A Case Study of Critical Reasons Behind Hospital Nurses Turnover Due to Challenges Across System Levels

PURPOSE: The aim of this study was to analyze how critical factors at different levels in a health-care system interact and impact nurses’ intention to leave and decision to quit their job at a hospital unit. METHODS: A case study of assistant and registered nurses’ intentions to leave as well as staff turnover at a smaller Swedish public hospital was performed. Employee surveys and interviews with assistant and registered nurses who had quit their job at four units in the hospital during the period 2012–2019 were performed. Critical factors regarding nurses’ intention to leave and staff turnover are analyzed by combining narrative methods with a critical incidence technique. RESULTS: Three main themes emerge from the analysis of factors contributing to the decision to quit, namely lack or loss of buffering factors, not owning your spare time and not feeling valued by and listened to by upper management. CONCLUSION: Decision-makers, including hospital management, need to consider how supportive factors in nurses’ closest work environment that promote staff retention may be impacted by decisions at higher levels, such as health-care reorganizations and stricter governance. In this context, upper management adopting a servant leadership approach might contribute to employees to a greater extent feeling valued and being listened to. Finally, the results indicate that individual nurses’ recovery, ability to work and ability to coordinate their personal life with their work life need to be supported by policies and decisions at higher levels in order to retain nurses in intensive and emergency health-care settings.