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In my diploma thesis I deal with the reasons for turnover of nurses working in hospitals. Health care workers turnover is a topical issue. It is therefore desirable to pay attention to this issue, to focus on identification of its causes and explore the motivations that lead nurses to leave their jobs. Only when we know the causes, it is possible to start fighting against turnover and to introduce measures for its reduction. The aim of the thesis was to identify causes of turnover of nurses in selected hospitals of the South Bohemian region, to survey the current state of turnover of nurses in selected hospitals of the South Bohemian region, and to identify measures imposed by the management in selected hospitals of the South Bohemian region to affect the excessive turnover of nurses. The goals of the thesis were met. Based on interviews conducted with nurses who had left their workplaces, hypotheses of this thesis were stated. These are the following hypotheses: H: 1 One of the main causes of nurse turnover is the psychically demanding job, H: 2 One of the main causes of nurse turnover is the physically demanding work of nurses, H: 3 Nurses change jobs due to problematic interpersonal relationships, H: 4 Nurses change jobs because of increasing demands for nursing competencies, H: 5 Younger nurses change jobs more frequently than older nurses, H: 6 Younger nurses change jobs because they cannot ensure care for their children when pursuing their profession, H: 7 Nurse turnover rates are uniform over all departments in selected hospitals in the South Bohemian region, and H: 8 Management of selected hospitals in the South Bohemian region implements measures to affect the excessive turnover of nurses. To verify the established hypotheses, quantitative research through a questionnaire survey was conducted in selected hospitals in the South Bohemian region. Furthermore, the interviews with the Deputy Director of Nursing in individual hospitals of the South Bohemian region were carried out. The research outcomes show that hypothesis H: 1 One of the main causes of nurse turnover is the psychically demanding job, H: 2 One of the main causes of turnover of nurse is the physically demanding work of nurses, H: 3 Nurses change jobs due to problematic interpersonal relationships, H: 5 Younger nurses change jobs more frequently than older nurses, and H: 7 Nurse turnover rates are uniform over all departments in selected hospitals in South Bohemian region, were confirmed. However, the research survey proved that H 4: Nurses change jobs because of increasing demands for nursing competencies, and H: 6 Younger nurses change jobs because they cannot ensure care for their children when pursuing their profession, cannot be uniquely confirmed. Hypothesis H: 8 Management of selected hospitals in the South Bohemian region implements measures to affect the excessive turnover of nurses was disproved by my research.

This thesis examines issues pertaining to health human resources in the Ontario nursing profession, focusing on registered nurses (RNs) and registered practical nurses (RPNs). It consists of four chapters that explore the following nursing labour market trends: (1) multiple jobholding, part-time and casual employment, and other individual nurse and job-level characteristics (2) nursing job instability as measured by turnover and the number of years a job-worker (job-nurse) match exists, (3) nurse staffing agency employment, and (4) occupational attrition or turnover rates. The first two chapters compare nurses employed in the long-term care home (LTCH) sector, to the following healthcare sectors: hospitals, primary care, home care, supportive housing, public health (Chapter 2 only), and an aggregate “other” category. In Chapters 2 to 4, pre-COVID-19 trends are compared with the first, and where possible, the second year of the pandemic. All chapters in this thesis employ the Health Professions Database (HPDB), a dataset from the Ontario Ministry of Health, which derives from regulatory registration data. Chapter 1 examines the prevalence of multiple jobholding, part-time and casual employment, employment status versus employment preference, and other individual nurse and job level characteristics (e.g., the location of first education, languages spoken in practice). The results indicate the likelihood of multiple jobholding does not significantly differ in the LTCH sector compared to other healthcare sectors, especially among