Turnover intention is defined as a probability of an employee to leave his or her current job within a certain time period due to various factors like dissatisfaction on salary, carrier development opportunity, work environment condition, work overload and other personal factors ( 1,2).In the nursing profession history, turnover of nursing job or professional quitting remains a serious problem associated with the crisis. It resulted in 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 (3). It is the best actual turnover predictor as expectation increase with intention increases (4). 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 the decision to leave and withdrawal behavior to leave from the current job or actions oriented to future opportunities, (5).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 an intention to leave the organization(6-10).
Turnover of employees is a matter of concern for organizations. It has an impact over the organization including loss of knowledge gained by the employee while on the 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. (11).
Emergency nurses are the key components from the emergency team to understand the criticality and breadth of patient care needs to address most efficiently. Thus, emergency nurse turnover has a significant impact on the organization and emergency department leaders who desire to preserve a seasoned and competent nursing workforce (12). 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 (13).
Studies showed that multiple factors influence the decision of emergency nurses to stay in or leave their workplace. According to the Tourangeau and Cranley model for determinants of Nurse Intention to Remain Employed, four predictor variables were identified: (1) job satisfaction, (2) nurses' characteristics, (3) workgroup 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 (14). 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(15-18). According to the Price and Mueller causal nurse turnover model, nurse turnover is directly influenced by nurses' organizational commitment and indirectly through their job satisfaction, with job satisfaction being influenced by a variety of organizational, demographic and environmental variables(19). The ability of hospitals to retain trained and experienced emergency nurses in a cost-prohibitive healthcare environment requires action on behalf of hospital administrators (20)
Emergency Departments (ED) are highly acute patient care environments that are often unpredictable (12). Nurses working in Emergency Departments are especially vulnerable to turnover because of their increased potential for developing burnout and compassion fatigue(21). ED nurses with invaluable experience and mentoring capacity may consider leaving the ED for less stressful and physically demanding working conditions. Also, while ED patient volume continues to increase, patient boarding decreases the amount of available treatment spaces (22). 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(23, 24).
Nursing Turnover is represented as a major problem for both the profession itself and healthcare provision. It has a negative impact on care of 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, concerning morale and increased workload leading to complicate the hospital's goal of providing quality care for its patients'(25). Studies have shown considerable potential cost savings where health service managers implement effective strategies to reduce nurse turnover (26).
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 hospital managers to develop and institute practices designed to increase job satisfaction thus retain nurses (27).
Even if there are limited studies on nurses’ turnover intentions in Ethiopia, they focused on general nurses’ turnover intention. There are no studies conducted in the study area on nurses' working in emergency departments that need further studies separately which initiated to this study.
Thus there is a great need to conduct an organized study on nurses' turnover intention among nurses working in ED whose 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 administrators to develop the appropriate retention strategies and programs for attracting nurses to work in the emergency departments.