Emergency Nurses’ turnover is a resignation of a licensed nurse from current working emergency unit or health institution due to various factors like dissatisfaction on salary, carrier development opportunity, work environment condition, work overload and other personal factors(1).
In nursing profession history, turnover of nursing job or professional quitting remain a serious problem associated with crisis. It resulted a loss of a trained employee as transfer, termination, or resignation. Turnover intention is an individual's own estimated probability of leaving the organization at some point in the near future permanently (2).It is the best actual turnover predictor as expectation increase with intention increases (3). Turnover intention is due to multiple factors including psychological, cognitive, and behavioral components. It is claimed to start with psychological responses to negative aspects of organizations or jobs. The cognitive component involving decision to leave and withdrawal behavior to leave from the current job or actions oriented to future opportunities (4).Studies conducted in different countries like japan (44.3%), republic of Ireland (60%), Lebanon (67.5%), Egypt (18.4%), southern Ethiopia (50%) and east Gojam (59%) of nurses had been intention to leave the organization(5–9).
Turnover of employee is a matter of concern for organizations. It has an impact over the organization including loss of knowledge gained by the employee while on job, understaffing which in turn lead to decreased effectiveness and productivity of the remaining staff and also organizations’ costs relating to recruitment and selection, training of new employee, personnel process and induction and above all. (10).
Emergency nurses are the key components from emergency team to understand the criticality and breadth of patient care needs to address in the most efficient way. Thus, emergency nurse turnover have a significant impact to the organization and emergency department leaders who desire to preserve a seasoned and competent nursing workforce (11). However they are entering and leaving the emergency department in higher than average numbers, which incurs higher costs for hospitals to replace staff.. The cost of replacing a specialized, emergency nurse may be even higher when the additional training, verifications, and education for critical competencies needed to care for high-acuity patients is provided by the hospital. It is estimated that one in five RNs leaves the profession within one year of hire, while up to one-third leave within two years (12).
Studies showed that multiple factors influence the decision of emergency nurses to stay in or leave their work place. According to Tourangeau and Cranley model for determinant factors of Nurse Intention to Remain Employed, four predictor variables were identified: (1) job satisfaction, (2) nurses’ personal characteristics, (3) work group cohesion and collaboration and (4) nurses’ organizational commitment. They reported that control over these four main factors had direct effects on nurse intention to remain employed (13).Among these; job satisfaction, job stress, work experience, pay and benefit, long shifts and work-family conflict were identified as variables that could force nurses to leave their workplace(14–17).The ability of hospitals to retain trained and experienced emergency nurses in a cost-prohibitive healthcare environment requires action on behalf of hospital administrators (18).
Emergency Departments (ED) are highly acute patient care environments which are often unpredictable (11).Nurses working in Emergency Departments are especially vulnerable to turnover because of their increased potential for developing burnout and compassion fatigue(19). ED nurses with invaluable experience and mentoring capacity may consider leaving the ED for less stressful and physically demanding working conditions. In addition, while ED patient volume continues to increase, patient boarding decreases the amount of available treatment spaces (20). This stressful environment is exacerbated by hospitals reducing nursing staff to meet productivity goals, causing some EDs to require mandatory overtime to fill gaps. When nurses must work beyond their shift, at times over 12 hours, patient safety is impacted as fatigue makes nurses more prone to errors(21, 22).
Nursing Turnover is represented as a major problem for both the profession itself and healthcare provision with respect to the ability to care for patients, quality of care provided, loss of continuity of care, loss of skills and local knowledge, increased length of stay, and financial costs of replacement. Turnover may also have deleterious implications for staff left behind, with regard to morale and increased workload, leading to complicate the hospital’s goal of providing quality care for its patients’(23). Studies have shown the considerable potential cost savings where health service managers implement effective strategies to reduce nurse turnover (24).
Understanding more about the interrelationships between individual factors, organizational factors, environmental factors and job satisfaction with turnover intent can be used by nurse administrators and nurse mangers to develop and institute practices designed to increase job satisfaction thus retain nurses (25).
Even if there are limited studies on nurses’ turnover intentions in Ethiopia,they focused on general nurses’ turnover intention. There is no studies conducted on nurses’ working in emergency departments that needs further studies separately which initiated to this study.
Thus there is a great need to conduct organized study on nurses’ turnover intention among nurses working in ED whom turnover intention is expected higher due to the department’s nature, job stress due to over crowdedness and workload. Therefore, this cross sectional study was aimed to assess the magnitude of turnover intention and associated factors among nurses working in emergency departments of governmental hospitals in Addis Ababa, Ethiopia and it could provide insights for ED leaders and hospital administrative to develop the appropriate retention strategies and programs for attracting nurses working in emergency departments.