Nurse Hiring & Retention Issues

1. Nurse Hiring & Retention Issues By Abby L. Bacon

2. Statement of the problem • At the time of hiring a new employee, it is unknown whether precipitating factors are present that may contribute to the departure of the registered nurse within one year from the date of hire.

3. Purpose of the study • The purpose of this study is to explore possible precipitating factors before employment that may lead to the departure of a registered nurse from a critical access hospital (CAH) in South Dakota within one year from the nurse’s original hire date.

4. Research Question • What are the precipitating factors present at the time of hire that may contribute to the registered nurse departing a CAH of South Dakota within one year of the original date of hire?

5. Significance • Affects of high turnover among nurses • Cost is considerably high • Outcomes of a facility decline • People (staff and patients) are directly and negatively affected • Productivity decreases • Staff can become more negative leading to an increased turnover

6. Definitions • Critical access hospital (CAH) • a hospital certified to receive reimbursement from Medicare • Precipitating factor • element that causes or contributes to the occurrence of a disorder or problem • Registered Nurse • Approved/accredited school of nursing, passed NCLEX, active license

7. Review of the Literature Factors relating to increased turnover • Job Satisfaction • (Parry, 2008) (Ma, Lee, Yang, & Chang, 2009) (Lai et al., 2008) (Klug, 2009) • Poor management • (Morgan & Lynn, 2009) (Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010) • Decreased salary/benefits • (Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010) (Chan and Morrison, 2000)

8. Review of the Literature Factors relating to increased turnover • Intent to stay or leave • (McCarthy, Tyrell, & Lehane, 2007) (Klug, 2009) • Job embeddedness • (Mitchell, Holtom, Lee, Sablynski, & Erez, 2001) (Holtom & O’Niell, 2004) • Nurse’s health & the physical workload • (Lai et al., 2008) (Atencio, Cohen, & Gorenberg, 2003)

9. Review of the Literature Factors relating to increased turnover • Nurses’ attitudes, dedication, and perception of work • (Lu, While, & Barriball, 2007) (Chan & Morrison, 2000) • Work environment • (Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010) (Chan & Morrison, 2000) • Other External Factors • (Tourangeau, Cummings, Cranley, Ferron, & Harvey, 2010)

10. Conceptual framework Theory of planned behavior • The factors include behavioral attitude, subjective norms, & perceived behavioral control • Describes the relationship between attitudes and behavior • The best predictor of behavior is one’s intent to behave • These factors influence intention and thus behavior.

11. Model Based on the Theory of Planned Behavior

12. Conceptual Frameworkrelated to this study • Behavior : factors may be present at the time of hire affecting the intent of the nurse that result in voluntary departure • Attitudes: positive and negative beliefs about the behavior • Subjective norms: perception of social pressure • Behavioral control: Perceived ability to control the behavior.

13. Research Design • A typical descriptive study design will be used for this qualitative study • A descriptive design is ideal for discovering areas of concern within a current practice where little information is known

14. Sample Registered nurses included in the sample must have the following • Be previously employed by CAH in South Dakota • Worked less than one year before voluntarily leaving the facility • Completed a course of study at an approved/accredited school of nursing • Passed the National Council of Licensure Examination. • Have an active license at the time of the study.

15. Study Setting • Facility is critical access hospital of South Dakota • The location is where each of the subjects were employed prior to departure • The survey includes the number of beds, the number of registered nurses employed by the facility, and the number of open positions for registered nurses.

16. Study Procedure • Approval from Human Subjects Committee at SDSU and the internal review board of the participating CAHs. • A survey will be mailed to HR dept. of the CAHs of SD • Each department will forward the questionnaire to 10 RNs • RN voluntarily stopped working, employed for less than one year • Include letter about the study, the confidentiality, and return steps • Include a stamped, return envelope for convenience of returning survey

17. Instrument A self-reported questionnaire 1. Demographics of nurses (age, gender, years of nursing experience) Information of their hospitals (# of beds, # of RNs, # of open positions) 2. Statements to be answered with a likert scale response • 1 meaning strongly agree to 5 meaning strongly disagree. 3. Fill-in-the-blank statement, • Labeled as internal or external & if it was present at the time of hire.

18. Sample of the Survey Demographics: Gender: Male or Female; Age: ____; Number of years as a nurse? _____ Hospital: beds _____, RN’s employed _____; open RN positions _____ Answer the following with the number 1 through 5 1 – Strongly Agree, 2 – Agree, 3 – Undecided, 4 – Disagree, 5 – Strongly Disagree 1 2 3 4 5 The factor that lead me to leave my position was present at the time I was hired 1 2 3 4 5 My perception of rural health nurse requirements affected me leaving 1 2 3 4 5 When I was hired, I understood the position required knowledge of multiple areas  1 2 3 4 5 Only work related factors lead me to leave my position 1 2 3 4 5 Only personal related factors lead me to leave my position Complete the following of as many that apply to you  Name a factor for you leaving your current position in the CAH. ____________________________________________________ Was the factor external (personal related) or internal (work related) Was this factor present at the time you were hired? Y N (Last section is repeated three more times on actual survey)

19. Projected Analysis • Demographic data will be analyzed using frequencies and percentages. • Statement answers will be analyzed using frequencies and percentages. • Fill-in-the-blank statements categorized into themes or patterns. • Categorized factors into internal/external & if present at the time of hire. • The researcher will focus on factors that were present when the nurse was hired. • Present all of the data in narrative and graph form

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