A qualitative Study on Factors that Contribute to Job Dissatisfaction and Nurse Turnover in Primary Care Facilities and Strategies to Enhance Nurse Retention
Job dissatisfaction and nurse turnover continue to be major problems in the field of the nursing profession. This research proposal proposes research that aims to study the factors that contribute to job dissatisfaction and nurse turnover in primary care facilities. The paper examines different research studies that were conducted from 2011 to 2016 in regard to the subject of job dissatisfaction and nurse turnover. Most of the reviewed literature focuses on interventions that nursing leadership can implement, such as improving the working environment, improving the remuneration of nurses, and hiring more nurses. This paper discusses the transformational leadership theory as the guiding proposition for the research. The main question that is regarded concerns the factors that contribute to job dissatisfaction and nurse turnover in primary care settings. The descriptive qualitative approach will be discussed as the most appropriate method for answering the research question. The sample will include a minimum of ten and a maximum of fifteen participants from primary care facilities. Finally, this proposal covers a timeline of three months. The investigator will analyze the data thematically, and then recommend the strategies that could improve nurse retention.
This research proposal aims to study factors that make nurses dissatisfied with their jobs in primary care facilities, thus leading to an increased number of nurses quitting their jobs. The study will also recommend approaches that employers, both public and private, can use to ensure job satisfaction for nurses in primary care facilities and to enhance nurse retention. Various research studies have already examined the issue of job dissatisfaction and nurse turnover, and they have come up with different solutions. Some of them include improving nurse staffing, increasing autonomy among the nurses, and improving the management of nurses (Dawson, Stasa, HRoche, Homer, & Duffield, 2014). However, Antwi and Bowblis (2016) contend that nurse turnover is still a significant problem in various healthcare facilities which has resulted in lower quality of nursing care delivery. Therefore, studying this issue in depth can help various employers come up with efficient ways of retaining nurses in primary care facilities. This research focuses on primary care settings because they are the places where patients make the first contact with nurses before they are referred to other advanced healthcare facilities. The next sections of this proposal include a review of the literature, underlying theory, research question, study design, research timeline, and data analysis.
Chipas and McKenna (2011) applied a descriptive study in order to examine the current level of stress and its physical manifestation in certified and student nurse anesthetists. The research also analyzed different mechanisms that nurses utilize in coping with stressful situations. This study investigated the 28,000 nurse anesthetists. The researchers designed a multifactorial questionnaire and presented it to the President of the American Association of Nurse Anesthetists, who in turn distributed it to all 28,000 nurses. The response rate was 26.9% (7,537 respondents), but it still reflected the demographics of the study population efficiently, thus guaranteeing the applicability of the results to many nurses. The research found out that 93.6% of nurses were satisfied with their jobs — however, 90% of them attributed their stress to their career demands. Most nurses indicated that they handled stress by interacting with others. According to this study, many nurses were satisfied with their jobs, but they experienced significant stress that made them intend to leave the field of their profession. Therefore, the researchers recommended the inclusion of stress management in nursing training schools as one of the main strategies of handling job-related stress. They envisioned this approach as one of the solutions to the problem of job dissatisfaction.
Similarly, Adib-Hajbaghery, Khamechian, and Masoodi Alavi (2012) conducted a qualitative study in order to comprehend the experiences and perceptions of nurses regarding job-related stress. They interviewed 19 nurses working in Kashan University of Medical Sciences hospitals. Then they analyzed the responses by using content analysis, and discovered that job demands and poor nursing management practices were among the factors that led to stress and thus to job dissatisfaction. The researchers (2012) thus concluded that improving nurse management and enhancing the working environment by providing the essential equipment can significantly reduce job-related stress. The results of this research are similar to the results of the study conducted by Chipas and McKenna (2011). Therefore, the recommendations of implementing the stress management in the studies of student nurses in the previous research and improving the work conditions in the current study could be considered as the appropriate solutions to reducing stress and to increasing job satisfaction.
However, in spite of the previous research recommending approaches to improve job satisfaction, the problem continued to be one of the main issues that the nursing profession faced. Raftopoulos, Charalambous, and Talias (2012) carried out a cross-sectional quantitative research in order to examine the factors associated with burnout syndrome among Cypriot nurses working in different clinical environments. The researchers investigated a sample of 1482 nurses, with a response rate of 80.4% (Raftopoulos et al., 2012, p. 4). The higher response rate indicated that nurses were willing to share information about the factors that contributed to their burnout syndrome. Additionally, it showed that they were committed to contributing to the efforts of finding a solution. The researchers discovered that 91.9% of nurses experienced fatigue and stress after work. However, as opposed to previous research studies, the investigators identified that stressful situations at work depended on factors such as depersonalization and age. Raftopoulos and his colleagues (2012) recognized that job-related stress and burnout syndrome were inevitable and recommended further research in order to identify other factors that contribute to burnout syndrome, to eventually come up with a complete solution.
