Nurse turnover: A literature review – An update

Abstract

Background

Concerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of inter-related factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations.

Objectives

The objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies.

Design

A comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years.

Data sources

Electronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications.

Review methods

Keyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies.

Results

From about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations.

Conclusions

Nursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.

Introduction

Concerns about nursing turnover continue to challenge healthcare leaders and workforce researchers. The issue is recognized as being complex and multifaceted with factors affecting every sector of health care (Jones, 2008, LeVasseur et al., 2009). Turnover, employment stability, workforce stability and the concept of retention are closely aligned, such that research showing the high cost of turnover and recruitment reflects the importance of employment stability. It is becoming harder to recruit nurses within environments of staff shortages and it remains unclear what impact nurse turnover will have on nursing outcomes and quality and safety of health care. Rondeau et al. (2008) pointed out the lack of knowledge relating to the impact of market factors on nursing turnover and vacancy. While effective retention strategies are part of the solution to address turnover in organizations, not all reasons for turnover are employer based. Nurses tend to be more mobile early in their careers, however it remains unclear which factors influenced mobility (LeVasseur et al., 2009). Generational differences in nurses are being examined to determine the implications for recruitment and retention strategies in healthcare organizations. There is worrisome evidence that, in comparison to nurses from the Baby Boomer generation, nurses from the younger generations experience their work settings as less consistent with their personal values, and display more indicators of job burnout and less inclination to participate in knowledge sharing (Leiter et al., 2009). As a follow-up to a previous literature review to examine the issue of nursing turnover, its determinants and impact on patient, nurse and system outcomes (Hayes et al., 2006), this paper summarizes subsequent research and describes ongoing methodological challenges and implications of new evidence for future studies.