Understanding the Individual and Organizational-level Drivers of Newly Licensed Registered Nurse Turnover in the United States after 2010
Creators: name: Ismail, Yena 
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2023

description: Background:
The nursing shortage is currently a major problem for US healthcare, set to only worsen as more nurses head towards retirement. A major contributor to this shortage is the high turnover rate of nurses, especially newly licensed registered nurses (NLRNs), who are RNs with less than 2 years of work experience. Despite the recommendations and adjustments made after the Affordable Care Act and the Future of Nursing report, NLRN turnover remains extremely high. Nurse residency programs have worked to reduce the turnover of NLRNs, as they ease the transition into practice. With turnover rates remaining at around 30% for the last decade, it is essential to understand the causes of this phenomenon.  
Objectives:
The purpose of this study is to conduct an integrative review of the literature to analyze the factors, both at the individual and organizational levels, that impact NLRN intention to leave and actual turnover. 
Search methods:
Three online databases (Pubmed, CINHAL, Scopus) were searched for studies related to new nurses and turnover published after 2010. A total of 458 unique articles were retrieved for the screening process. 
Selection criteria:
Studies were included if they focused on NLRNs and turnover metrics. Studies were excluded if they were not empirical, not in English, published prior to 2010, focused on the wrong variables, or if the study was not conducted in the US.
Data collection:
Two readers independently used a data extraction sheet modified from Li and Jones (2013) in order to collect data regarding the study characteristics, the variables affecting turnover, and the change in turnover metrics during the study period. 
Main results:
The integrative review yielded 24 relevant articles, 8 focused on interventional studies and 16 focused on descriptive studies. The descriptive studies found that on an individual level, job enjoyment and salary played a significant role in an NLRN’s decision to turn over. On the organizational level, they found that poor management and nurse relations were significantly correlated with higher turnover. The interventional studies assessed job embeddedness on the individual level, but there was inconsistency regarding the significance of personal factors when correlated with turnover. On an organizational level, social support and interpersonal conflict were also large contributors to turnover. When examining the studies all together, there were two main themes that emerged. On the individual level, the greatest contributor and driver of turnover was stress, specifically job performance stress. On an organizational level, the biggest protector against turnover behavior was group cohesion. 
Discussion:
The data indicates a greater impact on turnover from systematic factors such as social support, management, and environmental safety. While a focus on residency programs has eased transition into practice, turnover should be addressed through large-scale and organization-wide efforts to address the problems identified.