Leong, Gu, and Liu (2012) later performed a quantitative research to identify the factors that could be associated with nursing shortage in Macao. The researchers identified the increased workload as the main problem that made nurses dissatisfied with their work in Macao. The investigators distributed questionnaires to 743 nurses, but only 467 nurses returned them, establishing a response rate of 62.85%. Some of the factors that nurses said were associated with nursing shortage included performing non-nursing duties, small salaries, and increased patient-nurse ratio. This research can be considered appropriate because it established three factors that contribute to burnout syndrome and thus to job dissatisfaction. The researchers then recommended the improvement in nurse staffing and proper remuneration in order to reduce the degree of the burnout and to motivate the nurses, thus improving their job satisfaction.
Stimpfel, Sloane, and Aiken (2012) conducted a relevant cross-sectional descriptive study to examine the effects of longer working shifts on the well-being of nurses. The researchers used questionnaires to regard 22, 275 nurses in 577 hospitals in California. They examined the experiences of nurses regarding shift length, nurse outcomes, and patient satisfaction. Although the investigators do not indicate the response rate, the percentage of the nurses included in the results section shows that it was high. The researchers established that nurses working for more than 10 hours experienced burnout and job dissatisfaction. Furthermore, the longer working shifts increased nurse turnover. The researchers recommended regulating work hours for nurses, respecting their day offs, and allowing nurses to depart immediately at the end of the shift as important measures to reduce burnout and to increase job satisfaction. These findings and recommendations are relevant to the suggestions made by Raftopoulos and his colleagues (2012) in regard to identifying other factors that contribute to burnout, in order to come up with a comprehensive solution.
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Also, Flinkman, Isopahkala-Bouret, and Salanter? (2013) conducted a longitudinal qualitative case study to analyze why young nurses intended to leave their jobs. The researchers identified that many young nurses quit their jobs at a young age. This study focused on the professional lives of three young registered nurses, and it took place in Finland, from December 2006 to March 2011. The first interview was conducted between December 2006 and May 2007. The three nurses were between 29 and 32 years old. Four years later, the researchers interviewed the respondents. The questions in both interviews focused on understanding why the nurses chose to leave their careers. The researchers analyzed the data thematically and established that work demands and poor practice environment led to job dissatisfaction, thus making the nurses quit their jobs. This research is consistent with the findings of previous studies that identify the increased job demands and a stressful working environment as the main contributors to job dissatisfaction and nurse turnover.
One of the ways of identifying the effectiveness of previous research studies is to examine the issue of burnout in nursing schools. Accordingly, Tomaschewski-Barlem and her colleagues (2014) performed a quantitative study to examine the burnout syndrome among undergraduate nursing students. The investigators further sought to analyze the relationship of academic and demographic variables in regard to burnout. The research took place at the University of Southern Brazil and studied 168 students. The researchers collected data by using the Maslach Burnout Inventory — the Student Survey tool, and analyzed it by using descriptive and variance analysis. One of the findings of the data analysis indicated that most students did not experience burnout syndrome. Therefore, they were likely to enter the job market unaware of the stressful situations waiting for them. The researchers recommended educating students in regard to the effects of burnout and coping mechanisms, the knowledge of which could reduce the degree of the issue of nurse turnover. This research confirms the relevance of the study conducted by Chipas and McKenna (2011) which recognized incorporating stress management in nursing training school as a significant measure for helping the students cope with the increased job demands.
Uhrenfeldt and Hall (2014) then conducted a qualitative study in order to explore the experiences of public hospital nurses in regard to job satisfaction. The study examined ten registered nurses and excluded those nurses who did not work in clinical settings. The investigators conducted interviews with ten respondents and analyzed data thematically. They reached similar results as the previous research studies, which indicate that increased job demands lead to job dissatisfaction. However, the researchers also identified teamwork as a significant approach to improving job satisfaction. Finally, they recommended the improvement in staffing and the enhancement of the autonomy to promote job satisfaction and thus nurse retention.
The increased stressful situations in the clinical settings and the associated job dissatisfaction led to the need to study various experiences of nurses regarding the coping strategies. The studies had to determine the effectiveness of the coping mechanisms in preventing nurse turnover. Consequently, Salaree, Zareiyan, Ebadi, and Salaree (2014) employed a qualitative approach to examine the experiences of nurses regarding the coping strategies. The researchers acknowledged the efforts of other researchers in coming up with recommendations to improve job satisfaction. Their own research took place in Iran, and they used purposive sampling, coming up with a sample of twelve nurses in the end. After conducting in-depth, semi-structured interviews, the investigators recorded the responses and analyzed them by using content analysis. The study found out that most nurses felt dissatisfied with their work, but the level of dissatisfaction depended on demographic and educational achievements. However, linking nursing with spirituality helped them cope with challenges in the workplace efficiently.
