Abstract
Background: Nursing retention is a long-standing global issue, compounded by an ageing population, the increasing burden of chronic illnesses, and shortages in healthcare workers. In Singapore, reliance on foreign labour further complicates nursing recruitment and retention issues. In this study, we examined why nurses are leaving the profession and whether attempts to re-imagine the role of nursing in an integrated generalist-led care model at Alexandra Hospital have had any impact on retention.
Methods: We conducted a mixed-method evaluation using three approaches: 1) Analysis of exit interview records (2018-2023) at Alexandra Hospital (N=135); 2) An emailed job satisfaction survey for currently practising nurses in Singapore (March-June 2023) (N=479); and 3) In-depth interviews with current practising nurses and nurses who had left the profession, recruited via word of mouth and poster advertisement (February-May 2023) (N=35). In this report, we focus on the in-depth interview findings.
Results: We recruited nurses from various settings, professional levels, and ethnicities across Singapore. Interviews revealed a complex landscape of micro, meso, and macro factors influencing nursing staff’s desire to stay or leave the rofession. Major themes included 1) working culture; 2) work-life balance; and 3) role development. Theme 1: Nurses recognised Alexandra Hospital as offering a positive more collegial work culture. However, generational differences in communication, role expectations, and managerial styles were evident. Foreign nurses also experienced unique challenges, such as poor cultural adaptation, which impacted their integration. Greater comprehension of worker differences and experiences is needed to help synergise their strengths and create a more cohesive culture. Theme 2: Issues relating to work-life balance were common. A perception that work-life balance is better abroad pervaded and was a significant pull factor for leaving Singapore. Unpredictable work scheduling was attributed to poor work-life balance. Fixing shifts over a certain period were suggested as one solution. Reducing patients’ dependence on nurses to perform activities of daily living by empowering patients and caregivers to take on a more significant role in their self-care was also suggested to reduce the work burden. Theme 3: Younger nurses appeared to have a greater desire for breadth of experience and faster role development. Many reported an interest in rotating to different clinical settings, but this was often not an option. Nurses suggested that rotation could help to maintain interest and reduce burnout. Finally, while more experienced nurses observed significant advancements in the profession, there was still a desire for more autonomy. The care model at Alexandra Hospital was recognised as one that expanded their role and gave them more autonomy, although in some cases, role expansion created additional stress. Role development was also viewed as a route to improving the poor perception of the nursing profession locally.
Conclusion: Enabling nursing retention requires a multi-pronged approach to address micro, meso, and macro factors for leaving. This includes addressing concerns about the perception of the nursing profession locally, developing more autonomy in the profession, meeting the career expectations of younger nurses, greater flexibility in work hours, and improving inter-generational and cultural cohesion among nurses."