RPNs. Moreover, there is no evidence of excessive part-time and casual employment in LTCHs compared to other sectors. However, LTCH RNs and RPNs are significantly more likely to prefer full-time employment, while being employed in part-time or casual positions, referred to as involuntary part-time or casual status. Nurses are heterogenous across sectors in their individual characteristics and employment preferences. Notably, LTCH nurses are more likely to be internationally educated, and primary care nurses are more likely to prefer part-time employment. Chapter 2 investigates nursing job instability across the healthcare sectors found in Chapter 1, with the addition of public health. Average annual turnover (2014-2019) was 25.7 percent among LTCH RNs and 22.9 percent among LTCH RPNs. These findings demonstrate RN job turnover rates in LTCHs do not substantially deviate from those observed in other sectors and fall in the middle of the distribution. RPN job turnover rates in LTCHs are the second lowest observed, where turnover rates are lower in the hospital sector. Across both nurse categories, hospital jobs are the most durable, where a job-nurse match lasts 0.6 to 0.8 years longer than the average RN LTCH job, and 0.1 to 0.2 years longer than the average RPN LTCH job (over a five-year period). Results from 2020 indicate turnover increased the most in the LTCH and supportive housing sectors (by a maximum of 7.5 percent among LTCH RPNs) – the only two sectors where a single site restriction was implemented in 2020, making it difficult to interpret the cause of these findings. Chapter 3 documents the share of agency employed nurses, and the rate at which previously non-agency employed nurses obtain at least one agency position (the agency transition rate) over the 2011-2021 period. The results show that over the data period, the share of agency RNs was small (ranging from 2.4 to 3.4 percent), and slightly higher among RPNs (ranging from 6.1 to 7.1 percent). The agency transition rate is also low – ranging from 0.7 to 1.1 percent among RNs and 1.9 to 2.5 percent among RPNs from 2011-2021. The share of agency employment and the agency transition rate decreased during the first year of the pandemic (2020), and subsequently increased back to pre-pandemic levels in 2021. However, mean hours of work increased among agency (and non-agency) nurses, which may explain a small part of the increase in public spending on agency fees. Chapter 4 measures occupational turnover, where nurses leave the profession altogether, as opposed to job turnover (Chapter 2), which includes nurses who change jobs within the profession. Occupational turnover, or attrition rates, are lower compared to the job turnover rates found in Chapter 2. Annual attrition rates ranged from 6.1 to 7.2 percent among RNs and 6.6 to 7.5 percent among RPNs pre-pandemic (2014-2019). In the first two years of the pandemic, attrition rates increased modestly to 7.7 (2020) and 8.1 (2021) percent among RNs, and 8.0 (2020) and 8.6 percent (2021) among RPNs. Over the entire period of analysis, a larger share of attrition derives from nurses who register active, but are without Ontario nursing employment, compared to nurses who register inactive or do not register. Nurses who register active without Ontario nursing employment may be viewed as undertaking a more temporary exit, as such nurses are significantly more likely to return to the profession. / Thesis / Candidate in Philosophy / This thesis examines health policy relevant issues in the Ontario nursing labour market. Reports of health human resource deficiencies, especially in the nursing profession and the long-term care home (LTCH) sector, increased throughout the COVID-19 pandemic. I perform empirical analysis to ratify such claims. First, I compare the rate of multiple jobholding, part-time and casual employment, and other individual and job-related characteristics among nurses employed in LTCHs compared to five other healthcare sectors. Next, I measure nursing job turnover in LTCHs compared to six other healthcare sectors. Third, I examine the count and share of nurses employed at private staffing agencies, and the rate at which nurses in traditional jobs transition to agency employment. Finally, in contrast to job turnover, which includes nurses who change jobs within the profession, I measure occupational turnover at the individual level where nurses leave the profession altogether. In most analyses, I compare pre-pandemic and pandemic (2020 and 2021 where possible) trends.