Similarly, Azimian, Negarandeh, and Fakhr-Movahedi, (2014) carried out a qualitative exploratory study to examine the coping mechanisms of nurses. However, this study focused on nurse transition. According to Cheng, Tsai, Chang, and Liou (2014), a transition from one stage to another in the professional life of a nurse presents various challenges, such as the inability of dealing with a new environment, thus leading to job dissatisfaction. Azimian and his colleagues (2014) focused on the clinical setting and studied sixteen nurses. The researchers collected data by using semi-structured interviews, and conducted the content analysis. Some of the emerging themes included ‘inadequate preparation for the transition,’ ‘welfare services’, and ‘nursing staff shortage.’ One of the main findings indicated that nurses had difficulties in coping with the new environment, which led to job dissatisfaction. The researchers then recommended preparing nurses for coping with the challenges by removing any barriers associated with them. For instance, the researchers identified nursing shortage as one of the main barriers (Azimian et al., 2014, p.93). Therefore, to enhance efficient coping and to improve job satisfaction, employers must consider hiring more nurses and preparing them for their new work environment.
Bradley and his colleagues (2015) conducted a qualitative research to examine the impact the increased patient-nurse ratio had on the care provided by obstetric care providers. Performing this study was relevant in this case, because various researchers had already recommended ways of coping mechanisms that could reduce the burnout syndrome and increase job satisfaction. This research took place in Malawi. The investigators believed that the government of Malawi had made considerable efforts in increasing the number of healthcare workers, but the level of maternal mortality remained high. Understanding the situation from the perspective of health professionals was thus necessary for ensuring not only satisfaction and prevention of burnout, but also for enhancing health care delivery. The researchers interviewed eighty four nurses in regard to their experiences of the increased patient-nurse ratio. They analyzed their responses by using the NVivo software. Similar to the previous research studies, such as the study conducted by Flinkman and his colleagues, (2013), the researchers discovered that workload and poor practice settings increased the prevalence of burnout syndrome, led to job dissatisfaction, and made some healthcare providers intend to leave their jobs. From analyzing previous studies, workload and poor working environments are chronic problems that the nursing profession faces.
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Finally, Moussa, Aboshaiqah, and Alotaibi (2016) produced quantitative descriptive research that examined the impact of the leadership styles of nurse managers on job satisfaction among nurses. The researchers analyzed the leadership styles of fifty supervisors and departmental heads and a staff of 220 nurses. The study took place in Kind Saud University, Medical City, Riyadh, Saudi Arabia. The main finding in this research indicated that a combination of various leadership styles improved the attitudes of nurses toward their work and enhanced job satisfaction and patient outcomes. This research is related to the research conducted by Adib-Hajbaghery and his colleagues (2012) which recommended the improvement of the management of nurses in order to improve job satisfaction and to enhance nurse retention.
The guiding proposition for this research is the transformational leadership theory. According to Onwe (2014), the transformational leadership theory involves four components that include inspirational motivation, idealized influence, individual consideration, and intellectual stimulation. If leaders improve the practice of these four elements, people will become satisfied with their work, which will lead to staff retention. If they face the concept of inadequacy in any of them, they suffer from low-self esteem, become dissatisfied with their jobs, and start wanting to leave their jobs.
Application of Theory to Study Focus
From the literature review, the identified factors that contribute to job dissatisfaction and nurse turnover include stressful working environments, barriers to transition, increased patient-nurse ratio, and poor management of nurses. One of the reasons explaining why these factors persist is because the leadership does not consider the complaints of nurses regarding their job dissatisfaction (Negussie, & Demissie, 2013). Consequently, this theory guides this research by assuming that nurses experience job dissatisfaction when leaders and employers do not address their pleas. Consequently, they experience enhanced satisfaction when leaders and employers do address their concerns. Thus, the strategies to enhance nurse retention must focus on nurse management.
The research studies examined in this paper present various recommendations that focus on improving job satisfaction and nurse retention. Some of the recommended strategies concentrate on reducing stressful working conditions, removing barriers to transition, improving nurse staffing, and enhancing the nursing leadership. However, there is limited literature in regard to the intention of primary care nurses to leave their jobs and to the strategies of retaining them. According to Raftopoulos and his colleagues (2012), the issue of job dissatisfaction affects the wellbeing of nurses and leads to poor patient outcomes. Therefore, if stressful working conditions persist among the nurses in primary care settings, they can result in poor patient outcomes, increased nurse turnover, and increased referrals to secondary and tertiary facilities. These arguments lead to additional research questions, such as what factors contribute to job dissatisfaction and nurse turnover in primary care settings and what strategies can be employed to reduce job dissatisfaction and enhance nurse retention in primary care facilities.
