Running Head: NURSING SHORTAGE AND TURNOVER INTENTION 1

Nursing Shortage and Turnover Intention

Darian Lupton

Brigham Young University Idaho

NURS420

Sister Ardern

May 20, 2016

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According to Applebaum, Fowler, Fiedler, Osinubi, and Robson (2010), many nurses

claim that the nursing shortage is a large contributor to their stress, increased workload, and

decreased patient care. Although other factors contribute to turnover, the nursing shortage is

shown to be a major cause of increased workload on nurses, thus causing more stress and an

increased likelihood that they will leave their job (Chan, Tam, Lung, Wong, & Chau 2012). My

question is, How does the nursing shortage effect the nurse and their intention to leave their

job?

Method

The aim of this study is to review current literature on how the nursing shortage effects

nurses and whether or not it causes an increased turnover intention. In conduction of this

research, the following question is posed: How does the nursing shortage effect the nurses and

contribute to their intent to quit their job? A descriptive survey will be conducted due to the

nature of the study design to show relationships between variables in an environment

uncontrolled by the researcher. Research gathered in this manner will allow me to gain

information and results sufficient for the purpose of the study, which is designed to be qualitative

in nature. The purpose here is to show relationships between the nursing shortage, stress, and

turnover intention. The sample population will include 50 nurses from 5 different level one

trauma centers in Arizona. The names of all level one trauma centers in Arizona will be

randomized using a name generator online, and the first 5 names from the generator will be

chosen. These nurses must either be working in emergency care, critical care, or on a medical-

surgical floor. 50 envelopes enclosed with a questionnaire and information about the

questionnaire will be dropped off to the nursing manager in the ER, ICU, and Med/Surg floor of
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each hospital. Each participant will receive a 20 dollar Visa gift certificate to reimburse them for

their time.

A questionnaire inspired by the Meuller and McClosky Satisfaction Scale will be used to

survey the sample population, though the actual questionnaire used will be modified to more

closely reflect the goals of the research. Validity and reliability of the questionnaire is apparent

in that the questions are related directly to the research, each question is brief and concise, and

the questionnaire is re-testable. In this case, a Likert scale ranging from 1 (never) to 5 (always)

will be used. The subjects will answer 8 questions as follows:

1. I feel that my work and life are well balanced.

If < 3, why? What could the hospital do better?
2. I feel support from my co-workers.
If < 3, why do you feel this way?
3. With my patient load, I can give each patient sufficient time and care.
If < 3, why?
4. I get time off when I need it.
If < 3, why?
5. My co-workers help me when Ive got too much to handle on my own.
If < 3, what is stopping them from lending a hand?
6. My career choice leaves me satisfied at the end of each day.
If < 3, list 3 factors causing these thoughts
7. In the workplace, I feel like I have sufficient time to accomplish each.

task expected of me.

If < 3, why?

8. What is the average nurse to patient ratio in your unit?

Here, give an actual ratio. For example: 1:4 = 1 nurse to every 4

patients.

9. How long have you been a nurse?

A. 1-3 years

B. 3-6 years

C. 6-10 years
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D. 10+ years

10. How long have you worked in your current unit (ie: ER, ICU,

Med/Surg)?

A. 1-3 years

B. 3-6 years

C. 6-10 years

D. 10+ years

Participants will be given a time frame of 2 weeks to fill out the questionnaire. The

director of nursing will be asked to email the researcher once the questionnaires are filled out.

The questionnaire will be given to the director of nursing of the ER, ICU, and Med/Surg floors

of each hospital selected and will be picked up from the director of nursing at the end of the two

week time period. The number of each question will be summed to a total. A higher total

number indicates a higher level of job satisfaction, whereas a lower total number indicates a

lower level of job satisfaction. To safeguard the rights of human subjects, participants must be

18 years old to provide consent for themselves, and a consent form will be provided. Potential

ethical problems may arise in that the subject being questioned may experience an increase in

stress. While answering questions, a participant may experience emotional discord, acting out

against the nurse manager who gave them a survey. Other negative psychological experiences

may also occur. This has been taken into consideration, and there will be a counselor available

for any participants who may feel they need it. The counseling session will be scheduled

anonymously to protect the privacy and identity of the individuals participating. Permission will

be granted by the ethical review board after presenting them with the study. The only
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information required by the subject is the unit they currently working in (ie: ER, ICU,

Med/Surg), the length of time worked in that unit, and the length of time worked as a nurse. All

other information such as name, workplace, and any other personal information will not be asked

for in the survey. Nursing directors will not see these questionnaires and they are only to be used

for the purpose of research. This survey was developed with safe questions and is able to be

completed in the comfort of their own home if the nurse so desires.

Theory

Betty Neumans Health Systems Model will be used to show relationships between stress

and the human body, as these are the concepts of interest in the study. This theory underlines the

idea of stress and how it reacts on the body (Toto, Peters, Blackman, & Hoch 2009). The

research is focused on the increased workload of the nurse due to the nursing shortage, and the

stress that occurs as a result. Therefore, by using this theory we can learn more about the effects

of stress and how to treat it.

Framework

Neumans Health Systems Model supplies a structured outline consisting of various

descriptive categories and variables, and the relations between them that are presumed to account

for the phenomenon of stress in the nursing field (Nilsen, 2015). As part of this model, goals are

also added to provide real world application of the theory as it pertains to the research question

above.
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Literature Review

Nurses report that the nursing shortage and increased workload are major factors

contributing to their intention to leave their job (Applebaum, Fowler, Fiedler, Osinubi, &

Robson, 2010). One study done in Korea, including over 1000 participants, noted that half of the

surveyed subjects experienced some sort of burnout, and a quarter of those subjects reporting

burnout planned on leaving their job in the next year. The nurses who reported a high quality of

patient care had less patients to care for than the nurses who reported inadequate staffing and low

quality of patient care (Cho et al., 2009). The findings of another study including 20 interviews,

reflected that many nurses are finding that pay no longer satisfies them in the work that they do.