Bakgrund: Sjuksköterskebristen är ett växande problem samtidigt som vårdbehovet hos befolkningen ökar. I Sverige rapporterar endast en region en balanserad situation med tillgång på grundutbildade sjuksköterskor, vilket kan innebära framtida utmaningar i att bemöta efterfrågan på vård. Brist på sjuksköterskor har visat sig ha en negativ inverkan på vårdkvalitet samt patientsäkerhet, vilket gör det angeläget att behålla befintligt antal sjuksköterskor. Syfte: Syftet med litteraturöversikten är att beskriva faktorer som kan påverka sjuksköterskor att lämna respektive stanna kvar inom sin profession och arbetsplats inom hälso- och sjukvården. Metod: Litteraturöversiktens resultat har baserats på 15 vetenskapliga artiklar, varav nio kvalitativa och sex kvantitativa artiklar, publicerade under tidsperioden 2011 till 2021. Artiklarna söktes fram i databaserna CHINAL, PsycINFO och PubMed. Resultat: I resultatet presenteras två huvudkategorier. I kategorin Arbetsmiljö framkom det att stöd från kollegor och ledning påverkar sjuksköterskors varaktighet i sin anställning och att tillfredställelsen till arbetet ökar vid upprätthållande av god och säker vård. I kategorin Individuella faktorer framkom det att personlig och professionell utveckling är viktigt för att skapa trygghet och säkerhet i arbetsrollen. Det framkom också att det är viktigt att privatlivet inte ska påverkas av arbetet. Slutsats: Faktorerna som nämns i litteraturöversiktens resultat kan bidra till att öka möjligheten att skapa attraktivare arbetsplatser och förlänga sjuksköterskors varaktighet på arbetsplatsen. Det i sin tur kan resultera i ökad vårdkvalitet och patientsäkerhet samt även bevara professionens förtroende. / Background: The nurse shortage is a growing problem. Only one region in Sweden is reporting to have a balanced situation with access to educated nurses. The shortage of nurses has shown to have a negative effect on the quality of care and patient saftey, which makes it urgent to keep the existing number of nurses.Aim: The aim with the literature review is to describe factors which can influence nurses to leave or stay within the profession and workplace in health care.Method: The literature review is based on 15 research articles, published during the time-period 2011 to 2021. Databases that have been used is CHINAL, PsycINFO and PubMed.Results: In the result two main categories are presented. In the category Work environment it emerged that support from colleagues and management influences nurses' stay at the workplace and being satisfied at work contributes to maintain good and safe care. In the category Individual factors it emerged that personal and professional development are important to become comfortable and confident working as a nurse. It also emerged that it is important with recovery and that the personal life was not affected by work.Conclusion: The factors mentioned in the literature review result can contribute to increase the possibility to create more attractive workplaces, and thereby prolong nurses’ stay at the workplace. That in turn can result in improved quality of care and patient safety and thereby also keep the profession’s credibility.

The nursing shortage and high turnover rates are a problem in Canada and the world over. The purpose of this single case study was to explore leadership strategies that nurse leaders in specialty care clinics in Canada use to reduce nurse turnover. The participants were 7 nurse leaders from a single organization with specialty care clinics across Canada who all had above average nurse retention rates when compared to the case organization's average nurse retention rate. The authentic leadership theory was the conceptual framework. Data sources for this study were company documents, participants' semistructured interview responses, member checking of the interviews, and reflexive journal notes. Methodological triangulation was used to enhance validity. Data were analyzed using Yin's 5-step approach to qualitative data analysis. Data analysis yielded 4 categories of strategy themes for reducing nurse turnover: moral perspective, self-awareness, relational transparency, and balanced processing. The results of this study have the potential for positive social change in specialty care by providing senior leadership and nurse leaders of specialty care clinics with strategies that can contribute to nurse-retention initiatives. The availability of more nurses might improve the outcomes of patients who depend on these clinics for their regular infusion of specialty medicines to treat their critical illnesses, such as cancer or rare genetic diseases, where delay in treatment due to the unavailability of nurses can result in adverse consequences for patient care.

