Stone P, Cimiotti J, Dick A, Larson E, Mooney C, Zwanziger J; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 2081.
Columbia University, School of Nursing, 617 West 168th Street, New York, NY 10032 Tel. 212.305.1738 Fax 212.305.6937
RESEARCH OBJECTIVE: The purpose of this research was to identify factors related to turnover of critical care registered nurses (RNs) including: 1) demographics (i.e., age, work experience and tenure), 2) hospital characteristics (i.e., hospital size and region), and 3) perceptions of organizational climate. STUDY DESIGN: A cross-sectional design was used. RNs employed in intensive care units (ICUs) were surveyed. Hospital characteristics were identified using American Hospital Association (AHA) data. The measure of organizational climate included seven independent subscales: Collaboration, Participatory Governance, Staffing/Resources, Scheduling, Supervision, Professional Practice, and Training. Turnover was indicated by one item behavioral intention to leave (ITL) in the coming year. Narrative qualitative descriptions of reasons for those indicating positive ITL were obtained and coded. Descriptive statistics, analysis of variance, and logistic regression were conducted. POPULATION STUDIED: A voluntary sample of 2,330 RNs (response rate 41%) employed across the nation was obtained (East 38%, Midwest 31%, West 22%, and unknown 9%). A majority of respondents worked in large hospitals (400 beds or more 49%, 300-399 beds 23%, less than 300 beds 19% and unknown 9%). The average RN was 39.5 years old (SD =9.40), had 15.6 years (SD=9.20) experience in health care, and had worked in their current position for 8.0 years (SD= 7.50). PRINCIPAL FINDINGS: Overall, 17% (n=391) of the nurses indicated positive ITL. Reasons for ITL were coded as negative working conditions (72%), positive career move (25%), and retirement (3%). Those reporting ITL due to negative working conditions had significantly lower mean scores (p<.05) for all scales than non leavers or those leaving for other reasons. Three factors had independent effects on ITL: Participatory Governance (odds ratio [OR] = .54, 95% confidence interval [CI] .40, .72), Supervision (OR= .74, CI .55, .98), and Training (OR= .63, CI .46, .85). There were no significant differences in ITL related to nursing demographics or hospital characteristics. CONCLUSIONS: Turnover of RNs working in ICUs across the nation is great and negative perceptions of organizational climate significantly impact this phenomenon. Lack of participation in governance, poor leadership of supervisors and lack support for RN training are important factors in nursing turnover. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Organizational factors resulting in poor nurse working conditions is a problem in health services and has been related to patient safety outcomes. Turnover is expensive with the cost to replace one RN estimated to range from $30,000 to $50,000, with higher costs associated with high skilled critical care nurses. Interventions and policies aimed at improving RN participation in governance, supervisors leadership capabilities, and ensuring adequate training of RNs may decrease turnover, improve patient safety and reduce health care costs.
Publication Types:
Keywords:
- Data Collection
- Employment
- Humans
- Intensive Care Units
- Intention
- Interprofessional Relations
- Nurses
- Nursing Process
- Personnel Turnover
- Professional Practice
- nursing
- hsrmtgs
UI: 103625115
From Meeting Abstracts