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Compromised standards of patient care are forcing many rural nurses to quit, research suggests.
A Charles Sturt University (CSU) PhD graduate may have some of the answers to the persistent problem of nursing workforce shortages due to challenges in retaining staff, especially in rural areas.
Dr Susan Bragg, who graduated with a PhD from the CSU School of Nursing, Midwifery and Indigenous Health in December, explored the vexed issue in her PhD thesis, ‘Degree of value alignment – why nurses resign: a grounded theory study of rural nurses’ resignations.’
Bragg based her study on previous research that indicated job dissatisfaction is implicit in nurse resignations from rural hospitals, however, the identification of the underlying reasons that contribute to job dissatisfaction have remained elusive.
“My findings indicate that nurses resign from NSW rural hospitals when hospital values change and nurses are unable to realign their values to the hospitals’. The main value held by the nurses I interviewed was to provide a high standard of patient care, but nurses found it increasingly difficult to do so due to changes in rural hospitals,” Bragg said.
“These changes included rural area health service restructures, centralisation of budgets and resources, cumbersome hierarchies and management structures that inhibit communication and decision making, outdated and ineffective operating systems, insufficient and inexperienced staff, bullying, and a lack of connectedness and shared vision between nurse and hospital.
“A decreased degree of value alignment between nurse and hospital is paramount in rural nurse resignations; the greater the degree of value alignment, the greater the possibility of nurse retention.”
Bragg said that the theory emerges around the core category of “conflicting values”, which explains the conflict between nurses’ personal values - how they perceive nursing should occur, and organisational values - how the hospital enables nurses to perform their duties.
“Conflicting values emerges as a basic social process that encompasses three stages which nurses move through prior to their resignation.
“The first stage is sharing values, a time when nurse and organisation share similar values. The second stage is conceding values where, due to changes in the organisation’s values, nurses perceive that patient care becomes compromised and values diverge between the nurse and the hospital. The final stage, in which the nurse eventually resigns, is where nurses ‘give up’ and feel that they compromise their professional integrity, that their values are conflicted, and that they are unable to realign their values to those of hospitals.
“Unless nurses’ values and hospitals’ values are aligned, nurses will continue to resign.
“Effective retention strategies must address contributors to the decrease in value alignment. They must enhance shared values between nurses and hospitals, give nurses back control of nursing, and create an environment that is patient-focused and conducive to nursing,” Bragg said.
This story first appeared in CSU News.
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