Background: Nursing retention requires managers to focus on the retention of staff. Understanding the factors that influence the intent to stay of the staff is one of the strategies to keep nurses in the same work environment. Objective: The objective of this study is to find personal factors (physical, mental-emotional, social) and organizational factors (job stress, social support, and job satisfaction and organizational factors) that influence the nursing staff retention. Materials and Methods: A cross-sectional, descriptive, quantitative study was carried out in Tehran, the capital city of Iran. A total of 500 newly graduated staff nurses completed the questionnaire. Inclusion criteria were the minimum of a master’s degree in a nursing course. The research environments were 10 general hospitals. The data collection tool is a questionnaire including personal (physical, mental-emotional, social), job stress, social support, and job satisfaction and organizational factors. Results: The results show that job stress, social support, and job satisfaction and organizational satisfactions are an influence on retention. Attention to requesting shifts of staff (98.9%); insufficient of staff (63.9%); enjoying working with the supervisor (75.1%); and salary, reward, and benefit (90%) were mentioned as the effective factors on retention. Conclusion: New graduate nurses’ turnover intentions are a recurring problem, which could be reduced by improving nurses’ working conditions. Retention of nurses could be enhanced by creating supportive working environments to cut the susceptibility to the workplace and lower turnover intentions. The findings of the study support the claim that job satisfaction affects the staff nurses’ intent to stay in the same workplace and that it could improve the quality of nursing cares. Keywords: Job satisfaction, nursing staff, personnel turnover, retention
Nurses are one of the most valuable resources to the health-care industry, but the nursing profession is facing major challenges such as a growing shortage of nursing staff. Nurses face fatigue and negative consequences on their nurses’ health. This impacts the quality of patient care they give.[1],[2] Nurses comprise the greatest part of total health-care workers globally, as 24 h caregivers are essential for ensuring quality patient care. Nurse turnover is a global concern that is both costly for health-care organizations and in the context of the work environment, affects quality and safety.[3],[4] Health-care organizations are multidisciplinary entities with employees and customers at multiple levels.[5] Effective nurse managers play an important role in staff nurse retention and the quality of patient care.[2],[6] Nurses’ retention factors were categorized into three: organizational, role, and personal. Intentions to stay and retention of nurses are multifactorial.[7] The nursing shortage is a problem that is being experienced worldwide. It is a problem that could have a serious impact on providing quality health care. Understanding the reasons why nurses leave their place of employment are important.[8],[9] The factors that mitigate the intentions of nurses to leave their organizations need to be investigated to understand the determinants of nurse turnover. However, there is a paucity of studies identifying these mitigating factors.[10] Job dissatisfaction in the nursing work environment is the primary cause of nursing turnover. Job satisfaction has been linked to a high level of empowerment in nurses.[11] Unfortunately, hospitals and health facilities have suffered from a high staff turnover rate, which averages as much as 14% for bedside nurses and 24% for medical surgical nurse per year, and fatigue has been recognized as a significant problem nursing staff.[2] At least, 57 countries have reported a critical workforce shortage.[12] From a global perspective, nurse turnover rates are reported at about 10% in England and ranging from between 12% to 21% across 10 European countries and about 20% in Canada. Given the categorization of annual nurse turnover rates in health-care organizations as moderate (in the 12%–21% range), the rates of turnover on a global basis fall largely in categories of the moderate-to-high level. Health-care organizations must spend money to replace nurses who leave.[3] The World Health Organization (2011) has recognized nurse retention as a worldwide priority, as both developed and developing countries face a nursing workforce shortage. Given reports of turnover rates as high as 60% in the 1st year of employment and combined with the shortage of nursing, it is important for health managers to understand the factors that contribute to new graduate nurse retention.[13],[14] The reasons that trigger nurses’ intentions to leave are still unclear.[15] There is limited knowledge on nurse’s intent to stay in workplace setting in Iran, and the researchers want to find factors that influence the nursing staff retention in Iran.
This study is an analytical, descriptive study with an objective to determine personal factors (physical, mental-emotional, social) and organizational factors (job stress, social support, job satisfaction, and organizational factors) that influence nursing staff retention. The sample included 500 new graduate nurses’ work-life experiences in general hospitals settings in the first 2 years of practice. The inclusion criteria were the master’s degree or higher in nursing and working experience <3 years with that at least 1 year spent in the current setting. The research environments were 10 hospitals of Tehran, the capital city in Iran. They were selected through random clustering. The data collection tool is a questionnaire including personal factors (physical, mental-emotional, social), job stress factors (24 items), social support (15 items), and job satisfaction and organizational factors (33 items). The factors are determined based on Likert five scales from never effective to always effective. For data analysis, descriptive statistics were used. Content validity and test–retest reliability were used for the questionnaire. A general agreement was between academic members about the content of a construct. All nurses had the authority to enter or leave the study. The objective of the study was explained to participants, and the confidentiality of information and moral considerations were respected. This research was approved by the ethics committee of Tehran Medical Branch, Islamic Azad University.
