“High rates of staff turnover in nursing homes is not a recent phenomenon. As far back as the mid-1970s studies have documented average turnover rates for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nurse’s aides (CNAs) ranging between 55% and 75%” (Mor,V., Mukamel, D.B., & Spector,W. D. 2009, 1). Long term care facilities (LTC) have staffing issues related to the high turnover of licensed staff. The effect can have a heavy financial burden and also affect the care given to residents.
Many ask the question why is it hard to attract and keep nurses at a long term facility. The International Journal of Nursing Studies conducted a qualitative study titled: “Making tradeoffs between reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff” (Boscart, V.M. Bowers, B., Brown, M., & McGilton, K. S. 2014, 917). This study focuses on how the nurses feel about where they work and what makes them want to leave or stay at a job.
The high turnover of licensed staff in nursing homes, it not only effects the resident’s quality of care and the morale among staff members, and is also very costly to the facility. The purpose of the study was to understand what influences nursing staff to stay at a LTC facility. There have been studies conducted in the past but they were primarily done with nonlicensed staff or within the acute care setting. The goal of this study was to gain insight on how to retain nurses in LTC facilities. This study is significant as administrators in LTC facilities have a hard time attracting and retaining licensed nursing staff. When there is a high turnover of staff, it can affect the care of residents and morale of staff in a negative way, and is very costly.
Purpose and Research Questions
The purpose of the study was to understand what factors influence nurses to make a decision to stay at an LTC facility. The questions that the study determined to answer was: what is the motivations that nurses have that cause them to stay at their present facility? Another question would be: what are the reasons or factors that would cause a nurse to terminate their employment? The purpose and questions related to the problem; the findings resulted in learning about what is important to nurses when they are making decisions to stay or terminate employment. The methods used in this study were stated as qualitative –descriptive. The sample size was 17 RN’s and 24 LPN’s which, for a qualitative study is sufficient. The participants were mostly female with an average age of 48 years.
They interviewed staff from seven different LTC homes across Ontario, Canada. Prior to the study, permission was obtained from the Toronto Rehabilitation Institute Research Ethics Board, and also from the administrators of each facility. The researchers also obtained consents from staff who were interested in participating in the study, prior to setting up focus groups… Each focus group was digitally recorded; confidentiality was assured and information was analyzed, coded, and reached a level of saturation. “The sample was sufficient to explore and develop analytic generalizations about working circumstances that influence the nurses’ intention to stay in LTC facilities” (Boscart, V. M., Bowers, B., Brown, M., & McGilton, K.S.2014).
The author used several qualitative resources that were cited throughout their article, and were dated from the year 2000-2012, which is relevant to this type of study. The author clearly states the gaps of the study were that no retention research had been completed in LTC settings. Limitations were listed as interviewing both LPN’s and RN’s together. This could have been a limitation for the LVN’s as they may have felt intimidated to discuss information with their supervisors present. Discussions about their intentions of leaving, or the factors they feel make the work environment less than desirable. The researchers tried to minimize that problem by having staff attend focus groups with others that they did not work directly with. Another limitation was possible bias, as the lead researcher was a nurse. All members of the research team reviewed the findings to minimize any potential bias (BoscartV. M., Bowers, B., Brown, M., & McGilton, K.S.2014). The study gave helpful insights to retaining staff, but the study does not give any information about whether any of the facilities actually implemented any of the employees’ ideas.
Conceptional/ Theoretical Framework
The author did not identify a specific theory or perspective from which the study was developed. The theory that most relates to this study is the Herzberg’s two-factor theory.This theory examines the reasons employees are satisfied or dissatisfied with their jobs. “From this research, Herzberg suggested a two-step approach to understanding employee motivation and satisfaction: which were hygiene factors and motivator factors” (Riley, J., 2012, paragraph 1). This theory gives valuable information to employers on what is important for employee satisfaction and for retaining employees.
Several themes resonated throughout the article, a few of the main ones were why the nurses were staying in LTC, which was because of the relationships they had with the residents and their coworkers. The framework that was developed from the studies indicated why nurses stay or leave a job. Some of the reasons listed for terminating a job were regulations in LTC that effect role flexibility, and not being able to exercise professional judgment. The lack of supportive leadership and personal commitments were also mentioned. Nurses listed reasons to stay as: relationships with the residents, their coworkers, and having opportunities to learn and be educated.
As evidenced in the study, there are many reasons for leaving or staying at a job. With high turnover there are many disadvantages for the facility as well as the resident and employees. The study indicated what was important to nurses for job satisfaction. With the shortage of nurses and the difficulty in retaining nurses in the LTC facilities, this information could be very crucial to those who hire nurses in these settings. For future studies it would be good to follow up and see if any of the facilities in the study implemented the information given by the staff. This study is important for nursing, as it gives nurses a chance to voice their concerns and give employers the opportunity to make changes.
Boscart. V. M., Bowers, B., Brown, M., & McGilton, K.S. (2014). Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff. International Journal of Nursing Studies,51(6). 917-926.dpo:10/1016/j.ijnurstu.2013.10.015 Mor, V., Mukamel, D.B., & Spector, W. D. (2009). The costs of turnover in nursing homes. The Costs of Turnover in Nursing Homes. Retrieved from www.ncbi.nlm.nih.gov/… National Center for Biotechnology Information Riley, J. (2012). Motivation Theory – Herzberg. From Motivation Theory – Herzberg – Tutor2u Retrieved from www.tutor2u.net/business/people/motivation_theory_herzberg.asp