Do leaders in departments with low nurse turnover use unique strategies? A positive deviance study

Abstract

Abstract Background High nurse turnover in hospitals is a global problem and factors such as nurses' relationships with their managers have been associated with retention and turnover. Previous studies have utilized a deficit-based approach. This study aims to investigate nurse leaderś experiences and descriptions of practices in hospital departments with low nurse turnover in a region facing the highest nurse turnover rates in Denmark. The research questions were: What considerations and strategies regarding turnover do the nurse leaders have? How do the nurse leaders describe the culture and work environment in their departments? Methods A constructivist design with a focused ethnography methodology was used to construct data, primarily through interviews. Positive deviance inspired the theoretical perspective. Head nurses and ward managers from medical, surgical, acute and psychiatric departments with the lowest nurse turnover participated in the study (total 9 leaders). The female leaders, had an age range from 43 to 65; their management experience ranged from 1 to 27 years. Results Despite the fact that leaders came from very different contexts, they all had clear visions for the culture and values of their departments, including ideas about how to proceed with the current and future challenge of nurse turnover. The results are presented as two categories related to the research questions: The culture is unique, and Maintaining, protecting or re-establishing the unique culture. Conclusions Nurse leaders from departments with low nurse turnover compared to similar departments in the same region all described their cultures as unique, but held in common values of diversity and balance in the group of staff, and the leaders' roles were focused on maintaining, protecting or re-establishing that culture. Key messages Nurse leaders with clear cultural awareness and visions for the context in which they operate may be positively associated with lower nurse turnover. The head mainly nurses lead indirectly by securing the best possible conditions at a strategic level, so the nurses could thrive.