Retention, burnout and the future of nursing


Nursing retention continues to be critical in OECD countries (Simoens et al. 2005). Nurses' clinical knowledge, skills and engagement are an essential component of promoting and maintaining the health and well-being of a society. On the other hand, increasing concern about the well-being and retention of nurses is relatively new (e.g. Pisaniello et al. 2012). There are many new pressures affecting nurses' well-being and retention. One contributing factor is the ageing populations in many OECD countries, in turn changing the nature, and increasing the acuity of illness in patients at a time when health is chronically under-resourced and nurses are continually asked to ‘do more with less’. Another factor is the growing expectation by the public for high-quality service and care – in line with the implementation of public sector reform – refocusing the attention of the client. The third contributing factor is, perhaps, the most alarming because the average age of nurses is rising quickly in many OECD countries (in the case of Australia, the average age is 44·9 years (Australian Institute of Health & Welfare 2013); consequently, nurses and nurse managers have to consider the factors that compromise their well-being. The positive aspect of having an ageing population is that nurses have a wealth of knowledge and skills required to care effectively for patients to ensure good outcomes.

However, the negative side is that if (and when) they leave; they leave with the essential tacit knowledge required to ensure the safe and effective care of patients. This is a major risk factor for nurse managers and is the reason why researchers are focusing their attention on identifying those factors that compromise the well-being and retention of nurses. Research has shown that high nurse turnover continues to have a negative impact on patient safety, nurses' perception of psychological well-being and organizational effectiveness. Additionally, in a growing number of countries, it is a requirement that RNs obtain an undergraduate degree before they can work. Consequently, the replacement cost of losing skills nurses is not only the cost of educating new recruits, but also the resources involved in acculturating new nurses into the new health/hospital setting.

A continual threat to retaining nurses is that many nurses working in hospitals in OECD countries (such as Australia, USA, and the Netherlands) experience almost chronic conditions of under-staffing or poor skill base; hence, the issue of psychological well-being and burnout are a constant threat to the nursing context and organizational effectiveness. The contribution of this special section on workforce issues is that it provides a collection of empirical studies, which examine the antecedents that have an impact on nurse's turnover intention and/or their perception of psychological well-being. This special section uses an evidence-based deductive research approach to examine some of the major issues that have an impact on public and private sector hospitals, nurse managers and nurses in the USA, Netherlands and Australia. Research undertaken at the individual unit of analysis includes Rodwell and Gulyas (2013), Cheng et al. (2013), Brunetto et al. (2013) and Newton et al. (2013) articles. Three papers focused on identifying new antecedents of turnover intentions for nurses. For example, the study by Rodwell and Gulyas (2013) examined the impact of the psychological contract (particularly in terms of what management promises upon recruitment) and the implications for organizational justice and retention of Australian nurses. The contribution of the Cheng et al. (2013) is that it examined a set of different variables, namely the relationships among emotional labour, team climate, burnout, and perceived quality of care and turnover intention among Australian nurses. The paper by Brunetto et al. (2013) compares the impact of workplace relationships for US and Australian nurses and found that only the relationship with organizational management and psychological well-being and affective commitment were significant in impacting nurses' turnover intentions in Australia and the USA. The paper by Newton et al. (2013) added another dimension to examining psychological well-being and affective commitment in the context of organizational change in the Australian public health sector. In contrast to the previous four articles, the paper by Tummer et al. (2013) examines the reasons why nurses leave nursing in the Netherlands. The key factors are poor opportunities for career development, negative and unpleasant working atmosphere and a lack of perceived autonomy especially when working in homecare situations.

The new knowledge provides nurse managers with evidence-based information from which they can develop best practice management likely to enhance nurses' perception of psychological well-being, their commitment and, in turn, reduce their turnover intentions.