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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

Qualitative Study on Clinical Nurses' Intention to Stay in Hospital

Kwang-Ok Park1, Jong Kyung Kim2, Se Young Kim3
Korean Journal of Adult Nursing 2014;26(6):681-692.
Published online: December 31, 2014

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Corresponding author: Kim, Jong Kyung Department of Nursing, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 300-714, Korea. Tel: +82-41-550-3893, Fax: +82-41-559-7902, E-mail: jongkimk@dankook.ac.kr
• Received: September 22, 2014   • Accepted: November 28, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to evaluate the experience of hospital nurses regarding their intention to stay at hospital.
  • Methods
    Experiential data were collected from 10 experienced nurses through in-depth interviews. The main question was "Could you describe your experience and your work during your years at the hospital?" Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology.
  • Results
    The core category of experience regarding hospital nurses’ intention to stay was ‘following a stable rather than a challenging path’. Participants used three interactional strategies: ‘being encouraged via rapport with peers’, ‘accept reality’, and ‘find vitality in academic pursuits’.
  • Conclusion
    The retention of experienced nurses is critical to human resource management in nursing departments. This study found that experienced nurses have a vague uncertainty about their future in the hospital. Therefore, nursing managers should support experienced nurses by providing them with the opportunities needed to develop their careers, by managing conflicts in nursing units, and by implementing new programs to increase confidence.
  • Key Words: Nurses; Qualitative research; Interview; Hospitals
Figure 1.
The model of qualitative analysis of hospital nurses' intention to stay on hospital.
kjan-26-681f1.jpg
Table 1.
Categories, Sub-categories, and Concepts related to Clinical Nurses' Intention to Stay in Hospital
Categories Sub-categories Concept
Causal condition Lack of competitive alternatives - No benefits after turnover or transfer
- Salary adequate, salary increasing continuously
- Difficulty in finding another job, no alternatives
- Nursing offers a competitive advantage compared with other jobs, especially for middle-aged women.
- Patient care is a hard job, but it is bearable.
- Experiences fit nurses' aptitudes.
- Need to finance the cost of living
Core category Prefer following stability as opposed to a challenge - Pursue stability, avoid challenge.
- Try to adapt to current workplace conditions rather than seek a new start/new workplace.
workplace. - Avoid fear, because it is negative.
- Terminate difficult relationships.
- Accept kindness from everyone.
- Build a good self-image.
- Stable path, find your way
Action/ interaction strategies Seeing reality and finding power in yourself through learning and consensus 1) Being encouraged via rapport with peers - Make friends and socialize with nursing colleagues.
- Discuss work improvements with peers.
- Offer warm-hearted consolation and consideration.
- Provide mutual support in the nursing unit despite the hard work.
- Decision to stay in the same workplace because of peer relationships, reluctance to burden other nurses
- Enjoyment of nursing work
- Positive thinking
- Never worry about problems with difficult doctors.
- Repeatedly tell yourself “I am okay.”
- Don't try to change other people's minds.
- Let off steam.
- Unwind by engaging in conversation during work time.
- Recognize and accept challenging work conditions because they are common to every workplace.
