To examine the relationship between nurse knowledge, work environment, and registered nurse (RN) turnover in perinatal hospice and palliative care organizations.
Methods:
Using nurse intellectual capital theory, a multivariate analysis was conducted with 2007 National Home and Hospice Care Survey data.
Results:
Perinatal hospice and palliative care organizations experienced a 5% turnover rate. The professional experience of advanced practice nurses (APNs) was significantly related to turnover among RNs (β = −.032, P < .05). Compared to organizations with no APNs professional experience, clinical nurse specialists and nurse practitioners significantly reduced RN turnover by 3 percentage points. No other nurse knowledge or work environment variables were associated with RN turnover. Several of the control variables were also associated with RN turnover in the study; Organizations serving micropolitan (β = −.041, P < .05) and rural areas (β = −.037, P < .05) had lower RN turnover compared to urban areas. Organizations with a technology climate where nurses used electronic medical records had a higher turnover rate than those without (β = .036, P < .05).
Conclusion:
The findings revealed that advanced professional experience in the form of APNs was associated with reductions in RN turnover. This suggests that having a clinical nurse specialist or nurse practitioner on staff may provide knowledge and experience to other RNs, creating stability within the organization.
KPMG Healthcare & Pharmaceutical Institute. KPMG’s 2011 U.S. Hospital Nursing Labor Costs Study. Altamonte Springs, FL: KPMG Healthcare & Pharmaceutical Institute. Web site. http://www.natho.org/pdfs/KPMG_2011_Nursing_LaborCostStudy.pdf. Published 2011, Accessed November 15, 2015.
ParryABarriballKWhileA. Factors contributing to registered nurse medication administration error: a narrative review. Int J Nurs Stud. 2015;52(1):403–420.
8.
StalpersDde BrouwerBKaljouwMSchuurmansM. Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: a systematic review of the literature. Int J Nurs Stud. 2015;52(4):817–835.
9.
PrezerakosPGalanisPMoisoglouI. The work environment of hemodialysis nurses and its impact on patients’ outcomes. Int J Nurs Pract. 2015;21(2):132–140.
10.
TrybouJMailfaitSGemmelPClaysE. Nursing staff and their team: Impact on intention to leave. Int Nurs Rev. 2015;62(4):489–496.
11.
WangYDongWMaukKLiP. Nurses’ practice environment and their job satisfaction: a study on nurses caring for older adults in shanghai. PLoS One. 2015;10(9):1–13.
12.
ClineDReillyCMooreJ. What’s behind RN turnover? Uncover the “real reason” nurses leave. Nurs Manage. 2003;34(10):50–53.
13.
BeecroftPDoreyFWentenM. Turnover intention in new graduate nurses: a multivariate analysis. J Adv Nurs. 2008;62(1):41–52.
14.
StonePWLarsonELMooney-KaneCSmolowitzJLinSXDickAW. Organizational climate and intensive care nurses’ intention to leave. J Nurs Adm. 2009;39(7-8 suppl):s37–s42.
15.
BlakeNLeachLSRobbinsWPikeNNeedlemanJ. Health work environments and staff nurse retention. The relationship between communication, collaboration, and leadership in the pediatric intensive care unit. Nurs Adm Q. 2013;37(4):356–370.
16.
WoolC. State of the science on perinatal palliative care. J Obstet Gyn Neonat Nurs. 2013;42(3):372–382.
17.
Hospice and Palliative Nurses Association. HPNA Position Statement: Shortage of Registered Nurses. Pittsburgh, PA: Hospice and Palliative Nurses Association; 2011. Web site. www.hpna.org/PicView.aspx?ID.28. Accessed November 11, 2014.
18.
CovellC. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94–103.
19.
StewartT. Intellectual Capital: A New Wealth of Organizations. New York, NY: Currency Doubleday; 1997.
20.
CovellCSidaniS. Nursing intellectual capital theory: implications for research and practice. Online J Issues Nurs. 2013;18(2):2.
Centers for Disease Control and Prevention. National Center for Health Statistics. National Home and Hospice Care Survey, 2007. ICPSR28961-v1. Ann Arbor, MI: Inter-university Consortium for Political and Social Research (distributor); 2010.
23.
Centers for Disease Control and Prevention. Survey Methodology, Documentation, and Data Files. Centers for Disease Control and Prevention. Web site. http://www.cdc.gov/nchs/nhhcs/nhhcs_questionnaires.htm. Published 2011. Accessed November 15, 2015.
24.
CovellCSidaniS. Nursing intellectual capital theory: operationalization and empirical validation of concepts. J Adv Nurs. 2012;69(8):1785–1796.
25.
LindleyLCFornehedMLMixerSJ. A comparison of the nurse work environment between perinatal and non-perinatal hospice providers. Internat J Palliat Nurs. 2013;19(11):535–540.
26.
RondeauKVWilliamsESWagarTH. Developing human capital: what is the impact on nurse turnover?J Nurs Manag. 2009;17(6):739–748.
27.
CrookRCombsJToddSWoehrDKetchenD. Does human capital matter? A meta-analysis of the relationship between human capital and firm performance. J Appl Psych. 2011;96(3):443–456.
28.
American College of Obstetricians and Gynecologists, Committee on Ethics and American Academy of Pediatrics, Committee on Bioethics. Maternal-fetal intervention and fetal care centers. Pediatr. 2011;128(2):e473–e478.
29.
MunsonDLeuthnerSR. Palliative care for the family carrying a fetus with a life-limiting diagnosis. Pediatr Clinic Nor Amer. 2007;54(4):787–798.
30.
BaernholdtMMarkB. The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. J Nurs Manag. 2009;17(8):994–1001.
31.
BercovitzASenguptaMJonesAHarris-KojetinLD. Complementary and alternative therapies in hospice: the national home and hospice care survey: United States, 2007. Natl Health Stat Report. 2011;(33):1–20.
32.
FurukawaMFRaghuTSShaoBB. Electronic medical records, nurse staffing, and nurse-sensitive patient outcomes: evidence from the national database of nursing quality indicators. Med Care Research Rev. 2011;68(3):311–331.
33.
BuddenJZhongEMoultonPCimiottiJ. Highlights of the National Workforce Survey of Registered Nurses. J Nurs Regul. 2013;4(2):5–14.
34.
ThompsonJWCarlsonMDBradleyEH. US hospice industry experienced considerable turbulence from changes in ownership, growth, and shift to for-profit status. Health Aff (Millwood). 2012;31(6):1286–1293.
