Understanding Nurse Retention at a Mental Health and Addictions Facility During a Dual Pandemic

Abstract

Background

The COVID-19 pandemic exposed nurses to new and more severe workplace stressors; exposure to these workplace stressors has exacerbated nurse turnover. Nurses working in mental health and substance use (MHSU) have also experienced the unique stressor of the overdose crisis in British Columbia (BC). MHSU nurses have been at the forefront of working to manage these dual emergencies. There is limited evidence related to the compounding effect of COVID-19 and the overdose crisis on nursing turnover. Understanding the unique conditions that MHSU nurses are currently experiencing and what factors influence a nurse's intention to stay in or leave a healthcare facility is essential in developing strategies to minimize turnover and maximize retention.

Purpose

To explore the factors that affect nurse turnover while working through the dual emergencies within a MHSU facility in BC, Canada.

Methods

A qualitative descriptive approach with an inductive, descriptive thematic analysis guided this quality improvement project.

Results

Findings were grouped into two main themes: reasons for leaving and reasons for staying. Reasons for leaving included workplace safety, seeking new opportunities, lack of support, and being short-staffed. Reasons to stay encompassed connections with clients, leaders and colleagues, support from colleagues and leaders, and feeling valued, safe, and heard.

Conclusions

Perceived personal safety and protection from workplace violence were found to increase the likelihood of intent to leave and turnover among nurses. Further, psychosocial safety and connection among nurses and health leaders were found to decrease the likelihood of turnover.

Keywords

COVID-19 opioid epidemic overdose crisis nurses retention turnover intention

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References

BCCDC (2022, March). Overdose response indicator report. Retrieved May 5, 2022, from http://www.bccdc.ca/resourcegallery/Documents/Statistics and Research/Statistics and Reports/Overdose/Overdose Response Indicator Report.pdf

BCNU (2021). The future of nursing in BC: Impacts of the COVID-19 pandemic and the nursing shortage in British Columbia (Fall). https://www.bcnu.org/sites/default/files/2022-12/Future_of_Nursing_In_BC.pdf

Bellman

Thai

Chinthalapally

Russell

Saleem

(2022). Inpatient violence in a psychiatric hospital in the middle of the pandemic: Clinical and community health aspects. AIMS Public Health, 9(2), 342–356. https://doi.org/10.3934/publichealth.2022024

Blevins

Henry

B. F.

Sung

Edelman

E. J.

Black

A. C.

Dawes

Molfenter

Hagle

Drexler

Cates-Wessel

Levin

F. R.

(2022). Well-being of health care professionals treating opioid use disorder during the COVID-19 pandemic: Results from a national survey. Psychiatric Services, 73(4), 374–380. https://doi.org/10.1176/appi.ps.202100080

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Brunetto

Xerri

Shriberg

Farr-Wharton

Shacklock

Newman

Dienger

(2013). The impact of workplace relationships on engagement, well-being, commitment and turnover for nurses in Australia and the USA. Journal of Advanced Nursing, 69(12), 2786–2799. https://doi.org/10.1111/jan.12165

Cole

Ali

Ahmed

Hamasha

Jordan

(2021). Identifying patterns of turnover intention among Alabama frontline nurses in hospital settings during the COVID-19 pandemic. Journal of Multidisciplinary Healthcare, 14, 1783–1794. https://doi.org/10.2147/JMDH.S308397

Duffield

C. M.

Roche

M. A.

Homer

Buchan

Dimitrelis

(2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 70(12), 2703–2712. https://doi.org/10.1111/jan.12483

Falatah

(2021). The impact of the coronavirus disease (COVID-19) pandemic on nurses’ turnover intention: An integrative review. Nursing Reports, 11(4), 787–810. https://doi.org/10.3390/nursrep11040075

10.

Friedman

Akre

(2021). COVID-19 and the drug overdose crisis: Uncovering the deadliest months in the United States, January‒July 2020. American Journal of Public Health, 111(7), 1284–1291. https://doi.org/10.2105/ajph.2021.306256

11.

Fronda

D. C.

Labrague

L. J.

(2022). Turnover intention and coronaphobia among frontline nurses during the second surge of COVID-19: The mediating role of social support and coping skills. Journal of Nursing Management, 30(3), 612–621. https://doi.org/10.1111/jonm.13542

12.

Galanis

Vraka

Fragkou

Bilali

Kaitelidou

(2021). Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Advanced Nursing, 77(8), 3286–3302. https://doi.org/10.1111/jan.14839

13.

Habibzadeh

Namadi

Mahdi-Akhgar

(2023). Nurse-to-nurse horizontal violence during the COVID-19 pandemic and its impact on turnover intention: A cross- sectional study. Nursing Open, 10(4), 2631–2637. https://doi.org/10.1002/nop2.1523

14.

Havaei

Staempfli

MacPhee

(2021). Nurses’ workplace conditions impacting their mental health during COVID-19: A cross-sectional survey study. Healthcare, 9(1), 84. https://doi.org/10.3390/healthcare9010084

15.

Havaei

MacPhee

Lee

S. E.

(2019). The effect of violence prevention strategies on perceptions of workplace safety: A study of medical-surgical and mental health nurses. Journal of Advanced Nursing, 75(8), 1657–1666. https://doi.org/10.1111/jan.13950

16.

Havaei

MacPhee

Susan Dahinten

(2016). RNs and LPNs: Emotional exhaustion and intention to leave. Journal of Nursing Management, 24(3), 393–399. https://doi.org/10.1111/jonm.12334

17.

