Ph.D. student Texas A&M University College Station, Texas, United States
Abstract: Abstract
The American Nurses Foundation COVID-19 conducted a Two-Year Impact Assessment (American Nurses Foundation, 2022) that indicated that in year one, 2021, 40% of nurses intended to leave or considered leaving their positions. In year two, 2022, there was a significant increase of 53% of nurses reported intent or considering leaving. Before the COVID-19 pandemic, the estimated turnover cost for registered nurses (RN) was between US$44,380 to US$63,400 per nurse or US$4.21 to US$6.02 million per year (Yarbrough et al., 2016) or twice the annual salary of nurses (Han et al., 2015). Since the pandemic, the cost has increased, resulting in a disruption in nurses leaving their positions and patient care at $11,000 to $90,000 per nurse, with a higher cost of $8.5 million to healthcare (Kelly et al. (2021).
Mazurenko et al. (2015) identified three types of turnover: organizational turnover, changing the organization but remaining in the healthcare sector; professional turnover, leaving the healthcare sector for a different field; and voluntary turnover, leaving the job market permanently or retiring. Since the pandemic, Mercado et al. (2022) cross-sectional study, lower quality of work life was linked to higher burnout symptoms and turnover intention, highlighting the need for institutional support for the well-being and retention of workers through practice and policy change. This work-in-progress conceptual paper is twofold in identifying why nurses leave, pre and post-COVID, and how HRD professionals can address turnover through engagement. This paper will answer three main research questions: (1) Why do nurses leave? (2) What do nurses need? (3) How can nurse leaders engage nurses?
Methods
A traditional narrative review was conducted, and articles were searched in Advanced Search (discovery service), PubMed, and Google Scholar. A complementary search was also done through hand-searching journals and citation and reference tracking. The initial keywords used for the search were nurse, turnover, intention, nurse leaders, need, and engagement. Combined words further narrowed the search: nurse turnover, turnover intention, nurse needs, nurse leaders, and engagement, and twenty-six articles were selected based on the keywords. Preliminary findings were done by extracting broad categories related to the literature research questions.
Preliminary Findings
Why do nurses leave?
Berlin et al. (2022) survey with frontline nurses and US-based healthcare professionals in November 2021 indicated that 32% of registered nurses (RNs) expressed the likelihood of leaving their current position. Those percentages showed a sharp increase since February 2021, when they were only 22%. The reasons shared were insufficient staffing levels, seeking higher pay, not being heard or supported at work, and the emotional toll of the job. Christianson et al. (2023) cross-sectional, mixed-method study with 1224 registered nurses (RN) and 68 licensed practical nurses (LPN) during the Covid-19 pandemic revealed that nurses' intent to leave was due to frustration, feelings of uselessness, unappreciation, being understaffed, stress and experiencing abusive behaviors by patients.
What do nurses need?
During the COVID-19 pandemic, nurses may have lost their interest, passion, and altruism for healthcare, hence the need for support to recover (Jackson, 2021). Nowell (2022) stated that the COVID-19 pandemic gave nurses limited time to reflect on the meaning of their work and commitment to the profession. Thus, they need to engage them by reflecting on career plans and understanding how meaningful their work is. Jackson (2021) further alluded to the idea of reflection but for awareness of how nurses have been affected by the COVID-19 pandemic. Nurses can reflect on their stressors, adjust, and adopt healthier behaviors (Jackson, 2021). Nowell (2022) also cited support through professional development as a way of re-engaging in learning and development. Mentorship was also noted for skill development, self-confidence, transitioning into a new role, career satisfaction, and career opportunities (Nowell (2022).
How can nurse leaders engage nurses?
Lindsay and Mathieson (2022) noted that clinical nurses with authentic leaders reported job satisfaction and commitment to the organization and remained with their employer longer. Authentic leaders can foster autonomy and enthusiasm for work through supportive environments, positively impacting job satisfaction engagement and decreasing burnout. Bergstedt and Wei (2020) called for nurse leaders to be more visible and accessible and advocate for nurses' values and needs.
Contribution and Implications
According to Swanson and Holton (2009), HRD professionals must advocate for individual, group, work process, and organizational integrity. Nurses were at the helm during the COVID-19 pandemic and are still reeling from the aftereffects, resulting in turnover. HRD professionals are crucial in employee engagement by supporting leaders to re-strategize how they engage nurses to minimize nurse turnover. Keywords: engagement, nurses, human resource development (HRD)