About 99.15% of nurses were in the age range of 21–25 years old, and 72.77% were female 63.33% were single, 41.44% were worked nights, and 30.08% had rotation shifts. The frequency of nurses that working in the morning shift was zero. This could show job pressure. The majority of nurses (26.08%) worked in a surgery ward, 71.3% worked in a hospital, and 52.72% of samples had no desire to stay in the current hospital. From physical factors, 88.8% mentioned their residence proximity to the hospital as the most effective reason to stay, and 98.9% of nurses considered attention to requesting shifts of employees as an important psychological factor. Concerning social factors, 97.1% considered the positive attitude of their families as the most effective cause, and 21.2% mentioned the inclination toward migration as the most important reason to stay. The majority of nurses (56.13%) mentioned factors related to their workplace and hospital as the reason for their unwillingness stay in their current work environment, 15.81% mentioned personal factors, and 21.75% mentioned both factors as impacting their intent to stay. Physically illness in nurses due to continued activity in the workplace is negatively associated with intent to stay. Attention to demand shifts of staff with a frequency of 98.9% was mentioned as the most effective factors on retention. The factor, positive attitude toward retention in hospital on their families’ 97.1%, positive attitude toward nursing job within society scored 93.4%, and positive attitude toward staff retention within nursing managers scored 92.8%. The factor positive attitude toward nursing among the patients hospitalized 90.3%, closeness of house to hospital scored 88.8%, and convenience in accessibility to public transportation scored 88%. These are positive factors for staff retention. Organizational agreements with their choice of workplace based on closeness to home are an effective reason for retention. 44.41% of the sample work nights and none of them have morning shifts. It is obvious that 98.9% of samples mention the attention of organization to requesting shifts as a mitigating factor on retention [Table 1].
The job stress factors such as lack of choice in the selection of favorite ward (63.9%), insufficient of staffs (63.9%), and working as an on call nurse in another ward (51%) are always effective on nurse’s retention. Conflict with nursing managers (67.6%), conflict with other coworkers (63.6%), being criticized by nursing managers (62.2%), death of patients (56.2%) are also affected on retention. Implementation of painful procedures for patients (9.6%) is negatively associated with staying [Table 2].
To assess the social support factors, the factors of enjoy working with supervisor (75.1%), head nurse support in personal problems (73.9%), supervisor’s support when creating a dispute with doctor (67.3%), enjoy with colleagues (55%), and appreciating matron during performing tasks (51.3%) are often effective on retention. These factors are positively associated with intent to stay [Table 3].
Job satisfaction and organizational factors show that factors such as salary, reward, and benefits (90%); timely payment of salary and reward (88.3%); work load (80.8%); the hours of work (79.9%); shifts set (78.5%); stress (70.5%); and feedback from the supervisor (47.9%) are always effective on staff retention [Table 4].
The findings show that some factors affect staff nurse retention and will be discussed according to the research questions. The first research question is what are the physical factors effective on staff nurse retention? 99.16% of nurses are in age range of 21–25 years old and 72.77% were female. Being female has various roles within itself. Supplying mental and emotional needs, the important social role of women, the effect of job stress on those who have the responsibility of nurturing children in addition to the maternal role show significant factors on retention. Demographic characteristics such as age, the role of work values, personality traits, and type of hospital were crucial in enhancing the level of intent to stay at work.[16] Distance from home to the hospital (88.8%) and access to public transport to hospital (88%) are also affective factors on retention. Many have expressed concern that many new graduates may actually leave the professional role as a result of negative working conditions. New graduate nurses were positive about their working conditions. Structural and personal factors explained amounts of variance (31%–68%) in job satisfaction and turnover intentions. Empowerment and work engagement were important predictors.[17] Nurse managers can support new graduate nurses’ professional practice behavior by providing empowering supportive professional practice environments. It is very important for nurse managers to recognize personal characteristics to identify and implement successful strategies for improving the organizational culture and supporting the nurses’ personal. Successful workplace advocacy requires nurse managers who understand the importance of these intrinsic factors in the lives of their nursing staff so that recruiting and retaining a dedicated and qualified nursing workforce is becoming a common and widely used strategy.[18] The next research question is what are the effective psychological factors on staff nurse retention? The results showed that paying attention to demand shifts of staff (98.9%), having children and the need to receive support from the workplace such as in hospital childcare (72.2%) are affective on staff nurse retention. Fulfillment of the psychological contract and advancement opportunities are important for reducing nurses’ turnover intentions, especially among younger nurses.[10] A satisfying work environment for nurses is related to structural and psychological empowerment in the workplace. Structural empowerment preceded psychological empowerment and this relationship culminates in positive retention outcomes such as job satisfaction.[11] Furthermore, nurses’ initiative were associated with perceived differences in the nurses’ work environment.