Nursing Practice Environment and Turnover

The main factor in the overall practice environment that influenced RN turnover was the practice environment as a whole. This variable was measured by the PES-NWI score after correcting for RN features, units, and hospitals. Specific attributes under the overall practice environment included the tenure, age, and education level of the RN, hospital ownership, and case mix index (CMI). Hospital units owned by the government had lower RN turnover rates compared to hospitals owned by non-governmental bodies. This difference is linked to discrepancies in employee benefits, discipline practices, and performance.

The Association Between RN Turnover and Specific Practice Environment Characteristics

Specific practice environment features that affected RN turnovers were improved staffing and an abundance of resources. These factors were linked with reduced rates of RN turnover. The authors reported that a one-point increase in the staffing and adequacy of resources PESNWI subscale score resulted in a 14.8% reduction in RN turnover. Having sufficient resources and staffing levels reduces burnout, increases job satisfaction, and reduces intentions to leave, which ultimately minimizes RN turnover. In contrast, enhanced managerial support was associated with high RN turnover rates because RNs in such settings were unlikely to recount intentions to leave because of job dissatisfaction but ultimately leave because of other reasons. Other factors that affected RN turnover were CMI, hospital ownership, average RN age, tenure, and level of education. The direction of their contribution was similar to what was observed in the general practice traits. There was no significant relationship between the extent of involvement in hospital affairs, collegial RN-physician relations, and RN turnover.