Effective strategies for nurse retention in acute hospitals: A mixed method study

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Abstract

Background

The realization of an organizational context that succeeds to retain nurses within their job is one of the most effective strategies of dealing with nursing shortages.

Objectives

First, to examine the impact of nursing practice environments, nurse staffing and nurse education on nurse reported intention to leave the hospital. Second, to provide understanding of which best practices in the organization of nursing care are being implemented to provide sound practice environments and to retain nurses.

Methods

3186 bedside nurses of 272 randomly selected nursing units in 56 Belgian acute hospitals were surveyed. A GEE logistic regression analysis was used to estimate the impact of organization of nursing care on nurse reported intention to leave controlling for differences in region (Walloon, Flanders, and Brussels), hospital characteristics (technology level, teaching status, and size) and nurse characteristics (experience, gender, and age). For the second objective, in-depth semi-structured interviews with the chief nursing officers of the three high and three low performing hospitals on reported intention to leave were held.

Results

29.5% of Belgian nurses have an intention-to-leave the hospital. Patient-to-nurse staffing ratios and nurse work environments are significantly (p < 0.05) associated with intention-to-leave. Interviews with Chief Nurse Officers revealed that high performing hospitals showing low nurse retention were – in contrast to the low performing hospitals – characterized by a flat organization structure with a participative management style, structured education programs and career opportunities for nurses.

Conclusion

This study, together with the international body of evidence, suggests that investing in improved nursing work environments is a key strategy to retain nurses.

Section snippets

Background

There is a preponderance of evidence suggesting that adequate nursing care is an important factor in the delivery of quality inpatient care (Kane et al., 2007, Rafferty et al., 2007, Van den Heede et al., 2009a, Van den Heede et al., 2009b). On the other hand, nurses and general policymakers repeatedly express their concerns about the recurring cycles of shortages of qualified nurses. The European commission, for example, have estimated that there will be a shortage of 590,000 nurses by the

Study design

In the RN4CAST study a cross sectional design was used in 12 European countries (Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland). Data were gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). The design of the RN4CAST-study is described in detail by Sermeus et al. (2011). The study presented here makes use of a sequential mixed method research design (

Descriptive results

Of the 56 hospitals selected for the survey, 52 were non-academic general acute hospitals and 4 were academic hospitals; and 37 were located in Flanders, 4 in the Brussels region and 15 in Wallonia. The median bed size was 446 (IQR = 269). In total, the sample included 3186 nurses. The median age of nurses in the sample was 38 years (IQR = 19) and the median years of experience as a nurse was 15 years (IQR = 19). Most (90%) of nurses surveyed were female.

Table 1 presents summary statistics for the

Discussion

Managing turnover of nurses in hospitals is a critical strategy in conserving scarce human resources in nursing (Stordeur et al., 2006). In this study, which is part of a large European multi-country nursing workforce study, we investigated the relationship between different organizational characteristics and nurses’ reported intention-to-leave the hospital in a sample of Belgian acute hospitals. The results show that nurse staffing and the quality of the nurse practice environment (i.e.

Conclusion

We show that the nursing work environment and patient-to-nurse ratios influence nurses’ intentions to leave their hospital jobs. The themes identified by Belgian CNOs of hospitals with low intention to leave rates mirror organizational features promoted by the Magnet Recognition program. The elements of the Magnet program can therefore be considered as a valuable strategy to improve the working lives of nurses.

Conflict of interest

None.

Funding

The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007–2013) under Grant Agreement No. 223468.

Ethical approval

Ethical approval was obtained from the ethical committees of all participating hospitals and the central ethical committee of the University Hospitals Leuven (Approval No. ML 5879).

Acknowledgments

We thank the nursing directors, chief nurses, and nurses in the participating hospitals. The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007–2013) under Grant Agreement No. 223468. For more information on the RN4CAST project, please visit www.rn4cast.eu.

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