Micro-, Meso- and Macrofactor Relationships in Nursing Turnover: Insights From Survey and Interview Data

Abstract

Background: Nurse retention is a persistent and complex problem. Using a system approach, we aimed to understand what is currently impacting nursing turnover and the interplay between the micro-, meso- and macrolevel factors. Materials and Methods: We surveyed and interviewed current and former nurses using a convenience sampling approach. The survey n = 479, which targeted working nurses, included questions on job satisfaction and workload. For interviews, we recruited both practising nurses and nurse leavers n = 35. The interviews explored individual experiences and perspectives on nursing and what influences nursing turnover. The data were analysed through a system lens, exploring the relationship between an individual's behaviour, interactions and relationships (microlevel), the organisational environment, including policies and regulations (mesolevel) and the social, economic, political and cultural norms within which individuals and organisations reside (macrolevel). Results: Results showed a complex interplay of micro-, meso-, and macrofactors shaping the nursing experience. The survey data revealed poor satisfaction with work-life balance (51%), control over work (43%) and remuneration (43%). Over half (53%) of the participants were considering leaving their organisation, and 36% were contemplating exiting the profession due to exhaustion (74%), inadequate staffing (72%), feeling undervalued (66%), low pay (61%) and excessive pressure (58%). Qualitative interviews revealed negative personal interactions, generational conflicts, unmet or poor expectations of nursing (microlevel), limited autonomy, administrative burdens, poor work-life balance (mesolevel), integration challenges and prohibitive immigration policies for foreign nurses, negative public perceptions and the impact of education on nursing expectations (macrolevel). Furthermore, we found that these factors do not operate in isolation; rather, micro-, meso- and macrolevels interact. Conclusions: Our study underscores the importance of adopting a system approach to understand and address nursing retention issues. Examining micro-, meso- and macrofactors and the interplay between these levels is essential in developing targeted interventions to improve nurse retention.

Keywords: job satisfaction; nurse retention; qualitative research; turnover.

Figure 1

A summary of the key micro-, meso- and macrofactors influencing the decision to leave the nursing profession.

Figure 2

Waterfall plot of opinions around remuneration, workload and the work environment (proportion (%) agree, neutral and disagree).

Figure 3

Waterfall plot of selected mesolevel factors captured in the McCloskey/Mueller Job Satisfaction Scale (proportion (%) rated satisfied, neutral and dissatisfied).

Figure 4

Micro–meso–macro (blue, green and black, respectively) relationships (larger circles indicate more connections between factors).