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A qualitative study of experienced nurses' voluntary turnover: learning from their perspectives.

AIMS AND OBJECTIVES
The purpose of this research was to critically examine the factors that contribute to turnover of experienced nurses' including their decision to leave practice settings and seek alternate nursing employment. In this study, we explore experienced nurses' decision-making processes and examine the personal and environmental factors that influenced their decision to leave.


BACKGROUND
Nursing turnover remains a pressing problem for healthcare delivery. Turnover contributes to increased recruitment and orientation cost, reduced quality patient care and the loss of mentorship for new nurses.


DESIGN
A qualitative, interpretive descriptive approach was used to guide the study.


METHODS
Interviews were conducted with 12 registered nurses, averaging 16 years in practice. Participants were equally represented from an array of acute care inpatient settings. The sample drew on perspectives from point-of-care nurses and nurses in leadership roles, primarily charge nurses and clinical nurse educators.


RESULTS
Nurses' decisions to leave practice were influenced by several interrelated work environment and personal factors: higher patient acuity, increased workload demands, ineffective working relationships among nurses and with physicians, gaps in leadership support and negative impacts on nurses' health and well-being. Ineffective working relationships with other nurses and lack of leadership support led nurses to feel dissatisfied and ill equipped to perform their job. The impact of high stress was evident on the health and emotional well-being of nurses.


CONCLUSIONS
It is vital that healthcare organisations learn to minimise turnover and retain the wealth of experienced nurses in acute care settings to maintain quality patient care and contain costs.


RELEVANCE TO CLINICAL PRACTICE
This study highlights the need for healthcare leaders to re-examine how they promote collaborative practice, enhance supportive leadership behaviours, and reduce nurses' workplace stressors to retain the skills and knowledge of experienced nurses at the point-of-care.