Indiana University-Purdue University Indianapolis (IUPUI) / New nurses report feeling unprepared, incompetent, and highly stressed, contributing to first-year turnover rates of 25% in some healthcare organizations. Turnover, combined with a preparation-practice gap, has alerted advocacy organizations and researchers to recommend the development of nurse residency programs. Nurse residency programs are a post-graduate training period where new nurses receive enhanced clinical education in the healthcare setting. While highly variable in structure and attributes, programs usually include educational sessions, clinical immersion, and role socialization opportunities. Evidence supports that new nurses participating in nurse residency programs experience positive outcomes, including increased confidence, competence, and decreased turnover rates. Despite this, only half of the hospitals nationwide have implemented a program with most designed around a single health system mission. This dissertation study aimed to identify the attributes of nurse residency programs influencing the newly licensed registered nurse. An integrative review of the literature and evolutionary concept analysis was completed to examine the state of the science of nurse residency programs. Findings revealed a lack of conceptual and theoretical design and variability among program structures, creating a gap in the literature about the attributes of programs that are most influencing new nurses. Based on the literature's noted gaps, a qualitative description study was conducted. Purposive sampling strategies were used to recruit nurses who recently completed varied program models across the United States. New nurses reported the attributes of programs and described how those positively and negatively influenced the transition to practice experience. The overarching themes revealed that new nurses need a cadre of highly supportive individuals across the clinical and educational continuum who espouse astute interpersonal and communication skills. New nurses desire engaging activities with intra and interprofessional team members for clinical skill application, knowledge advancement, and role socialization. New nurses need the structure of meetings at times and in a sequence conducive to learning; and for preceptorship experiences to be facilitated by trained preceptors, on a unit, and of a length that supports confidence for autonomous practice. Future research will include the development and testing of an evaluation tool based on the findings from this study.

Le roulement infirmier représente un problème persistant dans le système de santé et il a des effets néfastes sur la satisfaction au travail chez les infirmières, ainsi que sur la qualité et la sécurité des soins. Le roulement est associé au processus par lequel le personnel infirmier quitte l’établissement de santé ou change d’unité de soins, de manière volontaire ou involontaire. Le leadership transformationnel de l’infirmière gestionnaire a démontré un effet positif sur la réduction du roulement infirmier. Plusieurs études ont exploré les conséquences du leadership transformationnel sur les patients, les employés et les organisations de santé. Toutefois, il existe peu de connaissances en lien avec les stratégies découlant du leadership transformationnel mobilisé par les infirmières gestionnaires qui permettent de contribuer à la réduction du roulement des effectifs infirmiers. Ce mémoire, présenté sous forme de revue rapide des écrits scientifiques, vise à mettre en évidence les connaissances actuelles et à émettre des recommandations en lien avec les stratégies contribuant à la réduction du roulement infirmier, qui découlent des pratiques de leadership transformationnel des infirmières gestionnaires. Ces stratégies sont présentées selon les pratiques de leadership transformationnel définies par le modèle conceptuel du développement et maintien du leadership infirmier, proposé par l’AIIAO. La question de recherche est : Quelles stratégies de réduction du roulement infirmier découlent des pratiques de leadership transformationnel des infirmières gestionnaires ? La méthodologie de la revue rapide est basée sur l’approche en cinq étapes de Dobbins. Les résultats mettent en évidence le fait que l’aspect le plus apprécié par les infirmières est lié aux compétences humaines de l’infirmière gestionnaire, au-delà de ses compétences en gestion du personnel et des finances. Dans cette perspective, plusieurs stratégies ont été identifiées en lien avec les trois premières pratiques de leadership transformationnel de l’AIIAO, soit : 1) Bâtir des relations et de la confiance ; 2) Créer un milieu de travail stimulant : 3) Créer une culture qui encourage le développement et l’intégration des connaissances. Les stratégies spécifiques aux dernières pratiques de leadership transformationnel du modèle conceptuel, soit 4) Orienter le changement et en assurer la durabilité et 5) Équilibrer les complexités du système, gérer les valeurs et les priorités concurrentes, sont moins soulignées dans les études retenues. Le forces et les limites de l’étude, ainsi que les implications pour la pratique sont mises en évidence à travers la discussion des résultats. En conclusion, le