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It is important for healthcare organization to analyze reasons that nurses (or healthcare occupationsthat are in shortage) leave a healthcare organization.

HCOs can utilize exit interviews or attitude surveys to discover the reasons for leaving.o Personal reasons: age, number and age of children, wage rate, years of experience,

educational level

o Professional reasons: workload/staffing issues, scheduling, stress, support frommanagers and administrators, communication, professional autonomy, professional

development, recognition

HCOs can control the work-related factors that influence turnover rates such as:o Payo Job performanceo Role clarityo Job design

o Overall job satisfactiono Satisfaction with payo Work itselfo Supervision

o Coworkerso Promotion opportunitieso Organizational commitment

Why is it important for HCOs to minimize turnover rates?o Shortages may jeopardize patient quality of care.o It is expensive to recruit and train new employees. Keeping costs low will make

an HCO more competitive by them being able to utilize monies in other areas.

EXIT INTERVIEWS

Information gathering session with departing employeesoUsed to create better public relationsoChecking for the soundness of initial

selection procedures

oUncovering poor personnel practicesoSpecific sources of job dissatisfaction

Criticisms of exit interviewso Difficulty in obtaining trained interviewerso Unknown accuracy of interviewees commentso Possibility of distortion of factso Unwillingness to discuss reasons honestlyo Managers may be biased b/c they are personally involvedo Employee does not want to jeopardize referenceo Validity may be very low for exit interviewso Deficient in identifying the overall intensity of employee dissatisfaction o Deficient in identifying conflict management within the organizationo (Weisman, Alexander, and Chase) study found data to be simplistic and

misleading for management purposes

Exit interviews remain the major data source for nurse turnover o There is a need to establish reliable data collection and analysis

ATTITUDE SURVEYS

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Management can learn how employees view their jobs, supervisors, wages and benefits,working conditions, and other work factors

Predetermined questions with low to high scale responses Surveys function as an employee voice Keeps the organization responsive to employee concerns NYSE study found 69% of corporate respondents found attitude surveys to be successful(28% did not respond ) Another study found that firms that used attitude surveys had the following:

o Better financial performanceo Higher financial ratingso Better employee relations

Attitude surveys give managers some time to intervene positively and address problemsbefore a nurse terminates or leaves the HCO.

CASE STUDY at Tertiary Care Medical Facility

1) Do exit interviews of terminating nurses or attitude surveys of nursing staff provide themost useful and valid information concerning factors associated with nurse retention?

2) Do exit interview or attitude survey questions regarding specific recommendations thenurses would like to see implemented add additional information beyond that which canbe generated by asking directly which factor impact the likelihood (or reality) of leaving?

Findings:

Terminated nurses were much more likely than nursing staff to identify non-job relatedfactors as determinants of termination.

o 50% terminating nurses responded non-job related factorso 3% of the nursing staff responded non-job related factors

The most serious issues identified on the attitude survey were not mentioned by thedeparting staff.

o Inadequate staffing (only response by terminating nurses)o Management favoritismo Work schedulingo Lack of appreciation

The nursing staff provided significantly more recommendations on the attitude surveythan the departing nurses did on the exit interview.o Concerns that were brought up as recommendations gave insight into further areas

of that may require attention and decrease negative feelings towards the

organization

RECOMMENDATIONS

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HCOs could use the exit interview and attitude surveys, in complement with each other. Human resource professional that is trained should conduct the exit interview. Attitude survey findings should be reported to employees. Actions should be taken to address problems.

o If management fails to act employees may become angry and resentful. Follow-up surveys should be taken. (Lack of follow-up can result in cynicism or higher

turnover.)