What matters to nurses is giving high quality of care to their patients. Several nurses in the study

viewed the nursing shortage as a direct reason for not being able to meet the needs of their

patients (Morgan & Lynn, 2009). A study done in Iran including 275 nurses found that increased

workload and inadequate staffing were indicated as the most significant contributors to

occupational stress among nurses. Two other notable contributors to stress included change in

hospital organization and policies. These changes cause an interruption in workflow, and a

decrease in confidence among nurses (Mosadeghrad, 2013). In some of the studies, pertinent

sociodemographic information was unable to be obtained because the IRB did not allow it.

Without this information it is hard know how to duplicate the study to check for validity and

reliability. Overall, across all research, a direct positive correlation was found between stress and

job satisfaction.
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Findings

Review of available literature shows that nurses view the nursing shortage as a direct

reason for the decrease in quality for patient care (Applebaum, Folwer, Fiedler, Osinubi, &

Robson, 2010). Research also found that pay is no longer the main motivator for nurses in their

work, but rather taking care of their patients at the best of their abilities. I am confident that the

nursing shortage contributes to an increase in turnover intention, however, in order for this

research to be implemented in practice, further studies should be done to find all reasons for

nursing turnover. The data collected thus far may contribute to nursing in that it can help nursing

managers know how to increase job satisfaction for their staff (Mosadeghrad, 2013).

Implications for Nursing Practice

Applebaum, Fowler, Fiedler, Osinubi and Robson (2010) identified through their research

that input from the nurse is essential in both assessing and guiding change in the hospital

environment. The findings in this research alert nursing managers to become more

knowledgeable about occupational stress, the risk factors, and how it effects their staff

(Mosadeghrad, 2013). Nurses want more increased autonomy, more time with the patient,

recognition of achievement for newer nurses, and enhanced support from peers (Morgan & Lynn,

2009). In attempts to achieve this, it is suggested that a standard of staffing be implemented in

order to provide each floor with adequate staffing (Cho et al., 2009). Doing this will increase

quality of patient care, increase job satisfaction for nurses, decrease their stress, and thus increase

retention rates. Overall, consistently assessing the nursing staff through questionnaires,

including them in decision making about their environment, and increasing staff numbers have

all been identified as implications that will increase retention rates for nurses.
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Recommendations

In future research, the use of an electronic questionnaire, such as a Qualtrics survey,

should be issued to each hospital for more convenience, improved response time and increased

response rate. Future research with a more extensive questionnaire should be used to investigate

more factors of stress. The data of this questionnaire should be laid out in table form so the data

may be easily analyzed. To improve the accuracy and reliability of future studies, research

should be expanded to different health care sectors in different parts of the United States, rather

than just limiting the research to 5 hospitals in Arizona.

Conclusion and Insights

Overall, the findings in these studies show that there is indeed an issue with increased

stress among nurses, and that much of that stress is caused by a shortage of nurses. This stress

contributes to burnout and increases the likelihood that the nurse will leave their job. Resolving

problems caused by the nursing shortage relies on different factors such as increased educational

facilities, nursing faculty, and graduates. Helping retention rates depends on a variety of factors

such as work environment, peer support, confidence, tenure, and others. Through this research I

have gained a greater appreciation for nurses all across the world who work with limited

resources to save lives every day. It also opened my eyes to what I have to look forward as a

future graduate.
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References

Applebaum, D., Fowler, S., Fiedler, N., Osinubi, O., & Robson, M. (2010). The Impact of

Environmental Factors on Nursing Stress, Job Satisfaction, and Turnover Intention. The

Journal of Nursing Administration, 40(7-8), 323328.

http://doi.org/10.1097/NNA.0b013e3181e9393b

Chan, Z. C., Tam, W. S., Lung, M. K., Wong, W. Y., & Chau, C. W. (2012, June 19). A systematic

literature review of nurse shortage and the intention to leave. Journal of Nursing

Management, 21(4), 605-613. doi:10.1111/j.1365-2834.2012.01437.x

Cho, S., June, K. J., Kim, Y. M., Cho, Y. A., Yoo, C. S., Yun, S., & Sung, Y. H. (2009). Nurse

staffing, quality of nursing care and nurse job outcomes in intensive care units. Journal

of Clinical Nursing, 18(12), 1729-1737. doi:10.1111/j.1365-2702.2008.02721.x

Morgan, J. C. & Lynn, M. R. (2009). Satisfaction in nursing in the context of shortage. Journal

Of Nursing Management, 17(3), 401-410.

Mosadeghrad, A. M. (2013, July 24). Occupational Stress and Turnover Intention: Implications

for Nursing Management. International Journal of Health Policy and Management, 1(2),

169-176. Retrieved June 25, 2016, from http://papers.ssrn.com/sol3/papers.cfm?

abstract_id=2352363

Nilsen, P. (2015). Making sense of implementation theories, models and

frameworks. Implementation Science: IS, 10, 53. http://doi.org/10.1186/s13012-015-

0242-0

Toto, D. L., Peters, A. B., Blackman, B. J., & Hoch, C. R. (2009). Bridging the gap: Answering

the need for nursing faculty. Teaching and Learning in Nursing, 4(4), 109-114.

doi:10.1016/j.teln.2009.02.006
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