Servizio Comunitario di Informazione in materia di Ricerca e Sviluppo - CORDIS

Sweden: Premature departure from nursing

The supply of nurses varies between countries and between different health care areas. In Sweden geriatric health care has problems recruiting nurses, and the status of geriatric health care as a professional arena is relatively low compared to other sectors in health care. The main challenge in Sweden is to promote retention of nurses in geriatric health care.

Voluntary turnover signifies active decisions on the part of nurses and is influenced by various factors (Lum et al. 1998; Morrell 2004). Identifying factors that influence turn over can hopefully help the organisations to increase their attractiveness and keep their nurses.

In the NEXT-questionnaire we investigated work conditions contributing to registered nurses and assistant nurses decision to leave their workplace. Literature reviews and turnover models identify poor job satisfaction as a significant contributor to turnover among nurses (Hayes, L., Duffield, et al. Nurse turnover: A literature review. International Journal of Nursing Studies, in press). Various studies have used various measures and scales to identify many sources of job satisfaction for nurses (Hong, L., E. W. Alison and L. Barriball. Job satisfaction among nurses: a literature review. International Journal of Nursing Studies 2005;42:211 227.), sources that include physical work conditions, relationships with co-workers and managers, pay, possibilities for advancement, job security, responsibility, management recognition, and hours of work.

The Swedish participating in the NEXT-study is a part of the longitudinal Swedish cohort study of sustainable health for working in the public sector (The HAKuL-study). The HAKuL-study started two years before the NEXT-study. The questionnaire to the leavers was the same as used in the NEXT-study but the baseline data were collected in another way. The study base consisted of registered nurses and assistant nurses employed at least three months during November 1999/2000 to 2003, in totally 3879 persons. Temporary nurses paid on hourly basis were not included. During 2000-2003 data on retirement pensions and leave from the employment was recorded by means of continuous contact with the work units and the superiors. All leavers received a NEXT-questionnaire focused on reasons for leaving.

During a three year period 18% of the nurses left their employment contract. A higher rate of leavers was observed in elderly care compared to other sectors, among nurses younger than 50 years with nurses 50 years of age and older and among registered nurses compared to assistant nurses. Ending their employment did not imply that the nurses left health care, most of them remained in nursing but changed institution. Of the registered nurses who left their workplace, 86% changed nursing institution but remained in the nursing, among assistant nurses 68% remained in nursing.

Unsatisfactory salary contributed most to both registered nurses and assistant nurses’ decision to leave the workplace. The factor consisted of four items describing salary in relation to work performance, educational level, pay opportunities at other workplaces, and salary trends. Lack of professional opportunities emerged as another important factor influencing the decision to leave. The factor contained items concerning promotion prospects and development opportunities, desire for change and unfulfilled professional expectations. For assistant nurses in geriatric health care the patient oriented workload; to much to do, to high emotional demands, physical strain, time pressure and inadequate number of nursing personnel, contributed to a larger extent to their decision to leave compared with assistant nurses in other health care sectors.

Reasonable pay and possibilities for development are core parts of sufficient rewards for balance the nurses’ efforts. For assistant nurses the trend of wages has been less positive and the wage differentials between organisations are less significant. A registered nurse can often increase her salary by mean of changing job in the health care sector, for assistant nurses the possibilities are more limited. Interventions required for retaining personnel in elderly care need to be addressed both at the political level giving more resources to geriatric health care, and at the organisational level to create possibilities for professional development. "There was no flight from the nursing profession and consequently the turnover of nurses mainly represents circulation between institutions. Turnover imposes costs, puts pressure on remaining nurses, and makes it difficult to maintain the knowledge base and care quality. On the other hand, a contributing factor for leaving was a desire for professional development and certain level of nurse circulation among organisations and institutions represents development and flexibility. The positive and negative consequences of turnover, for both nurses and the quality of care, need to be examined.

Reported by

Uppsala University, Occupational and Environmental Medicine
Occupational and Environmental Medicine, Akademiska sjukhuset
751 85 Uppsala
Sweden