Turnover intention is defined as an employee's own estimated probability of leaving his or her job or current organization at some point in the near future permanently due to various factors. Reasons include dissatisfaction with salary, carrier development opportunity, work environment condition, work overload, and personal factors (1,2).
In the nursing profession, the 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 (3). Turnover intention is the best actual turnover predictor as expectation increase with intention increases (4). It is associated with multiple factors including psychological, cognitive, and behavioral components. It is claimed that turnover intention starts as psychological responses to negative aspects of organizations or jobs. The cognitive component involves the decision to leave from the job. Finally, the withdrawal behavior is acted to leave from the current job or actions oriented to future opportunities.(5).
The magnitude of nursing turnover intention is a rapidly-growing global problem affecting the healthcare sector. The studies conducted across the world have shown to be considered a high rate ranging from 18% to 68% (6-10). It is a major worldwide problem especially in developing countries, including Ethiopia. In previous studies done in different areas of Ethiopia were ranged from50%-61% of turnover intention (9,10).
Turnover of employees is a matter of concern for organizations. It has an impact on the organization including loss of knowledge gained by the employee while on the job, understaffing which in turn leads to decreased effectiveness and productivity of the remaining staff. It has also additional costs related to recruitment and selection, training of new employees, personnel process, and induction. (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 Registered Nurses(RN) 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 nurses’ intention to remain employed, four predictor variables were identified: Job satisfaction, nurses' characteristics, workgroup cohesion and collaboration, and 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).
According to Meyer and Allen’s conceptualization model, organizational commitment is directly linked to an individual's intention to stay or leave. It has three sub-components; affective commitments, normative commitment, and continuance commitment which was widely used for researchers to study organizational factors (20,21). In this model, employees are remained in the organization to achieve the values and goals of the organization is affective commitment. Feeling to have an obligation is normative commitment and lose a lot if they left the organization is continuance commitment. Organizational commitment is an important predictive variable to assess intention to leave the organization (22).
Studies evidenced multiple contributing factors for nurses’ turnover intention. Lower professional title, working in the emergency department, and length of time in the workplace were the factors for turnover intention (23,24). A similar study conducted in Indonesia identified factors as workload, schedule and personal reasons were determinants for turnover intention (24).
The ability of hospitals to retain trained and experienced emergency nurses in a cost-prohibitive healthcare environment requires action on behalf of hospital administrators (25)
Emergency Departments (ED) are highly acute patient care environments that are often unpredictable (12). Nurses working in the Emergency department are especially vulnerable to turnover because of their increased potential for developing burnout and compassion fatigue(26). 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 number of available treatment spaces (27). 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(28, 29).
Nursing Turnover is represented as a major problem for both the profession itself and healthcare provision. It has a negative impact on the 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(30). Studies have shown considerable potential cost savings where health service managers implement effective strategies to reduce nurse turnover (31).
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 institute based practices designed to increase job satisfaction thus retain nurses (32).
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 was initiated to this study.
Thus, there is a great need to conduct an organized study on nurses' turnover intention on nurses working in ED whose turnover intention is expected higher due to the department's nature, job stress, 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 public hospitals in Addis Ababa, Ethiopia. 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.