[19] Moreover, a structured advancement support system needs to be implemented to cut nurses’ turnover intentions. The third research question was what are the effective social factors on staff nurse retention? Positive attitude toward retention within the family (97.1%), positive attitude toward nursing among the society (93.4%), positive attitude toward staff retention by nursing manager (92.8%), and positive attitude toward nursing among patients hospitalized in hospital (90.3%) are effective in staff nurse retention. Supporting factors are considerably significant on staff nurse retention and preventing them from leaving their job. The nurses prefer to work with managers who pay attention and support their personnel. The fourth research question was what are those factors creating job stress effective on staff nurse retention? The results showed that the factors of lack of choice in the selection of favorite ward (63.9%), insufficient resources (63.9%), and working as an on call nurse in another ward (51%) are always negatively associated with staying. Modifiable workplace factors play an important role in influencing new graduates’ job and career satisfaction and turnover intentions.[17] The fifth research question was what are effective factors creating social support on retention? The factors of head nurse support in personal problems (73.9%), enjoy working with manager (75.1%), supporting manager when creating a dispute with doctor (67.3%), enjoy working with colleagues (55%), encouraging manager (53%), and encouraging manager during performing tasks (51.3%) are more effective toward retention. Managers can use strategies to enhance quality work environments that promote retention of new graduates and lessen the nursing workforce shortage. New graduate nurses are a precious health human resources and as a profession continuous to experience a workforce shortage. The sixth and seventh research questions were what are the job satisfaction factors? And what are effective organizational factors on nurse’s retention? The factors of salary and rewards (87.2%), timely payment of reward and salary (83.7%), workload (78%), select working times (76.7%), and select working shifts (74.4%) are mentioned as more effective. A major cause of turnover among nurses is related to unsatisfying workplaces. Intention to stay was positively associated with higher job satisfaction, older nurses, and resident relationships. Work relationships were associated with intention to stay.[5] Proper salary and rewards and on time payment, not working as substituting nurse in other wards due to insufficient resources, not performing nonnursing jobs, selecting an interesting ward, having proper facilities for nursing care, having proper working shifts, proper working pressure, and physical condition of work environments are among the factors that are effective in nursing care. The nursing shortage is increasing because nurses are leaving the profession particularly as a result of difficult working conditions.[20] Unsatisfying workplace and job satisfaction can be considered to be a positive concepts describing work behaviors in work settings.[11] Insufficient educational opportunities and support, perceptions of favoritism, high workloads, and stressful work environment are important, and nurses would be more satisfied with their jobs if they had greater access to educational opportunities, if there was a reduction in the workload, and the perceived favoritism in the workplace was addressed.[13] Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviors and high-quality patient care.[14] The findings show that new graduate nurses’ turnover intentions are a recurring problem, which could be reduced by improving nurses’ working conditions. Retention of new graduate nurses could be enhanced by creating supportive working environments to cut the susceptibility to workplace burnout, and ultimately, lower turnover intentions. Managers must use strategies to enhance workplace conditions that promote a person-job fit and work-life balance to improve retention of new graduate nurses, and thereby, lessen the nursing shortage.[21],[22] The study findings give evidence for managers to develop an ideal strategy for nurses with specific personality traits and highly positive work values, which can guide the recruitment and retention of nurse.[16] There are associations between practice environment and work-related factors.[23],[24] The findings claim that the physical, psychological and social factors, job stress and job satisfaction affect nurse retention. Implications for management Health-care organizations and managers should feel a responsibility to support staff and understand work-life balance issues faced by nurses. This study should be helpful for nurse executives as they build a business case to discuss nurse turnover in their organizations, and for policy-makers, as they develop policies about turnover. This research could be useful for managers to develop and support an empowering work environment that enhances job satisfaction. This could lead to nurse retention and positive organizational and patient outcomes.
This study has described various aspects of reasons that affect nurse staff retention. It shows factors contributing to intent to stay in the work place in Iran. Nursing cares are highly specialized and need experienced nurses. This research will guide the managers regarding staff nurse retention factors. It provides insight that can be useful in designing and implementing strategies to support a sustainable workforce in nursing. Cost reduction is important for any organization, and addressing new nurse retentions issues can reduce costs. Attention to requesting shifts, stress reduction, and job stress, on time payment of salaries, encouragement of the personnel, support of managers, and attention to proper strategies for layoffs are the factors that the nursing managers should consider for staff retention. Acknowledgments The authors want to express a special recognition to the nurses who have participated in the data collection of this study, without whom the study could not be possible. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4] |
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