Nursing staff turnover at a Swedish university hospital: an exploratory study

Aim. The aim was to explore opinions on individual needs and other factors that may influence nursing staff turnover. Background. High staff turnover is a great problem for many hospitals. It is shown to have a negative effect on the quality of nursing care and to increase hospital costs. Design. In 2004 in a large university hospital in Sweden five focus group discussions (FGDs) including department heads (1), nursing managers (2) and members of nursing staff (2) were carried out. The questions to be addressed were 'Why do nurses leave?' and 'Why do nurses stay?' In addition, register data of staff turnover for 2002-2003 were analysed in relation to different facts about the units, such as number of employees, type of care and medical specialty. Categories of opinions identified in the FGDs were compared with results of the statistical analyses on the relationship between staff turnover and unit parameters to identify overall factors that may influence on nurse staff turnover. Findings. Four major factors were identified as having a possible influence on staff turnover: 'intrinsic values of motivation', 'work load', 'unit size' and 'leadership'. Smaller units had lower staff turnover as well as outpatient units and day care. It was not possible to compare statements from participants from smaller units with those from participants from larger units. Two factors had diverging data, 'salary' and 'spirit of the time'. A surprising finding was the little mention of patient care in relation to staff turnover. Relevance to clinical practice. It is important for managers to ensure that intrinsic values of nurses are met to minimise the risk for high turnover rates. Inpatient care must receive adequate staffing and nursing care could be organised into smaller units or work teams to avoid dissatisfaction and high turnover.