Abstract
Introduction
Few studies have examined emergency nurses who have left their job to better understand
the reason behind job turnover. It also remains unclear whether emergency nurses differ
from other nurses regarding burnout and job turnover reasons. Our study aimed to test
differences in reasons for turnover or not currently working between emergency nurses
and other nurses; and ascertain factors associated with burnout as a reason for turnover
among emergency nurses.
Methods
We conducted a secondary analysis of 2018 National Sample Survey for Registered Nurses
data (weighted N = 3,004,589) from Health Resources and Services Administration. Data were analyzed
using descriptive statistics, chi-square and t-test, and unadjusted and adjusted logistic regression applying design sampling weights.
Results
There were no significant differences in burnout comparing emergency nurses with other
nurses. Seven job turnover reasons were endorsed by emergency nurses and were significantly
higher than other nurses: insufficient staffing (11.1%, 95% confidence interval [CI]
8.6-14.2, P = .01), physical demands (5.1%, 95% CI 3.4-7.6, P = .44), patient population (4.3%, 95% CI 2.9-6.3, P < .001), better pay elsewhere (11.5%, 95% CI 9-14.7, P < .001), career advancement/promotion (9.6%, 95% CI 7.0-13.2, P = .01), length of commute (5.1%, 95% CI 3.4-7.5, P = .01), and relocation (5%, 95% CI 3.6-7.0, P = .01). Increasing age and increased years since nursing licensure was associated
with decreased odds of burnout.
Discussion
Several modifiable factors appear associated with job turnover. Interventions and
future research should account for unit-specific factors that may precipitate nursing
job turnover.
Key words
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References
- Nursing perspectives about the critical gaps in public health emergency response during the COVID-19 pandemic.J Nurs Scholarsh. 2022; 55: 22-28https://doi.org/10.1111/jnu.12795
- The powder keg: lessons learned about clinical staff preparedness during the early phase of the COVID-19 pandemic.Am J Infect Control. 2021; 49: 478-483https://doi.org/10.1016/j.ajic.2020.10.014
- Nurses’ burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis.J Adv Nurs. 2021; 77: 3286-3302https://doi.org/10.1111/jan.14839
- Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.Gen Hosp Psychiatry. 2020; 66: 1-8https://doi.org/10.1016/j.genhosppsych.2020.06.007
Dzau VJ, Kirch D, Murthy V, Nasca T. National plan for health workforce well-being. National Academies Press. Accessed XXX. https://nap.nationalacademies.org/read/26744/chapter/1
- The physician attrition crisis: a cross-sectional survey of the risk factors for reduced job satisfaction among US surgeons.World J Surg. 2018; 42: 1285-1292https://doi.org/10.1007/s00268-017-4286-y
- A death in the family.JAMA. 2017; 318: 1543-1544https://doi.org/10.1001/jama.2017.13531
- Association of clinician burnout and perceived clinician-patient communication.Am J Emerg Med. 2018; 36: 156-158https://doi.org/10.1016/j.ajem.2017.07.031
- Factors contributing to high turnover rates of emergency nurses: a review of the literature.Aust Crit Care. 2020; 33: 390-396https://doi.org/10.1016/j.aucc.2019.09.002
- Future emergency nursing workforce: what the evidence is telling us.J Emerg Nurs. 2019; 45: 132-136https://doi.org/10.1016/j.jen.2018.09.009
- Review article: staff perception of the emergency department working environment: integrative review of the literature.Emerg Med Australas. 2016; 28: 7-26https://doi.org/10.1111/1742-6723.12522
- Prevalence of burnout in mental health nurses and related factors: a systematic review and meta-analysis.Int J Ment Health Nurs. 2019; 28: 1032-1041https://doi.org/10.1111/inm.12606
- Prevalence of burnout in paediatric nurses: a systematic review and meta-analysis.PLoS One. 2018; 13e0195039https://doi.org/10.1371/journal.pone.0195039
- The impact of burnout on emergency nurses’ intent to leave: a cross-sectional survey.J Emerg Nurs. 2021; 47: 892-901https://doi.org/10.1016/j.jen.2021.07.004
- The unique environmental influences of acute care settings on patient and physician well-being: a call to action.J Emerg Med. 2018; 54: e19-e21https://doi.org/10.1016/j.jemermed.2017.08.092
- National estimates of the reserve capacity of registered nurses not currently employed in nursing and emergency nursing job mobility in the United States.Ann Emerg Med. 2021; 78: 201-211https://doi.org/10.1016/j.annemergmed.2021.03.006
National sample survey of registered nurses. Health Resources and Services Administration Health Workforce. Published 2019. Accessed April 22, 2020. https://bhw.hrsa.gov/health-workforce-analysis/data/national-sample-survey-registered-nurses
Nichols EM, Kephart KM, Malakhoff LA. Implementing branching logic by enabling and disabling questions in the online version of the National Sample Survey of Registered Nurses: results of a usability evaluation. Research and Methodology Directorate, Center for Survey Measurement Study Series, U.S. Census Bureau. Accessed May 1, 2022. http://www.census.gov/content/dam/Census/library/working-papers/2018/adrm/rsm2018-13.pdf