mémoire a permis de documenter une variété de stratégies de leadership transformationnel des infirmières gestionnaires qui démontrent un impact positif sur le travail et la satisfaction des infirmières, ce qui contribue à la réduction du roulement. / Nurse turnover is a persistent problem in the healthcare system and has a negative impact on nurses' job satisfaction and the quality and safety of care. Nurse turnover refers to the process by which nurses leave the healthcare facility or change care units, voluntarily or involuntarily. Transformational leadership practices of nurse managers have shown a positive effect on reducing nurse turnover. Several studies have explored the impact of transformational leadership on patients, employees, and healthcare organizations. However, little is known about the strategies resulting from the transformational leadership mobilized by nurse managers that can contribute to reducing nurse turnover. The purpose of this thesis, presented in the form of a rapid review of the scientific literature, is to highlight current knowledge and make recommendations regarding strategies that contribute to the reduction of nurse turnover, which stem from the transformational leadership practices of nurse managers. These strategies are presented according to the transformational leadership practices defined by the RNAO's conceptual model of nursing leadership development and maintenance. The research question is: What strategies for reducing nurse turnover result from transformational leadership practices of nurse managers? The methodology of the rapid review is based on Dobbins' five-step approach. The results highlight the fact that the aspect most valued by nurses is related to the human skills of the nurse manager, beyond their skills in personnel and finance management. In this perspective, several strategies have been identified in relation to the first three practices of transformational leadership of the RNAO, namely 1) Building relationships and trust; 2) Create a stimulating work environment: 3) Create a culture that encourages the development and integration of knowledge. The strategies specific to the last two transformational leadership practices of the conceptual model, namely 4) Guiding change and ensuring its sustainability and 5) Balancing the complexities of the system, managing competing values and priorities, are less highlighted in the studies included. The strengths and limitations of the study, as well as the implications for practice are highlighted through the discussion of the results. In conclusion, this thesis has documented a variety of transformational leadership strategies of nurse managers that demonstrate a positive impact on the work and satisfaction of nurses, which contributes to the reduction of turnover.

PURPOSE: Substantial research demonstrates that many nursing homes are not providing adequate quality of care for residents because of inadequate processes of care and insufficient numbers and training of nursing staff. Some residents experience poor-quality outcomes, such as pressure ulcers and unintended weight loss. To address these issues, the long-term care industry has focused on improving quality of care by improving staff education about care processes and reducing nurse turnover rate. The aim of this study was to compare the association between - licensed nurse hours of care and turnover rate to five quality measures—incidence of ADL decline, physical restraints, prevalence of pressure ulcers among residents with risk factors for skin breakdown, and prevalence of unintended weight loss. DESIGN: The study population included 618 freestanding Texas nursing facilities. A cross-sectional multiple regression analysis was conducted using 2007 data to examine the relationship between nurse staffing levels and turnover and resident outcomes with control variables for facility and resident characteristics. RESULTS: The high-risk pressure ulcer variable accounted for 10% of the variation in the regression model. LVN (hprd) was positively associated with an increase in high-risk pressure ulcers. The ADL decline variable accounted for 7.5% of the variation in the regression model, and RN hprd was positively associated with ADL decline. The prevalence of weight loss variable accounted for 3% of the variation in the regression model. RN turnover rate was approaching significance. The physical restraint variable accounted for 2% of the variation in the regression model. LVN contract hprd was significant and positively associated with an increase in physical restraint use although a minimal contribution to the model given the low percentage of LVN contract hprd. The prevalence of low-risk pressure ulcers was not significant. The control variable case mix index was positively associated with ADL decline, high-risk pressure ulcers, and weight loss. CONCLUSIONS: This research will contribute to understanding the relationship of licensed nursing staff to resident outcomes. Additionally, it will contribute to nursing education, research, and policy. While controlling for acuity using case mix index, some negative findings were still noted that requires further research. / text

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