Globally, the quality of the nursing workforce and the existence of professional practice environment (PPE) are in close association with client care satisfaction, quality of care delivery and positive staff job outcomes (1, 2). The subject of staff turnover is an important area in every health care setting; and it needs thorough research to sustain evidence-based nursing practice in health care organizations especially in low-resourced countries.
It is reported that health facilities with positive PPE and adequate nursing workforce had improved outcomes for both patients and nursing staffs (3, 4, 5). Nurses’ evaluation on quality care and job satisfaction in the high-resourced countries ranges from worst to best. It is noteworthy to know that countries using the Magnet Certification to encourage value-added practice environments such as the United States has improved in its provision of quality care to patients and other job outcomes (6).
Among the major challenges of low-and-middle income countries’ (LMICs) work environment is inadequate number of nurses with its corresponding negative effects of nursing job outcomes (job dissatisfaction, higher staff turnover and poor quality of care delivery). Studies have shown higher incidence of turnover intentions of nurses in LMICs (7, 8), though same cannot be said about the high-resourced countries (9). This phenomenon, if not effectively tackled can cause a lot of challenges in the health care provision in the long run globally.
Staff turnover is the process by which workers vacate their job or are transferred from the worker's employment (10). Health labour force scarcities have consequences on global health care delivery and quality of patients’ care; appreciating the challenges of turnover rate and retention of staff is essential to advice on strategies for improving the nursing workforce. Institutions where staff freely express their plans of quitting job usually have higher turnover, thus, employees' intent to leave a job is highly linked with actual quitting of their job (11, 12). In such circumstances, employers face difficulty of not knowing the reasons behind employees’ intention to quit an organisation. High staff turnover intentions in many organisation are attributed to factors such as poor quality of staffing and inadequacy of working material to care for the patient (13, 14, 15). Such poor work conditions present high work demand with low nurses’ autonomy over their job, inadequate group support, and increased physical and emotional work demand. Lack of support from nurse managers, unjustified workloads and increased emotional exhaustion of nurses mostly lead to increased staff intentions of resignation (10, 11, 12). Moreover, most nurses leave their job owing to financial reasons, professional/career development and organizational climate (12, 13).
Nursing leadership consciousness of the reasons behind turnover intention can help improve the organisational culture (14, 15). It can also inform nurse managers and administrators about important pillars in health care delivery that makes nursing workforce satisfied. Significantly, periodic organizational evaluation of the factors accounting for turnover intention is identified to usually boast of enriched self-esteem and satisfaction of staff, which are vital for quality of patients’ care and retention of nurses (16, 17, 18).
In LMICs settings such as Ghana, where turnover intention for workers is projected to be 25.9%; insufficient wages, increased burnout, limited prospects in the area practice and bias in career upgrade are cited as the reason of leaving job. The resultant problem is burnout of the few staff who remain to work at the practice environment (19, 20, 21). These factors account for the major cause of high turnover of health staff in the health care settings.
High turnover intentions in any organization presents its own challenges, notably is high monetary lost. Moreover; the financial costs of nurses quitting their job in organisations are projected to be higher than before (22, 23, 24). With a very challenging nurse-patient ratio in Ghana, there are still reported high rate of brain drain and rise in turnover intention among skilled workers (25, 26). With the health care industry depending on the few remaining nurses, the challenge of burnout also emanate. This situation is identified to bring about reduction of quality of care provision to patients, as facilities count on the few emotional exhausted nurses to provide service to the numerous patients (33).
The problem of high staff turnover rate is an important area in every health care setting; and it needs thorough discussion in the quest to sustain quality in the health care industry. Addressing this problem can fix the quality of patient’s care challenge in most health facilities. Contrariwise, there is limited data on the Ghanaian nursing work environment and its implications on turnover intentions among nurses. The study therefore assessed the impacts of PPE and burnout on turnover intentions among nurses in Ghana. Thus, the study sought to ascertain if nurses intended to leave job, assess the relationship between PPE and turnover intention of nurses and to determine the predictors of turnover intentions among nurses. Findings can inform policies to reduce staff turnover thereby addressing unhealthy practice environment, burnout and quality of patient’s care challenge especially in the sub-Saharan Africa.