Nurses' Strains and Sprains a Predictor of Job Turnover

New RWJF-funded study emphasizes importance of safety and job satisfaction in lowering turnover rates.

    • August 29, 2011

Newly licensed registered nurses who experience strains or sprains are more likely to leave their hospital jobs, according to a new study focused on hospital nurse turnover. Published in the online version of the Journal of Advanced Nursing, the study reports on the attitudes and opinions of 1,653 newly licensed and registered nurses working in hospitals in 34 states and the District of Columbia between 2006 and 2007. The study was funded by the Robert Wood Johnson Foundation (RWJF).

Researchers Carol Brewer, Ph.D., F.A.A.N., R.N., and Christine Kovner, Ph.D., R.N., F.A.A.N., found that while the vast majority of new nurses are staying in the hospital setting, many are changing jobs within the first two years. In addition, nurses who have the opportunity to work voluntary overtime and have multiple jobs were more likely to remain at work, most likely because of personal financial needs.

Despite weakness in the job market, the U.S. health care system continues to face a projected shortfall of up to 260,000 full-time equivalent nurses by 2025. Understanding the predictors of staff departures could give hospital employers a roadmap for improving their turnover rates, helping shore up hospital finances and improve patient care.

“Staffing turnover costs can be steep for hospitals,” says Brewer, a professor of nursing at the School of Nursing at the University at Buffalo—State University of New York and the lead author of the study. Turnover of new registered nurses is estimated to cost hospital employers more than $725 million a year. “A nurse’s intention to stay at a given job can make a very big difference,” she adds. “So if you can keep that intention strong by improving job satisfaction and commitment to the organization, you’re very likely to improve retention rates. Once that intention to stay weakens, and a nurse decides to leave, it may be too late for administrators to dissuade them.”

Among other findings from Brewer and Kovner’s analysis of the data:

  • Forty percent of nurses in the study experienced at least one strain or sprain, and 19 percent of hospital nurses who had experienced at least one strain or sprain left their first nursing job within two years or by the time a follow-up survey was conducted.
  • Some workplace attributes, including a hospital’s Magnet Recognition status and nursing residency programs were not related to turnover.
  • Nurses who worked part-time or had more hours of volunteer overtime and more than one job for pay were more likely to stay in their jobs.
  • Marital and family status had no effect on turnover, suggesting that turnover is related more to the job itself than the life stage of the nurse.

Turnover problems are complex, the authors conclude, and do not present employers with one solution. However, the study suggests that employers have multiple opportunities for possible intervention in areas such as workplace safety and overall job satisfaction.

“Hospital systems need to look carefully at methods that decrease injuries,” says Kovner, a professor at New York University’s College of Nursing. “Attention to the fundamental concerns of nurses that increase satisfaction and organizational commitment is likely to increase new nurses’ intent to stay as well as reduce turnover,” she adds. “The ultimate goal is for hospital employers to intervene before nurses make the decision that they’d like to look for another job.”

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