- Accept that it is difficult to change other people's minds.
- Open your mind to understanding differences.
2) Accept reality - Invest in your career future by assessing other people's words and behaviors continuously.
- Be strong throughout the work period.
- Consider changing your work unit to keep your job.
- Quit only after providing excellent nursing work.
- Don't allow others to scold you.
- Take the initiative.
- Work with discretion.
- Compromise and compliance
- Be able to let go of a problem.
- Remember the beginning of your work in the hospital.
- Work hard.
3) Find vitality in academic pursuits - Build knowledge through graduate school studies.
- Maintain an interest in learning.
- Study with a supervisor.
Consequence Familiarity with the applied nursing framework 1) Familiarity with work and workplace - Take pride in the hospital, remember self-esteem, self-reflection
- Familiarity with major events in the hospital
- Don't quit without having a confirmed reason
- When all is well, time passes quickly
- Less recognition about nursing work
- Narrow human relationships
- Less autonomy
- Repetition of daily life
- Doing non-professional work daily
- Consider living without goals
2) Vague anxiety and conflict about intention stay or not - No self-development
- Continuous worry about nursing work
- Worry about daily life
- Remnants of conflict to endure
Context Find support amid ambivalence 1) Favorable work conditions - Good work environment; fewer night shifts (some nursing unit), end of an unusually busy period during hospital evaluation
- Flexible workplace environment
- No verbal violence on the job
- Personal benefits such as living in my hometown, with parents, and near friends
friends - Characteristics of seeking safety, avoiding challenges
- Passed up a potential for change
2) Difficulty with child care - Difficulty seeking child care helper
- Burdens of child care
3) Difficulty with human relationships - Difficult peer relationships in the nursing unit
- Ambivalence regarding whether to stay or leave
- Difficult psychologically
Mediating condition Positive factors 1) Consider a retirement strategy - Pension plan
- Savings plan
2) Support from a close person - Encounters with good managers and patients' families
- Support and encouragement from family and peer groups
- Support from parents living nearby
3) Nursing unit with comfort and support - Don't like wages but enjoy nursing work
- Experience in medium-sized hospital
- Good working conditions
- Supportive hospital policy
- Parental leave system for child care
- Parental leave system for child care - Maternal leave system
Negative factors 1) Job stress - Severe job stress
- Heavy work during night shifts
- Difficulty in using new work system
- Difficulty in using new work system - Stress regarding notifying doctors
- Starting intravenous lines in infants
- Busy workload prevents answering the phone
- Deficient equipment and materials
- Poor and adverse conditions (e.g.,dressing room)
- Too busy to have lunch or dinner at my workplace
2) Confronting limitations of nursing organization - Frustration about failure to relieve patients' pain
- Others ignore nursing professionals
- Unfair workplace
- No fair personnel system
- Less power for the nursing department
- Frequent turnover of new nurses
- No significant difference in salary between new and experienced nurses
- New-nurse-centered atmosphere
- Not easy to acquire parental leave
- Unfair treatment (e.g., violence) from patients and families
- Uncertainty
- Scolded without reason
- Harassment
- Difficult relationship issues, including with the boss
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    Citations

