Causes of high staff-turnover amongst professional nurses at selected health facilities in Kwazulu-Natal Province

BACKGROUND: Staff turnover, defined as the total separations from employment, is expensive, can result in lost capacity, and can limit local health departments’ ability to respond to public health needs. Despite the importance of workforce capacity in public health, little is known about workforce turnover in local health departments. This study sought to determine the causes of high staff-turnover amongst professional nurses at selected health facilities in KwaZulu-Natal province and to identify corrective measures. Professional nurses are a critical staff category in any health organisation and make up the backbone of health care system. It is thus vital to ensure that this category is retained for the benefit of health services and its ultimate beneficiary, the patient. Furthermore, Personnel and Salaries System (PERSAL) statistics have shown that the hospitals selected for this study viz., Nkandla Local Municipality (LM) has more that two times (28%) the turnover rates (TORs) for PNs when compared to the district target of 11%, thus the decision to conduct this study at this particular municipality. METHODOLOGY: This research adopted a mixed methods retrospective study where both quantitative and qualitative approach was used to analyse data. The primary data source was the Exit Interview forms completed when a staff member resigns. It consists of three sections viz., section one contained demographics of each respondent with variables such as name PERSAL number, gender, rank, appointment and termination dates; section two contained closed ended statements on potential causes of termination where the respondent answered yes or no to statements such as offered senior position; and section three which was mostly qualitative information where respondents stated own additional views and comments regarding other causes of termination and recommended solutions. Both sections one and two were analysed using quantitative analysis while section three was analysed using qualitative analysis. Qualitative data from comments sections of the exit interview forms was thematically presented and analysed. These results were grouped into five themes namely; Career Progression, Management, Unacceptable or Poor Conditions of Service, Remuneration and Personal Issues. These previously completed exit interview forms were manually analysed in order to determine the causes of high staff-turnover amongst professional nurses at selected health facilities in KwaZulu-Natal province, during the period 2015-2016. Exit interview forms, previously completed by professional nurses for the period 2015 to 2016, were collected from both Nkandla LM district hospitals namely Ekombe and Nkandla. A self-designed spread sheet was used to collate the quantitative data from the exit interview forms which contained personal and demographic data (names, gender, PERSAL numbers, appointment and termination dates, rank, etc.), type of exit, and causes of exit, comments and proposed changes, following which it was manually analysed. RESULTS: A total of 54 participants completed the exit interview forms and selected the causes of service termination which were relevant to them. Ekombe Hospital participants were twelve (12) and Nkandla Hospital participants were forty two (42). Not all professional nurses who exited the service during the study period completed the exit interview form. The exit interview form completion rate was 78% (54/69). Twenty-four percent (13/54) of participants did not complete the exit interview form in full. The quantitative analysis revealed that the gender distribution of participants was mostly female, making 80% (43/54). The majority of participants, 30% (16/54), had 21-25 years’ service prior to exiting. On qualitative data analysis, the majority of participants selected unacceptable or poor conditions of service as the cause of service termination 65% (35/54) participants. This trend was also similar when each hospital participants’ selections were examined. In Ekombe Hospital 83% (10/12) participants’ selected unacceptable or poor conditions of service as the cause of service termination and in Nkandla Hospital this was 60% (25/42) participants. The majority of participants, 78% (42/54), stated that they still intended to re-join the department, and most were seeking employment in the public service. Furthermore, 70% (38/54), of the participants stated they would have stayed had their expectations been met. Further examination of themes and sub-themes derived from the qualitative data of the exit interview forms, the majority of comments, (20 comments), were related to Unacceptable or Poor Conditions of Service as the cause of termination. Sub themes analysis further identified resource shortages as the most common comments related to this determination. CONCLUSION: The leading causes of high staff-turnover amongst professional nurses at selected health facilities in KwaZulu-Natal province was determined to be unacceptable or poor conditions of service. On thematic analysis of qualitative data that emerged from the exit interview forms, the key areas that contributed to this determination included mainly resource constraints issues such as shortage of staff, shortage of equipment, shortage of funds, as well as poor infrastructure. Recommendations for staff retention and improvements in service conditions have been proposed.Thesis (MPH) -- Faculty of Health Sciences, 202