- Questions and answers when designing surveys for information collections. Office of Information and Regulatory Affairs, Office of Management and Budget.https://obamawhitehouse.archives.gov/sites/default/files/omb/inforeg/pmc_survey_guidance_2006.pdfDate accessed: July 24, 2020
ANA urges US Department of Health and Human Services to declare nurse staffing shortage a national crisis. American Nurses Association. Published September 1, 2021. Accessed September 1, 2021. https://www.nursingworld.org/news/news-releases/2021/ana-urges-us-department-of-health-and-human-services-to-declare-nurse-staffing-shortage-a-national-crisis/
- Professional Flourishing: the job demands-resources model and emergency nursing.J Emerg Nurs. 2019; 45: 607-610https://doi.org/10.1016/j.jen.2019.09.008
- Burnout, hopelessness and suicide risk in medical doctors.Clin Ter. 2010; 161: 511-514
- McGuinness TM suicide among RNs: an analysis of 2015 data from the national violent death reporting system.Am J Nurs. 2020; 120: 24-28https://doi.org/10.1097/01.NAJ.0000718624.25806.3f
- Nurse turnover: the mediating role of burnout.J Nurs Manag. 2009; 17: 331-339https://doi.org/10.1111/j.1365-2834.2009.01004.x
- Does unit culture matter? The association between unit culture and the use of evidence-based practice among hospital nurses.Appl Nurs Res. 2020; 53151251https://doi.org/10.1016/j.apnr.2020.151251
- On the threshold of safety: a qualitative exploration of nurses’ perceptions of factors involved in safe staffing levels in emergency departments.J Emerg Nurs. 2017; 43: 150-157https://doi.org/10.1016/j.jen.2016.09.003
- Why causal inference matters to nurses: the case of nurse staffing and patient outcomes.Online J Issues Nurs. 2016; 21: 2https://doi.org/10.3912/ojin.vol21no02man02
- Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals.Lancet. 2021; 397: 1905-1913https://doi.org/10.1016/S0140-6736(21)00768-6
- ENA Position Statement Committee. Staffing and Productivity in the Emergency Department.
- The state of the science of nurse work environments in the United States: a systematic review.Int J Nurs Sci. 2018; 5: 287-300https://doi.org/10.1016/j.ijnss.2018.04.010
- The relationship between mindfulness, triage accuracy, and patient satisfaction in the emergency department: a moderation-mediation model.J Emerg Nurs. 2019; 45: 644-660https://doi.org/10.1016/j.jen.2019.08.003
- Active intervention can decrease burnout in Ed nurses.J Emerg Nurs. 2017; 43: 145-149https://doi.org/10.1016/j.ijnss.2018.04.010
- Psychological interventions to foster resilience in healthcare professionals.Cochrane Database Syst Rev. 2020; 7: CD012527https://doi.org/10.1002/14651858.CD012527.pub2
- The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.The National Academies Press, 2021
- Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States.Gen Hosp Psychiatry. 2021; 69: 20-26https://doi.org/10.1016/j.genhosppsych.2021.01.001
- Nurse practitioner–physician comanagement: a theoretical model to alleviate primary care strain.Ann Fam Med. 2018; 16: 250-256https://doi.org/10.1370/afm.2230
- Nurse practitioner-physician co-management of primary care patients: the promise of a new delivery care model to improve quality of care.Health Care Manag Rev. 2019; 44: 235-245https://doi.org/10.1097/HMR.0000000000000161
- Nurse practitioner–physician comanagement of patients in primary care.Policy Polit Nurs Pract. 2018; 19: 82-90https://doi.org/10.1177/1527154418815024
National plan for health workforce well-being. National Academy of Medicine. Published 2019. Accessed July 24, 2020. https://nam.edu/initiatives/clinician-resilience-and-well-being/national-plan-for-health-workforce-well-being/
- The critical nature of addressing burnout prevention: results from the Critical Care Societies Collaborative’s National Summit and Survey on Prevention and Management of Burnout in the ICU.Crit Care Med. 2020; 48: 249-253https://doi.org/10.1097/ccm.0000000000003964
Biography
Allison A. Norful is Assistant Professor, Columbia University School of Nursing, New York, NY. Twitter: @USNursing. ORCID identifier: https://orcid.org/0000-0002-6202-058X.
Biography
Kenrick Cato is Assistant Professor, Columbia University School of Nursing, New York, NY. Twitter: @kenrickcato. ORCID identifier: https://orcid.org/0000-0002-0704-3826.
Biography
Bernard P. Chang is Associate Professor, Columbia University Irving Medical Center, Department of Emergency Medicine, New York, NY. Twitter: @bernardchangMD. ORCID identifier: https://orcid.org/0000-0001-8800-7140.
Biography
Taryn Amberson is PhD student, Department of Health Systems and Population Health, Seattle, University of Washington, WA. Twitter: @AmbersonTaryn. ORCID identifier: https://orcid.org/0000-0001-7088-2545.
Biography
Jessica Castner is President, Castner Incorporated, 2021-2022 Academy of Medicine Distinguished Nurse Scholar in Residence, Grand Island, NY. ORCID identiafier: https://orcid.org/0000-0001-9889-3844.
Article info
Publication history
Published online: February 06, 2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
