Turnover Intention Among Hospital-Based Registered Nurses in the Eastern Caribbean

AbstractPurpose: Vacancy rates for nurses in the English-speaking Caribbean are estimated at 30% with turnover typically associated with migration. The purpose of this study was to describe the characteristics of hospital-based registered nurses (RNs) in the sub-region, their practice environment and turnover intention in two and five years, respectively, and to determine the relationships among practice environment characteristics and turnover intention.Design: A descriptive correlational design was used with self-reported questionnaires from a convenience sample of 301 RNs working in hospitals in four English speaking Eastern Caribbean countries. Single-item visual analog scales (VAS) were used to measure turnover intention in 2 years and 5 years. The Practice Environment Scale of the Nursing Work Index (PES-NWI) measured the characteristics in the practice environment.Findings: The mean age of the nurses was 32.5 (SD = 6.75) years. Most nurses (58.8%) were single and 91.4% had relatives living abroad. Nurses scored three PES-NWI subscales Conclusions: The practice environment, while generally unfavorable, is not associated with the nurses' intention to leave their jobs. These findings support the current policy position that calls for managing turnover among nurses. Nursing and health system administrators should assess, plan, and implement workforce policies to slow the outflow of nurses.Clinical Relevance: Initiatives to improve the work environment and the delivery of high-quality care are important to RNs in the Eastern Caribbean. Managing the negative impact of continuous outflow of nurses through turnover requires long-term coordinated policy and human resource development and management initiatives to sustain the supply of RNs in the subregion.Key wordsTurnover intention, nurse migration, work environment, nursing human resources policyNurse migration is diminishing the supply of registered nurses (RNs) in the Caribbean. A recent study by the World Bank (2009) found 30% vacancy rates for all approved positions in the English-speaking Caribbean. Nurse migration is the main cause of turnover among nurses in the Caribbean region and accounts for an estimated 70% of losses in the nursing workforce (World Bank, 2009). This phenomenon is threatening the sustainability of health systems in the region to deliver high-quality health care.Researchers have identified push and pull factors related to nurses migrating out of their country. Factors include economic conditions, political factors, social reasons, job satisfaction, educational opportunities, working environment, and professional status (Buchan, 2006; World Bank, 2009; Yan, 2006). In response to the migration problem, the Caribbean region adopted a managed migration strategy to address push and pull factors. Some of the strategies relate to improving the practice environment in the Caribbean region, such as terms and conditions of work, management practices, and retention (Yan, 2006). Though these broad strategies to reduce the push factor are well intended, there is a paucity of research in the region to guide specific interventions.Literature ReviewNumerous studies support the importance of adequate hospital staffing by RNs. More recent studies show that lower levels of nurse staffing are associated with an increased risk of death (Needleman et al., 2011), higher mortality for non-intensive care unit patients (Sales et al. …