"Should I stay or should I go?" What are the factors that induce nurses to leave?

Abstract

Widespread evidence shows that nursing shortage and nurses voluntarily leaving their jobs is an issue affecting the delivery of health care worldwide. This problem is intensified by a rapidly ageing nursing workforce together with an ageing population placing unprecedented demands on health services. One way to reduce this shortfall is to decrease the number of nurses who voluntarily leave their job. Nurses' intention to leave is a very complex theme and the literature review demonstrates that it has been associated with a number of factors namely, job satisfaction, nurse self-concept, organizational commitment, demographic factors and pay. Most of these issues are interrelated to each other. In order to investigate nurses' intention to leave in the Maltese cohort of nurses three different approaches were taken. A cross-sectional survey involving staff nurses was carried out in three different state-owned local health entities. The tool used for the survey involved a nurse self-concept questionnaire, a nurse retention index and some demographic data. This tool was created and validated by Cowin (2001). Furthermore the Department of Human Resources of a local acute hospital distributes an 'exit' questionnaire to each nurse who resigns and the data collected by this department was also analyzed as part of this study. For the third part of the study the respective senior managers of the hospitals involved for the survey were interviewed. The results obtained in the first two parts of the data collection were discussed through a face to face structured interview. On average most nurses who took part in the study have no intention to leave. The nurse self-concept tool had six dimensions and all of them resulted inversely correlated to nurse intention to leave. The importance of these dimensions was also evident in the exit questionnaires and in the interviews. The findings of this study also indicate that locally the problem with retention lies more in the younger nurses. Contradictory findings were obtained while investigating the education dimension with nurses' intention to leave. One should also note that nurses' intention to leave does not seem to vary between nurses working in different local hospitals. The main recommendation of the study is the need to build better communication system between different hierarchal levels in the hospitals.