Nurse turnover: A literature review

Abstract

Ongoing instability in the nursing workforce is raising questions globally about the issue of nurse turnover. A comprehensive literature review was undertaken to examine the current state of knowledge about the scope of the nurse turnover problem, definitions of turnover, factors considered to be determinants of nurse turnover, turnover costs and the impact of turnover on patient, and nurse and system outcomes. Much of the research to date has focused on turnover determinants, and recent studies have provided cost estimations at the organizational level. Further research is needed to examine the impact of turnover on health system cost, and how nurse turnover influences patient and nurse outcomes.

Introduction

High nurse turnover can impact negatively on an organization's capacity to meet patient needs and provide quality care (Gray and Phillips, 1996; Tai et al., 1998; Shields and Ward, 2001). At the nursing unit level, high turnover affects the morale of nurses and the productivity of those who remain to provide care while new staff members are hired and orientated (Cavanagh and Coffin, 1992; Sofer, 1995). Ongoing workforce instability in many countries is raising questions about the impact of nurse turnover on the well-being of nurses, quality of patient care and system costs. Stated reasons for leaving that were common to nurses in the USA, Canada, England, Scotland and Germany include emotional exhaustion and problems in work design (Aiken et al., 2001). While numerous studies from several disciplines have been undertaken to better understand turnover behavior, further research is needed to address how turnover within the skilled nursing workforce impacts the capacity of health organizations to respond to demands for health care.

The past literature reviews and meta-analytic studies have been conducted to review factors associated with nurse turnover. Irvine and Evans's (1995) meta-analysis revealed a strong positive relationship between behavioral intentions and turnover, a strong negative relationship between job satisfaction and behavioral intentions, and a small negative relationship between job satisfaction and turnover. Turnover predictors were identified in a literature review by Tai et al. (1998) as age, tenure, job satisfaction, organizational commitment, perceived job possibilities and supervisor's behavior. Similarly, Yin and Yang's (2002) analysis revealed that internal environmental factors such as stress resulting from staffing shortages, leadership style, supervisory relations, advancement opportunities and inflexible administrative policies were significantly related to turnover. For this paper, a comprehensive literature review was undertaken to examine the current state of knowledge about the scope of the nurse turnover problem, definitions of turnover, factors considered to be determinants of nurse turnover, turnover costs and of most importance to the authors, the impact of turnover on patient, nurse and system outcomes. This review focuses on the recent research, also identifying methodological challenges and implications for further study.