Exploring Voluntary Turnover of Nurse Practitioners in the United States

Abstract

Access to care has been hindered by turnover in the NP workforce. The purpose was to describe the voluntary turnover behaviors of NPs to inform a contemporary model of NP voluntary turnover. A cross-sectional, descriptive, and exploratory secondary analysis of participants who self-identified as nurses with active certification, licensure, or other legal recognition to practice as an NP from a state board of nursing in the United States from the 2018 National Sample Survey of Registered Nurses (NSSRN) was used. Participants were excluded if they didn’t provide patient care or indicated involuntary reasons for leaving. Descriptive statistics were used to analyze four NP voluntary turnover groups informed by Herzberg’s Dual-Factor Theory of Job Satisfaction (i.e., dynamic leavers, static leavers, dynamic stayers, and static stayers). Two-step cluster analyses were used to distinguish subgroups of NP dynamic leavers reporting similar NP differences, reasons for leaving, working conditions, and training topic needs. Dynamic leavers (those who changed jobs but stayed in nursing) reported the highest percentages (35.2%) of job dissatisfaction. The study culminated in two cross-validated models best distinguishing dynamic leavers (i.e., Model 1: Burnout and Model 2: Job Satisfaction). The findings highlight job satisfaction, lack of good management, burnout, and other working conditions as contributors of NP voluntary turnover for dynamic leavers and support a wide variety of literature emphasizing job satisfaction as a predictor of NP turnover intention. Both models demonstrated strong validity evidence. The population estimates from the 2018 NSSRN parent study revealed findings related to race should be cautiously considered. Further refinement of Model 1: Burnout and Model 2: Job Satisfaction could maximize retention strategies, promote workforce development, shape healthcare policy, and project the future supply and distribution of NPs in the U.S. health care system. Future NP training initiatives should focus on working in underserved communities, social determinants of health, and evidence-based care. Accurate workforce projections related to scope of practice and the estimated costs of NP turnover would be beneficial. Instrumentation measuring burnout, stress, organizational climate, and satisfaction should be validated in the NP population. This study should be replicated using accurate race and ethnicity variables.