Why do nurses stay? A positive deviance study of nurse turnover

Abstract

Abstract Background Nursing shortage is a global problem and high turnover of nurses has negative effects on health care organizations and patients. In Denmark, the highest nursing shortage is found in the Zealand region, where an effort to recruit and retain nurses is urgently needed. However, not all departments are equally challenged, despite covering the same clinical areas. The aim of this study was to investigate nurses' experiences and descriptions of practices in hospital departments with low nurse turnover compared to similar departments in the same region: 1) How do nurses experience and describe the culture and work environment in their department? 2) How do nurses experience and describe practical nursing in their department? 3) How do nurses experience and describe the meaning, importance, or significance of nurse management? Methods A constructivist design with a positive deviance theoretical approach was chosen. 21 nurses from four different departments (medical, surgical, acute and psychiatric) with the lowest turnover of nurses participated during focused observations (N = 8) and focus group conversations (N = 13). Results The results revealed a sense of community between nurses and department managers; nurses identified these close relations as the reason for not seeking 'greener pastures' elsewhere. The results were presented as four categories: collaborative fellowship, professional pride, embracing management, and 'as green as it gets'. Conclusions Even though the nurses' daily practice was exhausting, they did not consider leaving their jobs due to the special culture in the departments, which brought the nurses closer together Key messages Due to the centrality of nurse managers as a reason for nurses’ retention, future attention should focus on the cultural and strategic perspectives and actions of nurse leaders. Collaborative fellowship and professional pride can not be underestimated as means to retention and recruitment of nurses.