Educational Preparation and Nurse Turnover Intention From the Hospital Bedside

Mary Jane K. DiMattio, PhD, RN; Adele M. Spegman, PhD, RN


Online J Issues Nurs. 2019;24(2) 

In This Article

Review of Literature

The relationship between educational preparation and turnover intention, defined as intention to leave or stay, depends on the way in which turnover is defined. One study found that baccalaureate education mitigated turnover intention at the unit level (Kovner et al., 2016), whereas another found that master's level education predicted turnover intention from the intensive care unit, while baccalaureate education predicted retention (Fitzpatrick, Campo, Graham, & Lavandero, 2010). When turnover was defined as intention to leave an employer, nurses with a baccalaureate degree were less likely to stay than those with less education (Kovner, Brewer, & Green, & Fairchild, 2009). Similarly, when turnover was defined as actual retention one year after hire, a significantly smaller number of baccalaureate than associate degree nurses was retained at one year despite higher job performance ratings among the baccalaureate nurses (Weathers & Raleigh, 2013). Perhaps even more concerning is when turnover was defined as intention to quit working or to leave the profession, baccalaureate nurses were more likely to report these intentions in two studies (Brewer, Kovner, Greene, & Cheng, 2009; Daniels et al., 2012).

Only one published study was identified that defined turnover as intention to leave the hospital bedside as a practice setting. DiMattio and colleagues (2010) found that baccalaureate nurses who intended to leave within the next three to five years scored lower on dimensions of the practice environment than those who intended to stay in that setting. Baccalaureate nurses who had already left the hospital bedside had done so after a median of 5 years. For both groups, the most frequent reason was the desire to pursue more education and other job opportunities.

Qualitative studies conducted in the United States and abroad have described the particularly challenging aspects of the hospital practice environment that drive nurses to leave that setting (MacKusick & Minick, 2010; Valizadeh et al., 2016; Zhu, Rodgers, & Melia, 2014). Pellico and colleagues (2009) reported that nurses seek to advance their education as a means to leave or "escape" the hospital bedside. Education as a means of escape, particularly early on in nurses' careers, is a troubling idea because nurses will not accrue the experience and expertise necessary to achieve optimal patient outcomes. Further, it suggests that hospitals offering tuition reimbursement might be educating their nurses out of the door, so to speak, leaving behind a less-educated workforce in this setting (DiMattio, Roe-Prior, & Carpenter, 2010).

There is an abundance of quantitative evidence on why nurses leave their jobs (Hayes et al., 2012) with practice environment emerging as a strong predictor of turnover and turnover intention (Breau & Rheaume, 2014; Nei, Snyder, & Litwiller, 2015; Van den Heede, et al., 2013), often through satisfaction (Kutney-Lee, Wu, Sloane, & Aiken, 2012; Park, Gass, & Boyle, 2016; Roche, Laschinger, & Duffield, 2015; Unruh & Zang, 2014), and burnout (Boamah & Laschinger, 2016). Even salary does not fully mitigate the effect of practice environment on turnover and turnover intention (McHugh & Ma, 2014; Nei et al.). Missing, however, is a clear understanding about turnover from the hospital bedside as a particular setting for practice, the extent to which education plays a role in turnover intention from that setting, and the relationship between education and practice environment on turnover intention from the hospital bedside. It is important to generate evidence about nurses' disposition toward the hospital bedside as a practice setting according to their educational preparation because of the harms known to occur to patients in hospitals (James, 2013); the costs to the healthcare system related to turnover; and the strategies to increase the educational level of the hospital nurse workforce.

The research questions for this study were:

  1. What is the intention of hospital nurses to leave the hospital bedside, according to educational preparation and enrollment in an educational program (i.e. school)?

  2. What is the difference in intention to leave the hospital bedside according to years of experience, self-reported expertise, and practice environment?

  3. Which RN and practice environment characteristics predict intention to leave the hospital bedside?

  4. What is the interaction of practice environment and education on intention to leave the hospital bedside?