Hayes

L. J.

O’Brien-Pallas

Duffield

Shamian

Buchan

Hughes

Laschinger

H. K. S.

North

(2012). Nurse turnover: A literature review – an update. International Journal of Nursing Studies, 49(7), 887–905. https://doi.org/10.1016/j.ijnurstu.2011.10.001

18.

Hayward

Bungay

Wolff

A. C.

MacDonald

(2016). A qualitative study of experienced nurses’ voluntary turnover: Learning from their perspectives. Journal of Clinical Nursing, 25(9-10), 1336–1345. https://doi.org/10.1111/jocn.13210

19.

Labrague

L. J.

los Santos

J. A. A.

Falguera

C. C.

Nwafor

C. E.

Galabay

J. R.

Rosales

R. A.

Firmo

C. N.

(2020). Predictors of nurses’ turnover intention at one and five years’ time. International Nursing Review, 67(2), 191–198. https://doi.org/10.1111/inr.12581

20.

Lee

H. M.

Kim

S. Y.

Park

Choi

J. Y.

(2021). Mediating effects of achievement emotions between peer support and learning satisfaction in graduate nursing students. Nurse Education in Practice, 52, 103003. https://doi.org/10.1016/j.nepr.2021.103003

21.

Lotfi

Akhuleh

O. Z.

Judi

Khodayari

(2022). Turnover intention among operating room nurses during the COVID-19 outbreak and its association with perceived safety climate. Perioperative Care and Operating Room Management, 26, 100233. https://doi.org/10.1016/j.pcorm.2021.100233

22.

Zhao

While

(2019). Job satisfaction among hospital nurses: A literature review. International Journal of Nursing Studies, 94, 21–31. https://doi.org/10.1016/j.ijnurstu.2019.01.011

23.

Nei

Snyder

L. A.

Litwiller

B. J.

(2015). Promoting retention of nurses. Health Care Management Review, 40(3), 237–253. https://doi.org/10.1097/hmr.0000000000000025

24.

North

Leung

Ashton

Rasmussen

Hughes

Finlayson

(2013). Nurse turnover in New Zealand: Costs and relationships with staffing practises and patient outcomes. Journal of Nursing Management, 21(3), 419–428. https://doi.org/10.1111/j.1365-2834.2012.01371.x

25.

NSI Nursing Solutions, Inc (2022). 2022 NSI national health care retention & RN staffing report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_ Retention_Report.pdf

26.

NSI Nursing Solutions, Inc (2023). 2023 NSI national health care retention & RN staffing report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf

27.

Nurses and Nurse Practitioners of British Columbia (2020). Understanding the implications of dual public health emergencies. https://www.nnpbc.com/pdfs/policy-and-advocacy/opioid/IS-Dual-Public-Health-Emergencies.pdf

28.

O’Donovan

McAuliffe

(2020). Exploring psychological safety in healthcare teams to inform the development of interventions: Combining observational, survey and interview data. BMC Health Services Research, 20(1), 810. https://doi.org/10.1186/s12913-020-05646-z

29.

Palys

(2008). Purposive sampling. In The SAGE encyclopedia of qualitative research methods. https://doi.org/10.4135/9781412963909.n349

30.

Purpora

Blegen

M. A.

(2015). Job satisfaction and horizontal violence in hospital staff registered nurses: The mediating role of peer relationships. Journal of Clinical Nursing, 24(15–16), 2286–2294. https://doi.org/10.1111/jocn.12818

31.

Roche

M. A.

Duffield

C. M.

Homer

Buchan

Dimitrelis

(2015). The rate and cost of nurse turnover in Australia. Collegian, 22(4), 353–358. https://doi.org/10.1016/j.colegn.2014.05.002

32.

Rodwell

Ellershaw

(2016). Fulfill promises and avoid breaches to retain satisfied, committed nurses: Retain satisfied, committed nurses. Journal of Nursing Scholarship, 48(4), 406–413. https://doi.org/10.1111/jnu.12215

33.

Rosser

E. A.

(2022). Investing in nursing and its leadership to secure global health: Are we making progress? International Nursing Review, 69(2), 121–124. https://doi.org/10.1111/inr.12765

34.

Somani

Muntaner

Smith

Hillan

E. M.

Velonis

A. J.

(2022). Increased workplace bullying against nurses during COVID-19: A health and safety issue. Journal of Nursing Education and Practice, 12(9), 47. https://doi.org/10.5430/jnep.v12n9p47

35.

Statistics Canada (2022, June 3). Experiences of health care workers during the COVID-19 pandemic, September to November 2021. The Daily. https://www150.statcan.gc.ca/n1/daily-quotidien/220603/dq220603a-eng.htm

36.

Tolksdorf

K. H.

Tischler

Heinrichs

(2022). Correlates of turnover intention among nursing staff in the COVID-19 pandemic: A systematic review. BMC Nursing, 21(1), 174. https://doi.org/10.1186/s12912-022-00949-4

37.

Van der Heijden

B. I. J. M.

Mulder

R. H.

König

Anselmann

(2017). Toward a mediation model for nurses’ well-being and psychological distress effects of quality of leadership and social support at work. Medicine, 96(15), e6505. https://doi.org/10.1097/MD.0000000000006505

38.

Varner

(2021). Hospitals grappling with nurse exodus. Canadian Medical Association Journal, 193(16), E569–E570. https://doi.org/10.1503/cmaj.1095934

39.

Zeytinoglu

I. U.

Denton

Plenderleith

J. M.

(2011). Flexible employment and nurses’ intention to leave the profession: The role of support at work. Health Policy, 99(2), 149–157. https://doi.org/10.1016/j.healthpol.2010.07.017