Estimating and preventing hospital internal turnover of newly licensed nurses: A panel survey

doi:10.1016/j.ijnurstu.2016.05.003

International Journal of Nursing Studies

Volume 60, August 2016, Pages 251-262

https://doi.org/10.1016/j.ijnurstu.2016.05.003 Get rights and content

Abstract

Background

Registered nurse job turnover is an ongoing problem in the USA resulting in significant financial costs to both organizations and society. Most research has focused on organizational turnover with few studies about internal or unit-level turnover. Turnover of new nurses in hospitals has particular importance as almost 80% of new nurses work in hospitals and have higher turnover rates when compared to experienced nurses. This paper focuses on new nurses’ unit-level turnover rates in hospitals.

Objectives

The purpose of this study is to: (1) identify factors that predict new nurses staying in the same units, positions, and job titles to inform unit-level retention strategies, and (2) examine the changes in work environment perceptions over time between nurses who remain in the same unit, position, and title to those who changed unit, position and/or title.

Study design

A panel survey design was used to analyze changes over time.

Participants

Participants were newly licensed registered nurses who were licensed for the first time between August 1st, 2004 and July 31st, 2005. The nurses came from metropolitan statistical areas or rural areas that were nested to reflect a nationally representative USA sample (58% response rate). The analytic sample for this study was 1335.

Data sources

Data were collected in January 2006 and 2007 following the Dillman total design approach. All potential respondents received paper surveys and non-responders received repeated mailings.

Results

Using multinomial regression the five variables with the largest effects on unit retention were (1) variety (positive), (2) having another job for pay (negative), (3) first basic degree (having a bachelors or higher degree increased the probability of staying), (4) negative affectivity (positive), and (5) job satisfaction (positive). Nurses who changed unit, and/or position, and/or title reported more positive change scores on a variety of work attitudes.

Discussion

Almost 30% of new nurses working in hospitals leave their unit, and/or position, and/or title during their first year of work. Our results point to the variables on which managers can focus to improve unit-level retention of new nurses. Although participants were from a nationally representative sample of nurses who were newly licensed in 2004–2005, with the geographical shifts in the USA population in the last 10 years the sample may not be geographically representative of new nurses who graduated in 2015.

Section snippets

Background/rationale

Job turnover has several conceptualizations (Kovner et al., 2014b). For example, job turnover can be voluntary or not and measured at the professional, organization, or unit-level. In this paper, we focus on internal or unit-level turnover.

Internal turnover is a sub-set of the general concept of job turnover. Mbah and Ikemefuna (2012, p. 279) defined internal turnover as “when employees leave their current assignment and take up new roles or positions within the organization” and Rentsch and

Study design

We used a panel survey design so that we could analyze changes over time.

Participants

Participants were newly licensed nurses who were licensed for the first time between August 1, 2004, and July 31, 2005. Details about the sampling approach are found elsewhere (Kovner et al., 2007). We requested names and addresses from state boards of nursing in 34 states and the District of Columbia. As the first question on the survey, we asked the potential respondent if he or she was licensed for the first time

Participants

We eliminated a further 343 cases due to list wise deletion leaving a sample of 1337.

Descriptive data

We report descriptive data for the four groups because we think these numbers will be of interest to readers. As shown in Table 2, a majority of respondents at Wave 1 were married (55.2%) and only 18.0% had children younger than 6 years old. A majority (54.1%) had an associate degree, and 42.6% had a baccalaureate as their first professional degree. By Wave 2, 45.1% had a baccalaureate degree or higher degree

Interpretation

Fully 30% of new nurses have some type of internal turnover during their first year of hospital work. This turnover is not part of organizational turnover. That is much higher than organizational turnover, which is estimated at 13.4% to 22.8% across all settings (Kovner et al., 2014b). Given that there is evidence (Hausknecht et al., 2009) that internal turnover has negative organizational consequences, internal turnover may be an overlooked problem for organizations. We suggest that nurse

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Estimating and preventing hospital internal turnover of newly licensed nurses: A panel survey

Abstract

Background

Objectives

Study design

Participants

Data sources

Results

Discussion

Section snippets

Background/rationale

Study design

Participants

Participants

Descriptive data

Interpretation

Int. J. Nurs. Stud.

Int. J. Nurs. Stud.

Int. J. Nurs. Stud.

J. Prof. Nurs.

Int. J. Nurs. Stud.

Soc. Sci. Med.

Hum. Resour. Manag. Rev.

Int. J. Nurs. Stud.

Int. J. Nurs. Stud.

Importance of work environment on work environments on hospital outcomes in nine countries

Int. J. Qual. Health Care

The effects of patient care unit organization on nursing turnover

Health Care Manag. Rev.

Impact of nursing unit turnover on patient outcomes in hospitals

J. Nurs. Scholarsh.

Managing customer services: human resource practices, quit rates, and sales growth

Acad. Manag. J.

Focus on nursing turnover: a system-centered performance measure

Nurs. Manag.

Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals

J. Adv. Nurs.

The Magic of the New: How Job Changes Affect Job Satisfaction

Organisational support, organisational identification and organisational citizenship behaviour among male nurses

J. Nurs. Manag.

Methodology corner. Methodological triangulation in as study of nurse retention

Nurs. Res.

The effect of work environment on intent to leave the nursing profession: a case study of bedside registered nurses in rural Florida

Health Serv. Manag. Res.

The importance of employment status in determining exit rates from nursing

Nurs. Econ.

The Registered Nurse Population: Findings From the March 2004 National Sample Survey of Registered Nurses

Mail and Internet Surveys: The Tailored Design Method

Nursing unit managers, staff retention and the work environment

J. Clin. Nurs.

Stress amongst nurses working in a healthcare telephone-advice service: relationship with job satisfaction, intention to leave, sickness absence, and performance

J. Adv. Nurs.

Taking the Measure of Work: A Guide to Validated Scales for Organizational Research and Diagnosis

Certification, empowerment, and intent to leave current position and the profession among critical care nurses

Am. J. Crit. Care

The relationship between effective nurse managers and nursing retention

J. Nurs. Adm.

Investigating the quitting decision of nurses: panel data evidence from the British National Health Service

Health Econ.

Factors influencing intent to stay in academia for nursing faculty in the southern United States of America

Int. J. Nurs. Educ. Scholarsh.

The relationships between nurses’ perceptions of the hemodialysis unit work environment and nurse turnover, patient satisfaction, and hospitalizations

Nephrol. Nurs. J.

Thirty years of nursing turnover research: looking back to move forward

Med. Care Res. Rev.

Determinants of Intent to Leave Among Nurses With Doctoral Degrees

Job satisfaction and organizational attachment of nurses holding doctoral degrees

Nurs. Res.

Nursing home staffing, turnover, and case mix

Med. Care Res. Rev.

Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: a meta-analysis

J. Appl. Psychol.

Unit-level voluntary turnover rates and customer service quality: implications of group cohesiveness, newcomer concentration, and size

J. Appl. Psychol.

Effects of job rotation and role stress among nurses on job satisfaction and organizational commitment

BMC Health Serv. Res.