Introduction
America has been, over the past year, faced with a critical shortage of nursing services which is expected to get worse in the near future (Andrews & Dziegielewski, 2005). It is expected that if this problem is not resolved the soonest possible, the demand for nursing services would exceed the supply for the same by the year 2020 (Health Resources and Services Administration, 2002). Thus, sustaining sufficient numbers of proficiently trained and off course registered nurses, is a critical action for nursing leaders in any institution, especially putting into consideration the previously mentioned expected shortage of nursing services. Nursing turnover has, over the past years, been affected by the ever increasing priority regarding work-related stress and job dissatisfaction which has, consequently, influenced nurses’ intentions forcing them to leave their positions for other preferable career opportunities (O’Brien-Pallas, Murphy, Shamian, Li & Hayes, 2010).
The nursing shortage emphasizes a greater need to better understand how to retain nurses in long-term positions. Much of the published research about nurse retention has focused on reasons which force nurses to leave their jobs rather than what can be done to make them stay in long-term employment. Nurse retention may be better understood from the perspective of nurses who have stayed in healthcare institutions for long periods of time. Previous studies have focused on the impact as well as the key determinants of nurse turnover (Ambur, Palumbo, McIntosh & Mongeon, 2003; Bij, Kummerling, van Dam, Estryn-Behar & Hasselhorn, 2010; Morgan & Lynn, 2009; O’Brien-Pallas et al., 2010)
The purpose of this study, therefore, is to use the method of grounded theory research to discover and analyze the reasons why registered nurses choose to stay for long term employment within the same institution as well as providing an insightful perspective on retention of registered nurses. However, the data that will be collected but does not support long term employment will be addressed at the conclusion of this paper and can be used later for further research in the future on related topics.
Literature Review
The review of literature will focus on previous research on provision of nursing services and other professions that address key determinants associated with long-term employment. Literature review will help in identifying gaps in the literature.
Methodology
As discussed earlier, the aim of this study is to discover the experienced nurses who chose to serve long-term employment and remain within the same institution for fifteen or more years. The research study utilized grounded theory methodology. Grounded theory is particularly useful in shedding new light in areas where little is known in the field. It is through this process and innovative perspective that ideas and perceptions become more objective (Glaser & Strauss, 1967, 1999). The grounded theory methodology is appropriate for the purpose of this study, where the research method is based on the experience of the participant group and does not reflect the opinions or bias of the researcher (Glaser & Strauss, 1967). The information provided from the interviews contributed towards a new view of the reasons why individuals stay long term in nursing employments. It is hoped that the results conceptualized from this study would aid administrators and managers with an insightful perspective on retention of registered nurses which would, in turn, help in preventing the expected shortage of the same mentioned earlier.
Sample
The data for this study was collected from 10 participants who met the study criteria which required all the participants to be Registered Nurses who have had stayed in one institution for not less than fifteen years. The primary investigator interviewed all the above participants.
Procedure
Data was collected during one-on-one interviews with the study participants. The interviews were conducted at Loyola University Chicago (LUC) in a conference room. Interviewers were asked to choose the best convenient time for the interviews. The interviews were tape recorded and transcribed verbatim.
Data Analysis
In grounded theory, data analysis usually occurs concurrently with data collection. Constant comparison would be used to generate concepts, without preconceived data, using all the data collected during the interviews (Glaser, 2001). Therefore, constant comparison and open coding were the basic techniques used for data analysis which enabled searching categories of an emergent theory. Several parts of the interviews were underlined and first-level codes were established. Memoing was used to note theoretical ideas and to capture personal biases during data collection. The constant comparative method consists of four main steps: 1) comparing incidents that are applicable to all data categories, 2) integrating categories and their properties, 3) delimiting the theory and 4) writing down the theory (Glaser & Strauss, 1967, 1999). In this paper, the first two-steps will be addressed explicitly.
Five main categories emerged from the collected data that contributed to the nurse’s ability to stay in a long term position in one institution. The categories obtained were based on appreciation of co-workers, impact of the administration, working environment and related conditions, caring and appreciating benefits. In this section, each main category will be defined and then supported by subcategories.
Appreciating coworkers
One of the main categories that all the nurses interviewed in this study mentioned was the appreciation of their coworkers and this emerged as one the strongest reasons for their long term employment. Coworker, in this case, included all doctors and nurses. More so, several nurses compared these positive relationships to that of their own families. They also emphasized that the strong relationships they experienced with long term employment has positively helped in resolving many of the bothersome issues they encountered in every day to day execution of duty. Some participants really appreciated the physicians’ relationships because most importantly, the nurses felt important and appreciated since they were given the chance to be heard out especially by their seniors. Coworkers were really appreciated for several reasons which were characterized as subcategories. One of the major reasons as a subcategory was helping each other and boosting one another’s morale when going through tough times.