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    Qualitative Study on Clinical Nurses' Intention to Stay in Hospital
    Korean J Adult Nurs. 2014;26(6):681-692.   Published online December 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.6.681
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    Qualitative Study on Clinical Nurses' Intention to Stay in Hospital
    Korean J Adult Nurs. 2014;26(6):681-692.   Published online December 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.6.681
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    Qualitative Study on Clinical Nurses' Intention to Stay in Hospital
    Image
    Figure 1. The model of qualitative analysis of hospital nurses' intention to stay on hospital.

    Figure 1.

    Qualitative Study on Clinical Nurses' Intention to Stay in Hospital

    Categories, Sub-categories, and Concepts related to Clinical Nurses' Intention to Stay in Hospital

    Categories Sub-categories Concept
    Causal condition Lack of competitive alternatives - No benefits after turnover or transfer
    - Salary adequate, salary increasing continuously
    - Difficulty in finding another job, no alternatives
    - Nursing offers a competitive advantage compared with other jobs, especially for middle-aged women.
    - Patient care is a hard job, but it is bearable.
    - Experiences fit nurses' aptitudes.
    - Need to finance the cost of living
    Core category Prefer following stability as opposed to a challenge - Pursue stability, avoid challenge.
    - Try to adapt to current workplace conditions rather than seek a new start/new workplace.
    workplace. - Avoid fear, because it is negative.
    - Terminate difficult relationships.
    - Accept kindness from everyone.
    - Build a good self-image.
    - Stable path, find your way
    Action/ interaction strategies Seeing reality and finding power in yourself through learning and consensus 1) Being encouraged via rapport with peers - Make friends and socialize with nursing colleagues.
    - Discuss work improvements with peers.
    - Offer warm-hearted consolation and consideration.
    - Provide mutual support in the nursing unit despite the hard work.
    - Decision to stay in the same workplace because of peer relationships, reluctance to burden other nurses
    - Enjoyment of nursing work
    - Positive thinking
    - Never worry about problems with difficult doctors.
    - Repeatedly tell yourself “I am okay.”
    - Don't try to change other people's minds.
    - Let off steam.
    - Unwind by engaging in conversation during work time.
    - Recognize and accept challenging work conditions because they are common to every workplace.
    - Accept that it is difficult to change other people's minds.
    - Open your mind to understanding differences.
    2) Accept reality - Invest in your career future by assessing other people's words and behaviors continuously.
    - Be strong throughout the work period.
    - Consider changing your work unit to keep your job.
    - Quit only after providing excellent nursing work.
    - Don't allow others to scold you.
    - Take the initiative.
    - Work with discretion.
    - Compromise and compliance
    - Be able to let go of a problem.
    - Remember the beginning of your work in the hospital.
    - Work hard.
    3) Find vitality in academic pursuits - Build knowledge through graduate school studies.
    - Maintain an interest in learning.
    - Study with a supervisor.
    Consequence Familiarity with the applied nursing framework 1) Familiarity with work and workplace - Take pride in the hospital, remember self-esteem, self-reflection
    - Familiarity with major events in the hospital
    - Don't quit without having a confirmed reason
    - When all is well, time passes quickly
    - Less recognition about nursing work
    - Narrow human relationships
    - Less autonomy
    - Repetition of daily life
    - Doing non-professional work daily
    - Consider living without goals
    2) Vague anxiety and conflict about intention stay or not - No self-development
    - Continuous worry about nursing work
    - Worry about daily life
    - Remnants of conflict to endure
    Context Find support amid ambivalence 1) Favorable work conditions - Good work environment; fewer night shifts (some nursing unit), end of an unusually busy period during hospital evaluation
    - Flexible workplace environment
    - No verbal violence on the job
    - Personal benefits such as living in my hometown, with parents, and near friends
    friends - Characteristics of seeking safety, avoiding challenges
    - Passed up a potential for change
    2) Difficulty with child care - Difficulty seeking child care helper
    - Burdens of child care
    3) Difficulty with human relationships - Difficult peer relationships in the nursing unit
    - Ambivalence regarding whether to stay or leave
    - Difficult psychologically
    Mediating condition Positive factors 1) Consider a retirement strategy - Pension plan
    - Savings plan
    2) Support from a close person - Encounters with good managers and patients' families
    - Support and encouragement from family and peer groups
    - Support from parents living nearby
    3) Nursing unit with comfort and support - Don't like wages but enjoy nursing work
    - Experience in medium-sized hospital
    - Good working conditions
    - Supportive hospital policy
    - Parental leave system for child care
    - Parental leave system for child care - Maternal leave system
    Negative factors 1) Job stress - Severe job stress
    - Heavy work during night shifts
    - Difficulty in using new work system
    - Difficulty in using new work system - Stress regarding notifying doctors
    - Starting intravenous lines in infants
    - Busy workload prevents answering the phone
    - Deficient equipment and materials
    - Poor and adverse conditions (e.g.,dressing room)
    - Too busy to have lunch or dinner at my workplace
    2) Confronting limitations of nursing organization - Frustration about failure to relieve patients' pain
    - Others ignore nursing professionals
    - Unfair workplace
    - No fair personnel system
    - Less power for the nursing department
    - Frequent turnover of new nurses
    - No significant difference in salary between new and experienced nurses
    - New-nurse-centered atmosphere
    - Not easy to acquire parental leave
    - Unfair treatment (e.g., violence) from patients and families
    - Uncertainty
    - Scolded without reason
    - Harassment
    - Difficult relationship issues, including with the boss
    Table 1. Categories, Sub-categories, and Concepts related to Clinical Nurses' Intention to Stay in Hospital

    Table 1.

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