurses' intentions to stay in their positions.[26]

Workload can also affect the nurse's intent to stay or leave. A heavy workload causes job tension, emotional exhaustion, and decreased job satisfaction, increasing the probability of leaving one's position.[4,27,28]

In a study based on a stratified random sample of 713 nurses, Shaver and Lacey[29] found that both job and career satisfaction in nursing were affected by perception of how frequently patient care suffers due to insufficient staff.

Empowerment and autonomy are associated with job satisfaction and retention.[30,31,32] Nurses' autonomy, control over resources, working relationships with physicians, emotional exhaustion, and decision making all correlate with nurse satisfaction and quality of care provided.[33] These findings are consistent with those of Laschinger and colleagues,[34] who surveyed 3016 nurses and found that hospital staff nurses' perceptions of autonomy, control, and physician relationships influence their job satisfaction and perceived quality of patient care. Managers' empowerment and leadership styles influence work coordination and therefore, nurses' intent to stay in employment.[35] Collegial relationships can also affect the turnover behavior of nurses. Snow[36] demonstrated that nurses who developed closer relationships with their coworkers had higher job satisfaction, and were significantly less inclined to leave.

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