In addition to the support and closeness they developed with each other over years of being together. The nurses addressed the importance of positive attitude of their coworkers, which was believed to be an essential composition of their relationships. They all had described their coworkers as generous, kind, supportive and respectful. Some believed that the respect they all had for each other was earned in the course of the long term employment which gave the nurses the chance to express themselves and the freedom and authorization of conversing freely with their patients and families without offending the doctors.
Dealing with administration
The interviewed nurses gave interaction with the administration as another key category which influenced the nurses’ decisions and long term employment in one institution. Nurses noted that the administrations’ positive leadership and attitudes is equally essential on the same matter. Furthermore, they emphasized on the importance of managers’ presence in the unit allow the managers to listen to the staffs’ needs and opinions thus enabling them to reach out to their employers through constructive and productive communication. The ties sub category greatly helped support the decision of long-term employment.
Working environment
Four subcategories emerged from the participant’s interviews supporting the category of working environment. Participants indicated that flexibility, stability, ownership, continuity and a comfortable zone, all contributed to long-term employment. First of all, the flexibility in changing time and scheduling fostered the nurses’ decisions for long-term employment. Flexibility in scheduling and having a choice in shifts was also important where there could be accommodations for both the organization and the individual patients. Secondly, some of the interviewed nurses emphasized that with long-term employment they took ownership of situations. They described the institution as their house and this nurtured professional behavior. Thirdly, all the interviewed nurses spoke about comfort level that comes with long-term employment as an essential subcategory in the work environment. Most of the participants used the term of a “comfort zone,” which they believed could only come along with the long term employment due to proficiency. Some preferred this comfort zone on the fear of the unknown that comes with short-term employment, and that supported their decision to stay and practice efficiently. Additionally, nurses recognized stability and continuity as another two subcategories that contributed to a positive work environment. The interviewed nurses appreciated stability ad continuity in the work setting where both has helped nurses in being clinically competent as they were recognized as role models.
Caring
Caring for patients and families was one of the reasons for long-term employment, which the interviewed nurses discussed explicitly. The caring category has nurtured nurses through satisfaction and rewards from their emotional experiences. The interviewed nurses also emphasized on the importance of interaction between the nurses and the patients as well as their families. This has enabled them to connect and reach out to patients and families for efficiently provision of services. One of the important subcategories is by looking at nursing as either a job or as a calling; nurses believed that those who look at nursing as a calling are the ones who stay in the profession and eventually serve long-term employment than those who see it as a job or simply a source of income.
Appreciating Benefits
The final category is appreciating benefits. The interviewed nurses mentioned retirement plans and other financial benefits they get from the medical institutions, which contributed to long-term employment. Nurses emphasized that benefits should encompass fair compensation as essential component along with retirement plans and educational benefits as subcategories.
Conceptual Map
The conceptual map is included in Appendix representing the arrangement of the five emerged categories that were empirically derived from the data provided by the interviewed nurses.
Conclusion
This study was conducted and initial categories were discovered. As discussed earlier, the study identified five main categories that influenced staff long-term employment. The description of these categories has provided the insight for nurse managers and administrators who are interested in improving both recruitment and retention of nurses from the perspective of the employers themselves. However, the purpose of the next study is to conduct interviews based on the preliminary finding. This was a pilot study with a small sample size whose results from the interviews made were constant in regards to reasons given by all nurses who stayed within the same institution for fifteen year or more.
The five categories that emerged represent significant data that is worthy of further investigation to enhance the knowledge regarding registered nurses long-term employment and retention. From this pilot study, provisional hypotheses were identified for further investigation. These provisional statements are as follows:
- Coworkers feeling like a family predicted long term employment.
- Experiencing stability and continuity in the work environment contributes to staff satisfaction and long term employment
- Flexibly in time and scheduling in the working environment predicted long term employment.
- Feeling a sense of respect for all including the workers and administrators is a predictor of long-term employment.
- Reaching a comfort zone in the work environment supports long term employment
- Financial and educational benefits in an organization are powerful reasons in long-term employment.
The focus of this research was to determine the reasons why nurses choose long-tem employment in the same institution. However, during the interview nurses addressed reasons for resigning and leaving institution. The data obtained that represents the reasons behind resignation by nurses resign from one institution to another should be considered for future research in a follow up study next year. Some of the factors to be researched on include turn off, staffing issues and poor administration.
Attachments of first level codes and conceptual categories are included in the Appendix.
Reference List
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Bij, Kummerling, A., van Dam, K., E, Estryn-Behar, M., & Hasselhorn, H. (2010). The impact of social support upon intention to leave among female nurses in Europe: secondary analysis of data from the NEXT survey. International Journal of Nursing Studies, 47(4), 434-445.
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Glaser, B. & Straus, A. (1967). The Discovery of Grounded Theory: Strategies for Qualitative Research. New Brunswick: Aldine Transaction.
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