Working Conditions and Staff Nurse Retention in Rural Healthcare Organizations
Authors:   , Brown Rebecca 
Published: February 2023

Retention of registered nurses is affected by a number of factors including, but not limited to, the aging current workforce, differences in women’s career choices, and work environment (Texas Nurses Association, 2000). Dissatisfaction and turnover in an organization can be related to employee and supervisor relationships, as well as to the employee’s perception of the supervisor’s ability, benevolence, and integrity. An organization may determine the need for a proactive approach to prevent the loss of staff, and this may be accomplished by assessing the culture of the organization. / The level of knowledge regarding the impact of organizational culture on nurse retention is extremely limited, with no studies on retention and organizational culture/climate in the rural healthcare facilities. The purpose of this investigation was to develop a knowledge base regarding working conditions and staff nurse retention, and to describe and quantify potential relationships between a healthcare organizations’ working conditions and the retention of registered staff nurses. The significance of this investigation was demonstrated by an alarming shortage of nurses that ultimately will compromise patient care. / Dorothea Orem’s Philosophy of Self-Care (Orem, 2001) and Kanter’s Structural Theory of Power in Organizations (Kanter, 1993) were utilized to develop the theoretical framework of this investigation. Orem suggests that nurses not only see the person nursed but also themselves as embodied beings with numerous powers and capabilities. Kanter notes that people react rationally to situations, and when placed in situations that produce empowerment they will thrive. With empowerment, affective commitment to the organization occurs. / This investigation demonstrated a significant relationship between organizational culture and registered nurse retention in rural hospitals in a Midwestern state. The Conditions of Work Effectiveness Questionnaire (Laschinger, Finegan, & Shamian, 2001) was utilized in conjunction with the Organizational Commitment Questionnaire (Mowday, Steers, & Porter, 1979) and Brown’s Demographic Questionnaire (2002). / The descriptive data results revealed that of the registered nurse participants, (N=176; 53% return rate), 72.2% were very likely to be retained by their healthcare organizations. Additionally, a mean score of 65 on the Organizational Commitment Questionnaire indicated positive organizational commitment of the participants. Assessment of access to opportunity, information, support, resources and power were completed utilizing the Conditions of Work Effectiveness Questionnaire. Statistical analysis using Pearson’s Product Moment Correlation coefficient determined if a correlation existed between: (a) number of years employed by the organization with work effectiveness, predictive work effectiveness and overall work effectiveness, (b) work effectiveness and organizational commitment, (c) organizational commitment with predictive work effectiveness, overall work effectiveness and global work effectiveness, and (d) intent to be retained with work effectiveness, predictive work effectiveness, overall work effectiveness, global work effectiveness and organizational commitment. Statistically significant correlations were found to exist in all areas of analysis. Correlation between total work effectiveness and organizational commitment was statistically significant at the 0.05 (p&lt;.05) level. All other correlations were statistically significant at the 0.01 (p&lt;.01) level. Conclusions regarding organizational working conditions and the relationship with registered staff nurse retention were made and recommendations for further research were identified with a focus on nursing theory, practice, research and education.