Factors that influence nurses’ intention to leave adult critical care areas: A mixed-method sequential explanatory study
Background: The shortage of critical care nurses is a global concern. Although all areas of nursing are affected, critical care areas are especially vulnerable to retention problems. Nurse retention in critical care areas impacts nursing shortages, staff morale, productivity, patient safety, and quality patient outcomes. The issue of nurse retention in critical care areas is evident; however, research into the factors that influence nurses’ intention to leave adult critical care areas is limited. Exploring factors that influence nurses' intention to leave adult critical care areas is therefore important and may help in the development of strategies to improve nurse retention, reduce critical care nursing shortages, and thus improve the quality of patient care. Aim: To examine factors that may influence nurses' intention to leave adult critical care areas and to explore critical care nurses' views and experiences about their working conditions. Method: A sequential explanatory mixed-method design was used. The main purpose was to use qualitative data to expand on the findings generated using a quantitative approach. Data were collected in two phases from November 2017 to April 2018. An adapted version of the Nursing Work Index-Revised (NWI-R) tool was used in phase one to survey all nurses currently working in adult critical care areas across England; 345 surveys were returned. Data were analysed using chi-square tests, t-tests, factor analysis and logistic regression analysis to determine factors that were associated with nurses’ intention to leave. Content analysis was carried out to analyse qualitative comments collected in phase one in response to the three intentions to leave questions. Semi-structured telephone interviews were carried out with a purposive sample of critical care nurses in phase 2 to gain in-depth accounts of the factors identified in phase 1 and to explore possible solutions to retain nurses. Qualitative data were collected from 15 participants. A framework approach was used to analyse interviews thematically. Data from both phases were integrated using a joint display and narrative weaving approach in phase three. Results: This study has successfully filled the gaps identified by the literature review including quantifying the data concerning the number of nurses who expressed intention to leave their current job and/or profession in the next one to five years. Quantifying the data regarding nurses' intention to leave is significant as this will hopefully attract the attention of critical care nurse leaders to take notice of this issue and develop strategies to reduce turnover intentions and thus reduce nursing shortages and high turnover. This study has explored the issue of critical care nurses' retention holistically rather than exploring a single factor associated with nurses' intention to leave contrary to previous studies. To our knowledge, this is the first mixed-method study that has explored factors influencing nurses' intention to leave adult critical care areas and hence, not only identified the factors that are significantly associated with nurses' intention to leave but also explained what these factors mean to nurses and why they influence their intention to leave. This detailed insight will make it easier for nurse leaders and policy makers to develop strategies in reducing nurses' intention to leave. The following themes were identified following the integration of findings in phase one and phase two: promoting nurse autonomy and a culture of shared governance, providing a supportive work environment and a system of wellbeing, enhancing workforce relationships and multidisciplinary collaboration, demanding a structured education and development programme and career progression opportunities, feeling demoralised due to the lack of appreciation and acknowledgement for their specialist knowledge and skills, providing flexibility and maintaining work-life balance when managing the roster, acknowledging nurses' level of experiences when managing teams and experiencing stress and anxiety because of workforce shortages. Discussion/Conclusion: Overall, the findings of this study have identified several key operational and management issues associated with critical care nurses' intention to leave such as providing educational and professional development opportunities, supportive work environment, promoting nurse autonomy, maintaining work-life balance while managing the roster and workforce shortages. Additionally, this study highlighted some of the more unpleasant aspects of the critical care nursing work environment within critical care and associated workforce misbehaviours. Some of these negative aspects of the critical care nursing culture included judgemental attitudes towards other colleagues; remarks that were anti-intellectual, racist, or ageist remarks towards others; and non-supportive, or even bullying behaviours directed at the junior workforce. Another interesting finding was the feeling among the critical care workforce that they should receive preferential treatment in relation to those employed within other non-critical care areas, such as financial incentives and accelerated career pathways on account of their specialist knowledge and skills which necessitate the completion of additional courses. Another important contribution of this study was the reinforcement and validation of the theories of intention to leave that were developed previously but which have not been acted upon since. Furthermore, based on the findings of this study, a detailed account of recommendations has been provided which will help critical care nurse leaders and policy makers in developing strategies to reduce critical care nurses' intention to leave and thus high turnover and nursing shortages within the adult critical care settings.
Networked Digital Library of Theses and Dissertations