According to Taylor, Bogdan, and DeVault (2015), the research methods that the researchers choose for any study should be able suitably satisfy the aim of the research study. Accordingly, the researcher has chosen to conduct descriptive qualitative research to answer the proposed research questions. The qualitative approach is efficient while studying experiences and perceptions of people regarding any given phenomena (Englander, 2012). Additionally, the descriptive approach is useful for explaining the essential findings of the study. The researcher aims to use this method to examine factors that contribute to job dissatisfaction and nurse turnover, with the goal of coming up with strategies of retaining nurses.
The population for the study includes nurses in primary care settings. From various studies analyzed, the problems of a chronic shortage of nurses, job dissatisfaction, and nurse turnover are common among nurses who undergo practice in clinical settings. Therefore, the research will exclude nurses who do not undergo practice in clinical settings.
The researcher will then obtain a list of all primary care nurses in one hospital by requesting the information from the hospital management. The list is essential because, in turn, it forms a reliable and comprehensive list from which the researchers will draw the samples. The study will thus consider the differences in education, job experience, and demographics in order to enhance the applicability of the results.
The researcher will utilize the purposive sampling. According to Elo and colleagues (2014), purposive sampling is a strategy where the researcher determines who should be included in the study. Additionally, the researchers (2014) believe that it is especially efficient in qualitative research because the researcher chooses the respondents with the best knowledge regarding the research topic.
Sample Size Justification
The study will examine a minimum of ten and a maximum of fifteen participants. The sample size is not large since the study is cross-sectional in nature. Moreover, it will include the smaller sample, because the process of identifying a suitable sample by using judgmental sampling is rigorous and requires more time (Elo et al., 2014).
Data Collection Method
The researcher has chosen to use open-ended, semi-structured interviews because the study is qualitative. The in-depth interviews will be conducted with nurses in order to discuss their experiences and opinions, which will elicit more information that the researcher will be able to use in creating themes for data analysis. The researcher will thus have topics with guided questions. Furthermore, the interviews will occur face to face, to enable the researcher to notice non-verbal expressions as nurses discuss their experiences regarding job dissatisfaction. Additionally, the interview will consist of seven open-ended questions and will take a maximum of 40 minutes.
After seeking permission from the participants, the responses will be audio-taped to facilitate data analysis. Most importantly, the researchers will give the participants the freedom to participate or to withdraw from the study. The respondents will also have the freedom to withhold the information. Finally, the interviews will happen away from the primary care setting, in a secluded place, in order to guarantee the anonymity of the participants.
Measurement of Variables
Since this is qualitative research, it does not manipulate any variables — it examines the experiences of nurses regarding their job satisfaction. It also discusses their opinions in regard to nurse turnover with the aim of formulating the appropriate strategies to retain them. The nurses will thus provide the responses which the researchers will analyze thematically.
The researcher has proposed a three months period for the research. The first month will involve conducting a pilot study and obtaining consent from the hospital before interviewing the nurses. The process of collecting data will last for one month. The activities needed for data analysis will also take a considerable amount of time, and three months will be enough to carry out the research.
The descriptive qualitative study will not be testing a hypothesis. It will involve the analysis of the responses and the creation of themes by using content analysis. According to Vaismoradi, Jones, Turunen, and Snelgrove (2016), the creation of themes is easy when the investigators describe, analyze, and interpret the responses from participants efficiently.
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Firstly, the investigator will transcribe audiotaped responses. Secondly, the researcher will focus on describing and categorizing the data by identifying common themes. The themes will include the descriptors of job dissatisfaction and nurse turnover. The investigator will then analyze and interpret the descriptors in order to answer the research question. The researcher will also use the descriptors and the opinions of nurses regarding the issue of them leaving their jobs in order to come up with recommendations for retaining nurses in the primary care facilities.
The descriptive qualitative research is appropriate for studying the experiences and opinions of people in regard to any problem. In the case of this research, the problem is job dissatisfaction and nurse turnover. Various nurse researchers have studied two aspects and made numerous recommendations. However, the problems persist and continue to cause the nursing shortage and poor patient outcomes. Therefore, this research proposal offers a descriptive qualitative study in order to analyze factors that lead to job dissatisfaction and nurse turnover. After conducting the research, the researcher will come up with recommendations that the employers could use in order to enhance job satisfaction and to retain nurses. Most importantly, the interviews will focus on nurse management, since most recommendations from the previous literature concentrate on the actions that only the employers and nurse leaders can implement. From analyzing the data thematically, the researcher aims to answer the research question efficiently.