Determinants of nurse turnover in rural primary health centres at micro, meso and macro levels within the health system of Tamil Nadu, India: a study protocol

Abstract

Introduction: Nurses play a critical role in delivering patient care services at the grassroots level. But, frequent nurse turnover in rural primary health centers (PHCs) becomes a barrier in achieving health goals in Tamil Nadu (TN), which is the highest populated state in South India. Objective: The study aims to identify the determinants of nurse turnover in rural PHCs and to inform policy-making at micro, meso, and macro levels within the health system of Tamil Nadu, India. Methods: We will adopt an integrative qualitative design consisting of five phases. In phase 1, we will do a rapid literature review to develop an initial analytical framework and in phase 2, we will conduct a systematic review for upgrading the analytical framework into an interpretive framework on the determinants of nurse turnover and on the policies adopted in rural PHCs in India to overcome it. In phase 3, we will proceed with a qualitative inquiry at the micro-level and leading to an enriched interpretive framework. In phase 4, we will conduct a policy analysis at the macro, meso and micro levels of the Tamil Nadu health system and will develop a nurse turnover policy outline. In phase 5, we will develop an integrated three-level analysis leading to a systemic multilevel framework on the determinants of nurse turnover with an overview of policy options in rural PHCs in Tamil Nadu. Conclusion: We anticipate the conceptualization of the current research design to be a pathbreaking model for nurse researchers in conducting Health Policy and System Research. We metaphorically picturise the design as a plant grafting model and will additionally conduct an empirical case study analysis on the basis of the current design.